For pregnant women living north of Interstate 70 in central Missouri, there weren’t many places to deliver a baby. Fitzgibbon Hospital in Marshall was one of them. 

Now it isn’t. 

Fitzgibbon delivered 252 babies in 2025. In April, the hospital filed for bankruptcy protection and began sale negotiations for its 60-bed hospital and its 99-bed long-term care facility. 

Just nine days after the sale closed in early September, Fitzgibbon’s new operator announced the hospital would end labor and delivery services at the end of the month. 

Now, Fitzgibbon joins the ranks of nearly a dozen hospitals in Missouri that have shuttered labor and delivery services since 2010. 

New owners Strawberry Fields REIT and operators American Medical Administrators are keeping prenatal and postpartum care running at Marshall Women’s Care, but their patients will have to leave Marshall to deliver their babies. 

The closure comes as maternity care continues to disappear across rural Missouri. More than half of Missouri’s counties have no local labor and delivery services or obstetric clinicians, according to a recent March of Dimes report. 

Bothwell Regional Health Center in Sedalia and Western Missouri Medical Center in Warrensburg are set to absorb the patients who were planning on delivering at Fitzgibbon. But both hospitals come with increased travel time for families, ranging from 30 minutes to over an hour. 

Preserving care was meant to be part of the deal 

Along with new owners and operators, Fitzgibbon is getting a new name: Missouri Valley Regional Medical Center. 

But the brand refresh doesn’t erase the financial difficulties that the sole hospital in the town of roughly 14,000 is facing. 

As the need to sell became more obvious, Fitzgibbon said it did what it could to make sure care would remain available to patients under new ownership.

Fitzgibbon said it had offers as high as $14.5 million to purchase the hospital, but accepted the lower $10.5 million offer from Strawberry Fields and American Medical Administrators partly because the groups had expressed a commitment to continue care, preserve jobs and participate in Medicare.

But those commitments got more complicated as the deal risked falling apart. 

While finalizing the sale, the prospective owners raised concerns about Fitzgibbons’s finances and operations, according to court records. Then the sale missed its Aug. 31 deadline.

To avoid the potential of closing the hospital, Fitzgibbon sued American Medical Administrators  and Strawberry Fields to force the sale through. In that lawsuit, Fitzgibbon alleged American Medical Administrators had proposed cutting services, reducing outpatient care and backing away from Medicare commitments.

It only took days for services to be cut after the sale was finalized. 

Dr. Abdullah Arshad, the chief medical officer at American Medical Administrators, said the company’s clinical team struggled to get enough visibility into Fitzgibbon’s operations during the sale process. Once the sale was closed and the company could closely examine the hospital’s finances, it became clear labor and delivery could no longer be sustained. 

For former labor and delivery staff at Fitzgibbon, the news didn’t come as much of a surprise. 

“I was not shocked, though I was sad,” said Rachel Leavitt, a nurse who worked in labor and delivery. “For me, it is mostly a concern for the community.” 

“One couple in one of our last births, they were already over an hour away,” Leavitt said. “She said with this it would be at least a two-hour drive. It’s mostly north of us that we really get into problems.” 

Is labor and delivery a losing game?

It’s getting more challenging for hospitals across the country to maintain their labor and delivery services, and to justify their cost. 

Labor and delivery require constant staffing, including an obstetrician, anesthesiologist and specialized nursing staff on any given day, even if births aren’t happening. 

Fitzgibbon’s maternity ward wasn’t sitting empty, but ultimately was still seeing fewer than one birth a day on average, which wasn’t enough to sustain the service in the face of the hospital’s broader financial problems. 

“You have over 100 days in the year that you have to maintain services, without having the ability to bill for those services,” said Arshad. 

Arshad said larger hospitals can often offset financial losses from labor and delivery with other services delivered across the hospital. But Fitzgibbon has spent years shuttering services, including its intensive care unit, leaving fewer profitable services to pad those losses. 

Medicaid’s lower reimbursement for births makes the situation more complicated. 

In Missouri, over 38% of the state’s births are covered by Medicaid. In areas outside a metropolitan hub, the number jumps to over 47%. 

Despite an average of less than one birth a day, Leavitt said the unit felt relatively busy to those working there. 

Nurses generally had several scheduled inductions or C-sections each week, in addition to unexpected deliveries and other emergencies. On slow days, nurses helped elsewhere in the hospital. 

“We always had something to do,” Leavitt said. “It’s not like we were twiddling our thumbs.” 

Labor and delivery service cuts following acquisitions

The problems at Fitzgibbon predated the bankruptcy filing and the following sale. Fitzgibbon previously shut down its inpatient behavioral health services, its intensive care unit and some of its primary care offices. 

But September brought a change in who was overseeing the books. 

The timing at Fitzgibbon mirrors a trend researchers have found nationally: Rural hospitals are more likely to lose maternity care after they are acquired. 

Eilidh Geddes, a health economist and assistant professor at the University of Georgia, and her colleagues studied what happened to obstetric care at hundreds of rural hospitals after an acquisition. 

Overall, they found that acquired hospitals were 11% less likely to offer obstetric care five years after an acquisition. 

“When rural hospitals are acquired, they are substantially more likely to close down their obstetrics units,” Geddes said. 

Geddes said that compared to hospitals with no acquisition, maternity wards in hospitals that have been acquired are closing at higher rates. 

And they found OB units that closed following acquisitions tended to be larger than OB units that closed without an acquisition. 

“It is suggestive that a hospital that has not been acquired is going to continue on with an unprofitable service longer than an acquired hospital,” Geddes said. 

She said that the maternity units they studied were generally small, at around 200 births annually. Geddes cautioned that the research doesn’t establish that an acquisition necessarily caused any individual hospital’s maternity ward to close. 

What’s next for Fitzgibbon? 

Arshad said his company will retain the hospital’s equipment needed to handle emergency deliveries if they happen. The hospital’s emergency room will stay staffed with on-call midwives and OB-trained nurses, and prenatal and postpartum care will still be available.

“Our ER is going to have a 24/7 OB-trained nurse, which is rare in rural hospitals,” Arshad said. “We are doing everything we can within our resources to staff our ER with a higher level of OB services than typical rural ERs.” 

Eventually, he added, the operator hopes to reopen labor and delivery for Marshall and the surrounding areas, although Arshad did not provide a timeline for when that may be. 

For Leavitt, many of her patients have chronic conditions or may not make it to all of their prenatal appointments, which can be associated with worse maternal or infant health outcomes. 

“We have a high Micronesian population that typically don’t get a ton of prenatal care. They’ll have maybe one appointment, then show up at the hospital,” Leavitt said. “I’m way more concerned about the populations that we serve.” 

Overall, more than 120,000 Missouri women live more than 30 minutes from a hospital offering labor and delivery services. 

For Leavitt, losing the unit is less about whether babies can be delivered at other hospitals. A lack of specialized care in an emergency room can make a risky birth even more dangerous.   

“I don’t think people realize how much we need maternal health. It is such a specialized field,” Leavitt said. “This is increasingly happening across the United States.” 

“I love birth,” Leavitt said. “To be with women in birth is one of the most amazing, humbling experiences. But it is also one of the most dangerous times for women and children.”