More than one-third of Virginia counties are maternity care deserts, leaving some families traveling an hour or longer for prenatal, specialty and delivery care.

Roanoke, VA

Author: Roanoke Rambler Staff, Tina Charisma

Published: 9:00 AM EST September 23, 2026

Edited: 9:15 AM EST September 23, 2026

For a pregnant woman living in rural Southwest Virginia, reaching maternity care may require a 30-, 45- or 60-minute drive. And it is not a journey made only once for delivery.

Throughout pregnancy, she may travel that distance repeatedly for prenatal appointments, ultrasounds, blood-pressure checks and other testing. She may travel even farther for specialty care, then make the journey again for postpartum and newborn appointments.

Each trip can require reliable transportation, time away from work, money for gas and childcare for other children. If labor begins unexpectedly or a serious complication develops, however, the distance can become more than an inconvenience: It can delay urgently needed treatment.

That is the reality facing families across parts of Southwest Virginia, where shortages of maternity providers and birthing facilities have left some families far from essential care.

“The biggest challenge really comes down to whether families can access the right care, in the right place, at the right time,” said Elizabeth Kielb, director of maternal and infant health at March of Dimes.

The organization’s 2026 report, “Nowhere to Go: Maternity Care Deserts Across the U.S.”, found that access remains limited across much of Virginia. According to Virginia figures provided by March of Dimes, more than one in three counties have neither a birthing facility nor an obstetric clinician.

Nearly two-thirds of Virginia counties — 63.9% — lack a hospital or birth center providing maternity care. Among rural counties, that figure rises to 84.8%, according to the organization. March of Dimes also reported that 35.3% of Virginia counties have no obstetric clinicians and another 18% have only one.

The organization defines obstetric clinicians as obstetricians, certified nurse-midwives, nurse-midwives and family physicians who deliver babies.

“Those statewide numbers are especially important when we look at Southwest Virginia,” Kielb said. “In rural and Appalachian communities, a shortage of maternity care providers or facilities can be compounded by geography, transportation, workforce shortages, insurance coverage and access to specialty care.”

A provider may exist somewhere within the broader region, Kielb said, but that does not necessarily make the care realistically accessible.

An Hour or More to Reach Care

Stephanie Spencer, a registered nurse and founder and CEO of Urban Baby Beginnings, said her organization is seeing Southwest Virginia women travel an hour or more for maternity care. Some must go to other parts of the state to obtain the services they need.

“If a mom needs specialty care, she may have to drive even longer or may have to wait for an appointment,” Spencer said.

March of Dimes estimates that approximately 154,000 Virginia women live more than 30 minutes from a hospital offering labor and delivery services. Women living in maternity care deserts travel substantially farther to reach a birthing hospital than those living in counties with full access to maternity care, the organization reported.

“Distance to providers is a very real and worsening challenge, particularly for families living in rural communities and maternity care deserts,” Kielb said.

Virginia women travel an average of approximately 17 minutes to reach a hospital with labor and delivery services, according to figures provided by March of Dimes. That statewide average can obscure the much longer journeys faced by rural residents.

“That has particular significance in Southwest Virginia, where communities can be spread across a large geographic area,” Kielb said. “Mountainous terrain and limited transportation options can turn what looks like a manageable distance on a map into a much greater burden for a pregnant person and their family.”

Travel is also not limited to the day a baby is born. A patient may need to make the journey repeatedly for examinations, imaging, blood-pressure monitoring and treatment. After delivery, the patient may need to return for postpartum care while also arranging newborn appointments.

“Every additional trip can require transportation, time away from work, childcare for other children and additional expenses,” Kielb said. “For someone who needs more frequent monitoring because of high blood pressure or another pregnancy complication, those barriers become even more significant.”

When Distance Becomes an Emergency

Long travel times create financial and logistical burdens throughout pregnancy. The consequences can become more immediate when someone goes into labor unexpectedly or develops a serious complication.

“Women who are having complications need prompt medical care and intervention,” Spencer said. “Delaying treatment during obstetrical emergencies, as well as delayed access when there are acute needs, can have severe adverse consequences.”

Serious bleeding, dangerously high blood pressure and other pregnancy-related complications can require urgent medical intervention.

“Every additional mile between a patient and the appropriate level of care can mean additional time before they receive the care they need,” Kielb said.

Spencer said traveling two hours or more while in labor may increase the likelihood of an adverse outcome.

“Having hospitals and clinical care close to home matters,” she said.

High-risk patients may have to travel beyond the nearest delivery hospital to see a maternal-fetal medicine specialist or reach a facility capable of providing more advanced maternal or neonatal care.

