More than half of rural hospitals in Missouri and Kansas no longer deliver babies

No surprise here! OB is labor intensive (no pun intended). You must have 24 hour nursing coverage, an OB/Gyn physician, maybe a few Certified Nurse Midwives, and Anesthesia coverage. Unfortunately, babies are not always born between 0700 and 1500. Often in the middle of the night.
Large hospitals have 24 hour staffing, rural hospitals don’t. Yes you have nurses on OB and the nursery but no in-house OB docs or midwives and no in-house anesthesia. Normally you would have only one anesthesia personnel on call for the hospital; good luck if you have anesthesia tied up in an emergency OR procedure and you need an emergency C-section.
The amount of reimbursement is the issue for rural hospitals. I understand it well, my last 11 years of anesthesia practice was in a small rural hospital.

We have a similar problem here in northern Idaho . . .