Far from Delivery is a multimedia reporting project examining access to maternal and infant healthcare in rural southern Arizona, produced by AZPM News with support from the USC Annenberg Center for Health Journalism.
In the backyard of Ali Jones’ home in Safford, she watched her sons take turns driving an electric ride-on car, kicking up clouds of dust as they made their way across the yard.
It was a late September afternoon – still warm, but the high desert climate offered reprieve from the high temperatures in the summer months.
Quincy, 7, and Bentley, 5, alternated between laughter and bickering. Jones occasionally played referee while holding the youngest of her five children, Brooklyn, on her hip.
“I always knew growing up I wanted to be a mom and I wanted to provide my kids… a loving home,” Jones said.
But her journey to motherhood hasn’t been easy.
Jones was 30 weeks pregnant with Bentley when she contracted COVID-19 in late 2020. She had been living in Safford for about three years after leaving behind an unhealthy upbringing and abuse in Iowa.
Jones visited the emergency department at the nearest hospital, Mt. Graham Regional Medical Center, after she found herself struggling to breathe. She said she visited four times before she was admitted.
Mt. Graham hospital has a labor and delivery unit, but lacks a Neonatal Intensive Care Unit (NICU) to care for an infant born before 36 weeks or with health complications. Jones said she needed immediate, highly specialized care that required traveling about 125 miles to Tucson to receive, if driven.
The fastest way for her to get there was by emergency helicopter transfer.
Jones recalled pleading with attendants in the helicopter to boost her oxygen supply before she was taken to Tucson Medical Center and placed on a ventilator in the intensive care unit.
She delivered her son, Bentley, via emergency C-section while unconscious. She could not see her newborn for six days.
Six years later, the pandemic that shaped Jones’ experience has subsided. But the distance she and many other rural Arizona mothers must travel for care remains.
Ongoing threats to obstetric services is a consistent pattern
The nonprofit March of Dimes estimates that 96 counties, including Arizona’s Greenlee and La Paz counties, are without obstetric services.
And more are shutting down. Over the last decade, rural communities across the country have watched maternity units close one after another.
An estimated 500 to 700 hospitals in the U.S. have discontinued obstetric and labor-and-delivery services since 2010, with a wave of recent closures triggered by cuts to Medicaid spending, according to the nonprofit.
With some exceptions, Arizona has been relatively lucky.
Access to maternity care varies considerably from one community to the next. Some have hospitals where women can give birth but lack the specialists needed to manage high-risk pregnancies or care for critically ill newborns. Others are hours from a labor and delivery unit, let alone a hospital.
For families, those gaps can mean hours on the road for prenatal appointments, delivering babies far from home and relying on emergency transportation when complications arise.
And as rural healthcare providers contend with workforce shortages, financial pressures and impending changes to Medicaid funding, the future of maternity care in some communities remains uncertain.
In Far from Delivery, a three-part multimedia reporting project, AZPM News examined what’s at stake for the families and healthcare providers working to keep maternity care close to home.
When specialized care is miles away
Safford is a small city of about 10,000 people — but it's not an isolated outpost.
It's a regional hub for Graham County and southeastern parts of the state, driven by copper mining operations, agriculture and corrections facilities.
It has something many rural communities across the country don’t: a hospital where women can still deliver babies.
Mt. Graham Regional Medical Center serves families in Graham County and neighboring Greenlee County, which has neither a hospital nor an obstetrician-gynecologist.
But even in communities with labor and delivery units, not every level of maternity care is available.
Mt. Graham hospital has a nursery for newborns, but it does not have a NICU, where premature babies and newborns with serious medical conditions can receive specialized care.
Pregnant patients who need more advanced care are transferred to larger hospitals.
Tawny Despain, Mt. Graham hospital’s director of maternity services, said her department transfers about two to four patients a month because of gestational age or other risk factors.
For Jones, the need for specialized care didn’t end with Bentley’s birth.
When she became pregnant again in 2022, her previous complications meant she needed to see maternal-fetal medicine specialists – doctors who care for patients with high-risk pregnancies.
Some specialists traveled to Safford to see patients. When appointments weren’t available locally, Jones made the two-hour drive to Tucson.
"You're told that you need to see a specialist and you hope and wish that we could have the resources here so we're not driving so far,” Jones said.
