CG spoke with self-identified climate refugee Margaret Reynolds and coalition co-founder Leslie Wolf about the effort to save an L&D unit amid a rash of maternity care closures across Maine & the country — & amid intensifying weather that can snarl travel to health centers farther and farther away.
"These things are not separable," Margaret Reynolds said of access to health care facilities, the power grid, and extreme weather.
Growing up in Mississippi and Louisiana, severe storms had a major impact on her life.
"I lost everything in Hurricane Katrina and in part moved to Maine because I'm a climate refugee," she told CG. "I mean, the year I left New Orleans, there were about 27 named storms."
Now a mother of two, Reynolds came to Maine several years ago, finding it a "desirable" location and a place where a family may not have to fear losing their home to a climate disaster.
But if the labor and delivery — or L&D — unit at MaineHealth Lincoln Hospital in coastal Damariscotta closes and forces rural patients to travel great distances to birth their babies, there could be a higher chance of obstacles like winter storms or floods impacting Reynolds's future maternal care.
Reynolds had been thinking about having a third child and asked her midwife about it at an appointment sometime around mid-May.
"I was in there asking about my age mainly. And my midwife said, 'Well, your age is not a problem, but you can't have your baby here.'"
Reynolds, who happens to be the Director of Program Implementation for the Maine Department of Health and Human Services, learned that this was because the MaineHealth hospital system was considering shuttering birthing services at its Miles Campus in Lincoln County by the end of the year.
"At that time, I was doing some of the writing and then all of the implementation of the Rural Health Transformation Fund," Reynolds said, referring to the federal grant program created through the same One Big Beautiful Bill Act that also slashed Medicaid by around $1 trillion.
"I was doing this all day, every day."
Reynolds thought she could bring her experience in rural health care programs to surface potential solutions that might keep the L&D unit at Lincoln Hospital's Miles Campus open.
She called up her friends and soon co-founded the Miles Delivers Action Coalition with community members Leslie Wolf and Moira Rose Richards in a staunch grassroots effort to save the hospital birthing services. It's an effort they hope can address a rash of rural maternity care closures across the state and the country.
Since 2015, 12 birthing units have closed at Maine hospitals. If the board of the not-for-profit MaineHealth hospital system decides to end L&D services in Lincoln County, it would become the state's fifth such unit to shut down in the last two years.
According to U.S. data from the Center for Healthcare Quality and Payment Reform, Maine residents already face a median drive time of 45 minutes to reach a hospital with L&D services — the longest median drive time in New England.
But this critical infrastructure gap reflects a broader rural maternity care crisis unfolding far beyond this one region.
Analysis from the Center has found that most rural U.S. hospitals no longer offer L&D services, with more than 140 such units having closed since 2020 and still others at risk of closing and increasing drive times for pregnant people across the country.
As dedicated birthing centers disappear, mothers and babies may increasingly experience emergencies at facilities less prepared to handle obstetric cases or en route to hospitals farther and farther away. Increasingly intense or unpredictable weather conditions are set to exacerbate those longer drives.
In Gulf and East Coast states, hurricanes like Katrina, floods, and landslides may disrupt road access for lengthy periods after storms initially hit. In Western states, extensive wildfires may do the same.
Climate-impacted maternity care is something global health researchers and program implementers have been studying and working to address in low- and middle-income communities outside the U.S. for quite some time. Together with maternal health risks linked to extreme heat and air pollution exposure, weather-snarled or -stopped access to care adds to the climate and environment hazards for pregnant people.
In Maine, intensifying floods, sou'easters, ice storms, and road-closing tree damage may pose some of the most significant climate threats to timely L&D access, and additionally so if patients have to drive farther to reach care. Notably, it was just last year at MaineHealth Lincoln Hospital — where the L&D unit is set to close — that Maine Gov. Janet Mills held a press conference alongside hospital President Cindy Wade to share the final report of the Maine Infrastructure Rebuilding and Resilience Commission.
"We are entering a new era of natural disasters that will threaten the future of communities like Damariscotta and communities across the state of Maine, inland and coastal," Mills said at the 2025 press event, where Wade highlighted work being done to improve the resilience of Damariscotta roads to flooding and improve the safety of patients.
Having to travel through severe weather to reach care is something Miles Delivers Action Coalition co-founder Leslie Wolf has worried about amid her own pregnancy. She told CG that fellow co-founder Moira Rose Richards had previously experienced a precipitous — or rapid — labor and had to drive herself to the Miles Campus in the middle of a snowstorm.
