At 23 weeks pregnant, Brooke Macumber's birthing plan came unraveled when she found out that the hospital where she planned to deliver her fourth child was closing its obstetrics unit after nearly 75 years.
The hospital, Bonner General Health in rural Sandpoint, Idaho, was the same place where she had given birth to two of her older children and also where her husband had been born. The closest hospital is now an hour away.
"I've just had nightmares of making my husband pull off and delivering in the front seat of our car," Macumber, 25, told The Washington Post.
While the closure of Bonner's labor and delivery department follows a national trend of limited obstetric services in rural areas, some say the problem has been exacerbated by the recent passage of legislation criminalizing abortion.
In a Friday press release, Bonner General Health officials cited a shortage of pediatricians and decreasing number of deliveries as factors that played a role in making the decision to close. The "legal and political climate" was also cited as a reason in a state where nearly all abortions were banned after a trigger law took effect following the reversal of Roe v. Wade.
"Highly respected, talented physicians are leaving," the release said. "Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care."
According to the American Hospital Association, at least 89 obstetrics units in rural U.S. hospitals closed between 2015 and 2019, leaving 2.2 million women of childbearing age with limited access to maternity care.
Passed in 2020, Idaho's abortion trigger law criminalizes the controversial procedure in nearly all cases. Possible defenses under the law include if a doctor deems abortion medically necessary to save the life of the mother or if the woman has reported rape or incest to law enforcement.
Medical providers who violate the law face felony charges punishable by up to five years in prison, as well as the suspension or revocation of their medical license.
Idaho GOP chairwoman Dorothy Moon disputed Bonner's claim that Idaho's political atmosphere influenced its decision, saying that the real issue was the mismanagement of resources and an "inability to position the hospital to accommodate declining demographics."
The number of babies delivered in 2022 was simply not enough to cover the costs of the facility and staff, she said.
"The real issue here is one facing all of rural America: the failure of large health care entities to provide financially affordable healthcare in a sustainable fashion," Moon wrote in an email to the Post. "This isn't about abortion; it's about making excuses for staffing issues."