To Residents of the Houlton and Surrounding Communities
Since our announcement that Houlton Regional Hospital will be closing the OB (LDRP) unit effective May 2, 2025, there has been considerable public discussion and feedback regarding this action. We welcome these diverse perspectives and appreciate that this is an issue of great importance and concern for our community. On behalf of the organization and its Board of Directors, we would like to comment on the facts that forced the hospital to take such action.
First, it is important to recognize that we are not the only community that has faced this issue. Between 2006 and 2021 there have been 400 rural OB unit closures nationwide. Here in Maine the OB units in Rumford, NMMC, York Hospital, Inland Hospital, MDI, and Waldo have closed.
Why is this happening? There are several factors, all of which have combined to make the continued operation of an OB unit unsustainable for HRH.
Patient safety is the prevailing concern in making this decision. Houlton Regional Hospital birth rates have been steadily declining for several years. In 2018 there were 129 births, and 2025 births are projected to be only 77. This low birth rate compounds the financial picture as well as the proficiency of the staff. While the American Hospital Association (AHA) doesn’t have a specific universally mandated annual birth volume requirement for maintaining OB skills in a hospital unit, studies suggest a minimum of 200 births per year may be needed for patient safety as well as financial viability. While we have tremendous confidence in the competency and professionalism of our clinical staff, the declining birthrates at HRH make it increasingly difficult for our OB staff to practice their skills with the regularity needed to maintain proficiency.
There is also significant difficulty in staffing an OB unit. Practitioners and nursing staff must be maintained 24/7 even if unit utilization is low. Part-time staffing of an OB unit is not an option. Compounding this problem is the reality that rural hospitals like ours are unable to attract and maintain providers, and all too often must rely on temporary (locum) staff at a much greater cost than permanent staff.
Additionally, and also of importance, the cost of staffing and maintaining OB units is extremely high. The median of 200 births is also cited for financial viability. Inadequate reimbursement rates from federal, state, and private sources fail to cover the cost of maintaining the unit. Recent cuts in state reimbursement rates have only exacerbated these existing financial shortfalls. While the Board has delayed this decision throughout years of financial losses, these losses from the OB unit are a significant drain on the hospital’s overall financial performance, and one that would have a long-term impact on the hospital’s continued viability if not addressed.
We have been listening to many diverse perspectives on this issue, including feedback from staff and the community. The decision to take this action was not made lightly or quickly, and every effort has been made over the past years to avoid it. Unfortunately, it is now in the best interest of our patients; our staff; the communities we serve; and the hospital’s future to close the OB unit. The HRH Emergency Department will continue to provide responsive care for emergency births and additional training is already underway.
While the financial viability of all rural hospitals is under serious challenge both nationwide and here in Maine, we are confident Houlton Regional Hospital is well positioned to continue providing exceptional care to the patients and communities we serve.

Sincerely,
Houlton Regional Hospital Board of Trustees