Community Forum | MaineHealth Lincoln Hospital

Family medicine physicians with obstetric surgical training can be an effective model in very remote areas where OB/GYN specialist care is many hours away. However, at MaineHealth Lincoln Hospital, this approach would not solve the underlying staffing challenge.

To safely provide 24/7 labor and delivery coverage, a sustainable call schedule requires approximately a 1:4 rotation. MaineHealth Lincoln Hospital currently has one family medicine physician with obstetric surgical training (FM-OB), which means the hospital would need to recruit three additional surgically trained FM-OB physicians to create a sustainable schedule. Additionally, surgically trained FM-OB physicians require access to OB/GYN collaboration for more complex cases and do not cover gynecologic emergencies that come through the emergency department. Given MaineHealth Lincoln Hospital's low birth volume, the community does not have enough obstetric demand to support that many additional obstetric providers. The result would be a department staffed primarily to meet call requirements rather than to meet patient volume. Importantly, MaineHealth Lincoln Hospital has previously interviewed an additional, surgically-trained, FM-OB physician; and low birth numbers and the call schedule were cited as reasons the candidate declined the position.

In addition, recruiting family medicine physicians with obstetric surgical training would not address the community's unmet need for expanded gynecologic specialty services, such as gynecologic surgery, menopause care and urogynecology. 

While no definitive safety threshold exists, annual birth volumes below 200 are widely classified as “very low” in national obstetric quality research.¹ Contemporary, multi-state analyses demonstrate a strong association between low birth volume and adverse maternal outcomes in rural hospitals. Rural hospitals delivering 10-110 births per year experience approximately 65% higher rates of severe maternity morbidity compared with rural hospitals delivering more than 460 births per annually.²

Delivery Volume from 1998-2025

Key Observations

• Peak years occurred around 2004–2007 (highest: 224 deliveries in 2006).
• A clear decline begins after 2010, reaching a low of 95 in 2019.
• Recent years (2023–2025) show a partial rebound to ~130 deliveries.

Full Data Table

The following is a table of deliveries at Miles/MaineHealth Lincoln Hospital from calendar years 1998-2025:

1 - Maine CDC. Infant Mortality in Maine, 2023.CDC National Center for Health Statistics. Vital Statistics Rapid Release, 2024. 

2 - Kozhimannil KB et al. Health Affairs. 2025.  Kozhimannil KB et al. JAMA. 2024.

The most significant funding opportunity is the Rural Health Transformation Program. On December 29, 2025, the U.S. Centers for Medicare & Medicaid Services (CMS) notified the State of Maine that it will receive $190 million for Year 1 of the federal Rural Health Transformation Program, which was established through the passage of H.R. 1.  

The State of Maine has announced plans to invest these funds across five different initiatives, including workforce. Of the money the State expects to receive, approximately $12.5 million has been allocated to the Finance Authority of Maine (FAME) for recruitment and retention of licensed health care professionals. Details regarding specific programs and eligibility requirements have not yet been released, but it is our understanding that FAME intends to issue $50,000 incentive payments to recruit licensed health care professionals to rural Maine and to support those training to become a licensed health care professional.

Recruitment and retention costs for physicians, particularly specialists, often substantially exceed $50,000 when accounting for relocation expenses and student loan debt, as two examples. As a result, these funds may help support workforce development and recruitment efforts for certain licensed professionals but are not likely to resolve immediate recruitment challenges for physicians and specialists.

MaineHealth has led a federal grant – RMOMS – that is looking at ways to improve access to labor and delivery services in rural areas. MaineHealth Lincoln Hospital has participated in this grant, implementing remote monitoring for postpartum hypertension, participating in an orientation program where OB RN learners from MaineHealth Pen Bay and Lincoln Hospitals come together for shared learning opportunities, and participate in simulation training for skills improvement.   

In December 2024, Maine DHHS was awarded a Transforming Maternal Health (TMaH) grant from CMS. The State expects to receive up to $17 million in funding over 10 years to improve maternal health care for women enrolled in MaineCare and the Children’s Health Insurance Program (CHIP). As part of this work, Regional Rural Planning Groups were created and are scheduled to start a two-year planning process on June 25, 2026. MaineHealth Lincoln Hospital serves on the District 4 Planning Group. This initiative represents an important long-term investment in maternal health, but it is not designed to address immediate provider recruitment needs.

Birth data for FY2023-2025:

2025 birth data, by town:

The eight communities with the highest birth volumes (Waldoboro, Wiscasset, Jefferson, Whitefield, Nobleboro, Damariscotta, Boothbay and Newcastle) accounted for 167 births (76.6% of all service-area births), but only 54 births at MaineHealth Lincoln Hospital. This means MaineHealth Lincoln Hospital captured approximately 32.3% of births from those communities.

The National Institute of Health reports 200 births annually to be sustainable, if there are enough OB/GYN providers on staff. The average annual birth volume at MaineHealth Lincoln Hospital is around 130, with an average of only 18 deliveries per provider. 

Because the volume is low, we have been challenged to recruit providers and have not been able to recruit an OB/GYN since 2020. As a result, we currently rely on contracted providers, who work elsewhere, to provide coverage at MaineHealth Lincoln Hospital. 

This model has not proven to be sustainable, and we have been forced to go on diversion more frequently in the past year because coverage cannot be secured. Not having predictable coverage does not promote patient safety and is not patient-centered care. 

We continue to promote the maternity program through social media, birth announcements, press releases, community events and community class offerings—including childbirth classes for parents and new moms play groups, whether they choose to deliver at MaineHealth Lincoln Hospital or not. These efforts have not led to a significant increase in births over the years.