"She was able to have a successful and safe birth, but … [that may not be] the kind of scenario she would have found herself in if she was driving what we think would be about 50 minutes [even] if there wasn't a snowstorm," Wolf said.
Wolf, the Communications and Member Services Manager at Maine Primary Care Association, is an expectant mother in Lincoln County. If MaineHealth decides to close the Miles Campus L&D unit in December, hers could be one of the last babies to be born there.
Birthing services can be among the most expensive offered by hospitals, which are generally understood to lose money on obstetric care. According to 2025 reporting from Stateline, this can be complicated by insurance and by falling birth rates in rural areas.
In Lincoln County, however, the Miles Delivers Action Coalition says that Lincoln Hospital is not only profitable and outperforming its parent hospital system but that the number of births and the birthing-age population have both seen increases in recent years. In 2024, the group documented 132 births at the Miles Campus — roughly one every three days — with care provided to not only the infants but also the birthing parents.
In its answers to frequently asked questions from the community, collected at a website where the hospital system has also shared an assessment of its L&D services at Lincoln Hospital, MaineHealth has indicated that the total of around 130 births per year equates to about 18 per provider and that "the National [Institutes] of Health reports 200 births annually to be sustainable, if there are enough OB/GYN providers on staff."
But when it comes to the reasons for considering the closure of Miles Campus L&D, the hospital system has largely pointed to recruitment and staffing issues.
Coalition co-founder Margaret Reynolds says that because birthing services are essential, staffing issues are a problem in need of a solution — not another problem. She likens the situation to other essential services.
"If there were a firehouse in a pretty large confluence of towns like ours and you couldn't find firefighters, you wouldn't just say, 'OK, well, time to shut down the firehouse. We've had really big problems recruiting.'" Instead, Reynolds says the approach would be: "'OK. We have to figure this out.'"
MaineHealth says the comparison is imperfect as hospitals' funding models often rely on reimbursement for services rather than just preemptive funding.
The not-for-profit hospital system is also supported in part by donors, however. On July 23, the Miles Delivers Action Coalition shared a memo that referenced a letter signed by about 10 donors who called on MaineHealth to at least pause the closure decision.
In a July 28 open letter cited this week by the Lincoln County News, hospital president Wade wrote, "Across Maine, communities are facing workforce shortages, financial pressures, changing demographics, and growing demand for care."
"Meeting those challenges will require health care organizations, clinicians, elected leaders, and community members working together to strengthen and sustain health care close to home."
In many ways, the Miles Delivers Action Coalition's strategy has focused on surfacing potential solutions to meet that call.
Reynolds and Wolf told CG that the possible remedies they were most excited about were creative workforce workarounds that might include investing in a home for staffers who could regularly rotate in and out, perhaps spending portions of the year on and portions of the year off duty. It's a model that could appeal to some physicians looking for predictable, seasonal switch-ups in the state known year-round as Vacationland.
In its collection of responses to frequently asked questions, MaineHealth wrote, "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." It also wrote that the hospital is already using a "float pool of OB/GYNs," with some advantages and disadvantages.
But the grassroots coalition has also proposed that decision-makers see the situation as an opportunity rather than a lack: Instead of closing L&D services in Lincoln County, why not expand them and make the hospital a national model for rural maternal and infant care? The hospital could attract more business by adding sought-after fertility care, for example, and more attention by setting the standards of excellence for other states looking to address their own L&D deserts.
While MaineHealth has said that it will keep prenatal and postnatal care going at Lincoln Hospital even if the L&D ward closes, many places lack these and other reproductive health care services.
The Reproductive Healthcare Desert Project, powered by researchers at Purdue University and the University of Colorado Denver, launched its dashboard earlier this year to help map the breadth and complexities of the crisis.
The dashboard identifies counties across the U.S. that lack access to contraceptive, abortion, maternity, and assisted reproductive technology — or fertility — care. It also shows where, for example, contraceptive care deserts and abortion care deserts may overlap and tracks travel distances to each type of care.
"When reproductive health care is limited and concentrated in one location, extreme weather can easily disrupt access to care for an entire region," research assistant Anayra Maldonado Quiles, who worked with the Pregnancy, Abortion, and Reproductive Rights Research Collective at Purdue, told CG.