“There is also a larger systems issue,” Kielb said. “When maternity services are concentrated in fewer locations, rural families may need to travel not only to deliver, but also to see maternal-fetal medicine specialists or receive a higher level of maternal or newborn care.”

Rural and Medically Complex Patients Face Greater Barriers

Rural families are among the populations most affected by Virginia’s uneven distribution of maternity services, according to March of Dimes.

Insurance presents another barrier. Figures supplied by the organization show that approximately 173,000 Virginia women ages 19 to 54 are uninsured. In 15.8% of the state’s counties, the uninsured rate among women of reproductive age exceeds 10.9%.

Spencer said Urban Baby Beginnings has spoken with pregnant and postpartum women across Southwest Virginia who have experienced gaps in access and delays in treatment. Women with complex or chronic conditions, those needing mental-health support or treatment for substance-use disorders, and families who are uninsured or covered by Medicaid can be particularly affected, she said. Transportation barriers compound the difficulty of navigating the region’s terrain.

“A pregnant person may also be managing high blood pressure, diabetes, behavioral-health needs or another chronic condition that requires ongoing care,” Kielb said. “When maternity care, primary care, behavioral health and specialty services are all harder to reach, those needs can compound one another.”

The problem is not limited to the number of obstetricians practicing in a community. Families may also need family physicians, midwives, nurses, doulas and community health workers.

Spencer said limited coordination among medical providers and community-based services is among the most significant challenges facing rural Virginia families.

A Regional Delivery Center in Roanoke

Carilion Roanoke Memorial Hospital is one of the region’s major delivery centers. The hospital recorded 3,293 live births during the Leapfrog Group’s most recent reporting period. The hospital uses certified nurse-midwives, permits patients to bring doulas and offers lactation services, according to Leapfrog’s hospital profile.

Carilion also conducts community health assessments every three years for the areas it serves, including the Roanoke Valley, New River Valley, Franklin County, Giles County and Tazewell County. The health system says the assessments are used to identify barriers and guide its programs, partnerships and investments.

In May 2026, Carilion opened its first Roanoke clinic dedicated exclusively to midwifery. The clinic consolidated the health system’s existing Roanoke City midwifery services into one location near Carilion Roanoke Community Hospital and provides weekday access to two or three midwives.

“This new clinic and midwifery expansion underscore our commitment to accessible, relationship-based care for women,” Dr. Tristi Metcalf, chair of Carilion’s Department of Obstetrics and Gynecology, said in Carilion’s announcement.

Carilion’s announcement did not say whether the consolidated clinic increased the number of midwives available or would reduce travel times for patients coming from rural communities.

Virginia’s Outcomes Reflect Broader Concerns

Virginia Department of Health data offer broader context about pregnancy and birth outcomes across the state.

Virginia recorded 92,639 live births in 2023. Approximately 9.8% of babies were born prematurely, and the state recorded 5.8 infant deaths per 1,000 live births. Between 2019 and 2023, Virginia’s maternal mortality rate was 34.5 deaths per 100,000 live births. Hypertensive disorders of pregnancy accounted for 6.7% of those deaths.

More recent March of Dimes data show that 10.1% of Virginia babies, approximately 9,467 infants, were born prematurely in 2024. That year, 79.5% of infants were born to mothers who received prenatal care classified as adequate or adequate-plus.

Spencer said Urban Baby Beginnings has encountered families experiencing delayed treatment for pregnancy-related complications, including preeclampsia and postpartum preeclampsia.

For her, those cases demonstrate why the presence of a provider somewhere within a region is not enough to guarantee meaningful access.

“For me, the question is not simply whether care exists,” Kielb said. “It is whether every family can actually reach high-quality care and stay connected to it throughout pregnancy, delivery and postpartum.”

Efforts to Close the Gaps

Virginia has begun investing in programs intended to improve rural maternity care.

A federally funded Rural Maternity and Obstetrics Management Strategies initiative serves the Cumberland Plateau and LENOWISCO health districts. The program is designed to expand perinatal services, train and deploy community health workers and doulas, incorporate telehealth and strengthen coordination among health-care providers.

In April 2026, VDH also announced the state’s first perinatal health hubs. The pilot program is intended to connect families with coordinated, community-driven care, with contracts continuing through June 2027.

Those initiatives may help families navigate the health system, but advocates say solutions must also address the availability of hospitals, specialists, transportation and the broader maternity-care workforce.

“That is why we cannot define access simply by putting a hospital or provider on a map,” Kielb said. “The real measure is whether a family can reach the right level of care when they need it, and whether the systems around them are connected enough to make that happen.”

The Roanoke Rambler