Alternative staffing models have been discussed with the steering committee, assessment work groups and the MaineHealth Lincoln Hospital board. To be clear, the cost of care, including staffing, is not the challenge – it is the inability to recruit providers given the high call ratio and low birth volume. 

MaineHealth Lincoln Hospital care team members, including providers, have been involved with the assessment of labor and delivery services. Our ongoing communication with providers and care team members continues to inform the conversation, and we have been transparent about the discussions that are taking place during the assessment process. 

The forums were designed for us to listen to and consider your perspectives during this assessment process. As a final recommendation has not been made from the assessment, no one should have been told that labor and delivery services are ending.

Labor and delivery is the only reproductive service being assessed. MaineHealth is committed to keeping prenatal and postnatal care at MaineHealth Lincoln Hospital and is seeking to improve access to other gynecological services.

According to a published study on choice of birthing location, results showed the following as the most influential: Safety vs. Risk; Influence of Family, Friends and Media; Presence or Absence of Choice; and Control and Access to Options. 

Being on call requires providers to be away from their family and to stay near the hospital while on call. While this model sounds like a good solution, we have learned from our recruitment efforts that this is not a tenable work solution for OB/GYN providers.

While MaineHealth can educate patients and providers about available services, physicians exercise independent medical judgment when recommending where a patient receives care. Referral decisions are based on patient needs, provider recommendations, and patient choice, not health system mandates. 

Family medicine physicians who complete an additional year of specialized training in obstetric care, including performing C-section deliveries, have been part of MaineHealth Lincoln Hospitall's maternity care model.

As part of the assessment, MaineHealth considered whether expanding the number of these specially trained physicians could help sustain labor and delivery services. However, this model has limitations. While fellowship-trained family medicine physicians can provide routine maternity care and perform C-sections, they are not trained to perform certain complex emergency procedures that may be needed during childbirth, such as emergency hysterectomies for severe bleeding or some urgent gynecologic surgeries.

In addition, maintaining a safe and sustainable on-call schedule would require at least four fellowship-trained family medicine physicians. Recruiting and retaining that number of specially trained physicians in a rural setting has proven challenging.

Yes. MaineHealth Lincoln Hospital has physicians who are trained to perform emergency deliveries. They participate in regular simulation training to maintain their skills in responding to obstetric emergencies.

Care team members have been actively engaged throughout the assessment process through committee meetings, town hall meetings, leader discussions, email updates, and frequently asked questions. In addition, physicians, advanced practice providers, nurses and other team members have had opportunities to share feedback, ask questions, and offer perspectives on potential options and challenges facing the Family Birth Center at MaineHealth Lincoln Hospital.

No care team members from labor and delivery are receiving severance pay. 

MaineHealth Lincoln Hospital is conducting a review of its obstetrics program due to ongoing OB/GYN recruiting challenges and the impact of low birth volume. 

No. We are looking at ways to redesign labor and delivery services to better meet the needs of our communities within the realities of our recruitment challenges and low birth rates at the hospital. 

Several factors contribute: 

• The median age in Lincoln County is 51, the oldest in Maine and among the oldest in the country, according to the US Census Bureau.  
• Nearly 7 of 10 expectant parents in Lincoln County are choosing to deliver at hospitals other than MaineHealth Lincoln Hospital. 

There are many factors: 

• Candidates do not want to be on call for multiple evenings a week to cover after-hours care. 
• OB/GYN providers want to be busier, and younger providers seek more opportunities to strengthen their skills which requires a higher volume of deliveries than we are seeing at MaineHealth Lincoln Hospital. 

MaineHealth Lincoln Hospital has not been able to recruit a full-time OB/GYN provider since 2020. The continued use of contracted, per diem providers does not allow for care consistency and stability.

In an effort to maintain access to high quality services across our region, MaineHealth is strengthening its regional structure and assessing the benefit of service delivery redesign.

MaineHealth has no plans to close services at MaineHealth Lincoln Hospital at this time. MaineHealth has invested more than $20 million to improve and expand access to important services such as infusion therapy and integrated primary care at MaineHealth Lincoln Hospital.

Of the 11 labor and delivery closures at Maine hospitals in the last decade, only two reduced services, neither of which were MaineHealth hospitals.

In addition, we are constantly reviewing opportunities to expand services to better meet the needs of the communities we serve.  For example, we are currently embarking upon a review of GYN services, as there is an unmet need in Lincoln County.

Updated June 30, 2026

Today, 67 percent of Lincoln County’s expectant moms delivered their babies somewhere other than MaineHealth Lincoln Hospital – including MaineHealth Pen Bay Hospital, MaineHealth Mid Coast Hospital, Maine General and MaineHealth Maine Medical Center. 

While travel time is important, this data shows that for many it is not a deciding factor guiding decision-making. 

The average drive time for residents of Lincoln County would increase by 18 minutes or less. While a closure scenario would increase travel times, impacts vary by town and are modest for most patients.

In a closure scenario, only a small subset of patients would experience a drive time of over 50 minutes:

• 86% would have a drive time of 39 minutes or less
• 12% would have a drive time of 40-49 minutes
• 2% would have a drive time of 50 minutes or longer

We expect to complete our assessment by the end of June. Recommendations will be shared in July with the local community board for advisement before going to the Coastal Region board. Only the MaineHealth Board has the authority to approve any change, and they meet in August. 

Updated June 30, 2026

We have been working closely with the maternity team to keep them informed and to incentivize them to stay while we complete this process. If changes to the service are made, we have plans in place to support team members in finding new opportunities. We have many openings available, and we are confident that we can retain anyone who may be impacted if change occurs.