As families across the U.S. and around the world grapple with the effects of intertwined and compounding crises — from lacking affordability to health care, reproductive rights, and climate resilience — the ideas that the Miles Delivers Action Coalition has been pooling for keeping rural L&D units open could prove invaluable in numerous states and settings.
"I would love to create a playbook and band together," Reynolds said.
And if MaineHealth shutters birthing services in Damariscotta? Reynolds and Wolf still want others to be able to use that playbook.
"The ruckus we've created, even if they close Miles Labor and Delivery, is going to cause every health system in Maine to think twice before they close another, and I want every state to have the ability to do that," Reynolds said.
She also underlined that the fight to keep the L&D unit open isn't only about birthing.
"When you lose labor and delivery, it's a waterfall effect. You lose on-call anesthesiology, which means you can't do emergency surgeries. And when you can't do that, you don't need an ER, and sort of the trickle happens."
According to Stateline, having fewer L&D units can also stress already strained ambulance services. And recent reporting from The 19th described cuts to services like obstetrics as "one of the precursors to overall hospital closure." Plus, once rural hospitals disappear, they can be very difficult to bring back.
With all of this in mind, the work of the Miles Delivers Action Coalition could help protect a range of closer-to-home health care services — as well as jobs — and, in so doing, strengthen the climate resilience of hospital systems more broadly.
The group's fight comes one year after the One Big Beautiful Bill Act, passed under the second Trump administration, brought major cuts to Medicaid that many warned would pose an existential threat to rural hospitals. While the law included $50 billion in relief for these hospitals, experts at the Center for American Progress and The Arc wrote last July, "The relief fund designed to blunt the negative impacts caused by the bill would not come close to filling that gap."
This summer, as reported by The 19th, the shuttering of rural hospitals and of rural maternity care specifically have become campaign issues in states like Ohio, Iowa, Wisconsin, and Maine as midterm elections approach.
Last week in Maine, Democratic gubernatorial candidate Hannah Pingree called on MaineHealth to keep Lincoln Hospital's birthing services open while also proposing a statewide moratorium on L&D closures until a new governor takes office in 2027.
"Weather isn't a hypothetical here," Pingree spokesperson Mary-Erin Casale told CG in a statement. "And the increasing nature of extreme weather events is making that worse. It's a real risk layered on top of a maternity care system that's already stretched, and it's part of why Hannah is pushing for a statewide moratorium on labor and delivery closures while Maine builds a real plan, including things like mobile health units and expanded midwifery care that can serve families closer to home."
These proposed solutions won't be surprising to anyone in global health who has been working to improve capacity and climate resilience of reproductive care in low- and middle-income countries, where mobile clinics and midwives have long been helping communities to sustain access amid storms and floods.
Back in Maine, Republican gubernatorial candidate Bobby Charles and Independent gubernatorial candidate Rick Bennett have also said they oppose the L&D closure. According to local news station WGME, Charles blamed Democrats for other rural health care closures.
Reynolds and Wolf praised Pingree's call for specific solutions but also said their community needs more than campaign promises — in part because the midterms aren't until November and the MaineHealth Board's final vote on the Miles Campus is set for August 6.
Speaking to how the grassroots effort came together, Reynolds said, "I think we all feel like it was the right people at the right time at the right place to do this. It was the confluence of events between the election, between who we are, between the jobs we do — it just happened that the conditions were sort of all right."
"And then, we worked really, really hard."
Kirsten Krueger contributed to the editing of this article.
Are mothers' lives at risk due to smoke exposure? Are pregnancy outcomes? Should IVF be delayed? Is sperm affected? CG spoke with Amy Padula, a professor at UC San Francisco and the Acting Director of the Program on Reproductive Health and the Environment, about these and other potential impacts.
"Being a queer [or] trans activist and an environmental activist puts you in a greater sense of danger because both agendas are heavily under attack," Diego De Leon, Advocacy Chair at Out for Sustainability, told CG.
"While every family is different, mothers are disproportionately the default parent, meaning climate disruptions can add to the mental load, logistical challenges, and economic pressures many women already face," Laura Schifter, a Senior Fellow at the D.C.-based Aspen Institute, told CG.
"Incineration inevitably has an impact on the environment," Selma Benkhelifa of Progress Lawyers Network told CG about the U.S. government's previous plan to burn a cache of contraceptives instead of distributing them. "But the worst thing is depriving millions of women of access to contraception."