For rural families, those appointments can mean arranging childcare, taking time off work and paying for gas. For those without reliable transportation, accessing care becomes even more complicated.
And unlike a scheduled appointment, labor doesn’t always allow time to make those arrangements.
The cost of keeping maternity care close to home
For years, physicians with Sun Life Health delivered babies at Banner Casa Grande Medical Center, serving families from communities including Coolidge, Eloy and Florence.
In 2025, Sun Life was delivering about 900 babies a year at the hospital, according to its chief medical officer, Dr. Jonathan Willms.
But after struggling to recruit and retain enough obstetricians to safely staff the unit, Willms said Sun Life stopped providing delivery services there in August.
"I can't safely cover the unit with only two doctors. I really need about four or five to safely cover the unit,” Willms told AZPM News.
He said there are some shifts that have required him to be up for the entire 24 hours.
"It’s kind of hard to bounce back from that. When I'm tired, I don't make decisions as well. I can't communicate as clearly. It gets to a point where it's just not safe and we're actually putting people in harm's way."
For Sun Life patients, the change now means traveling to Banner Ocotillo Medical Center in Chandler, about 45 minutes away.
Willms said he is confident it’s a temporary pause. For now, Banner Casa Grande is staffing the unit with substitute doctors, known as locum tenens doctors, who fill in staffing gaps.
But if a community were to lose obstetric services, Willms said it can have implications for an entire community.
“One of the most important things (to a family) is, how can I get the proper care that I need? Where can I deliver my baby?” Willms said.
The challenges facing Sun Life illustrate why maternity care can be so difficult to sustain.
“One of the most important things (to a family) is, how can I get the proper care that I need? Where can I deliver my baby?”Dr. Jonathan Willms
Hospitals must have staff available around the clock, regardless of how many babies are born on a given day. Nurses, physicians, anesthesia providers and other medical personnel must be prepared to respond when complications arise.
For smaller hospitals with fewer deliveries, maintaining that level of staffing can be expensive, according to Dr. Marta Crispens, a physician at Banner University Medical Center Tucson. Crispens was named the chair of University of Arizona’s Department of Obstetrics and Gynecology in February.
She said that even in urban centers, there is a shortage in the OB/GYN workforce. That shortage is accentuated in rural centers where there’s only one OB/GYN.
“To be a solo or one or two providers in a community and you're going to be responsible for care 24/7 365, that's almost untenable,” Crispens said.
And when physicians leave, finding replacements can be difficult. Willms said Sun Life anticipated spending nearly $3 million annually on temporary physicians to maintain coverage.
Dr. Erin McMahon, a certified nurse-midwife who directs a nurse-midwifery program at the University of Arizona, said labor and delivery is particularly resource-intensive.
“For any health system, the labor and delivery unit is not where they're making a profit,”
McMahon said.
But closing a unit doesn’t eliminate the need for maternity care. It shifts the responsibility and cost elsewhere.
Emergency room doctors, nurses, paramedics and flight crews have become part of the maternity care safety net.
“When a labor and delivery unit closes, or even if there just isn't one in your rural community, that doesn't stop pregnancies from happening,” McMahon said. “It doesn't stop labor and birth from happening.”
Even hospitals without obstetric services must be prepared for pregnant patients who arrive in need of emergency care.
For some patients, transferring to a larger hospital before delivery is the safest option, particularly when a baby is expected to need neonatal intensive care.
But arranging those transfers can be complicated. Weather can ground helicopters, and traveling by ambulance can mean hours on the road – not to mention expensive bills.
For families, the experience can be frightening.
‘I felt like a burden’
Lilly Gaskill, a mother from Hereford in Cochise County, was 38 weeks pregnant when she went to a clinic in Sierra Vista for a routine appointment and learned she was having regular contractions.
She said she was told she couldn’t go to the local hospital. She said she was eventually instructed to go to Tucson Medical Center.
“I felt like a burden,” she said.
With her husband needing to work and care for their two young children, Gaskill said she made the drive alone, while having contractions.
She delivered by cesarean section that evening.
An uncertain future
For rural healthcare providers, maintaining maternity services could become even more challenging in the coming years.
More than half of births in the state are covered by the Arizona Health Care Cost Containment System, or AHCCCS, the state’s Medicaid program.
It’s also a vital source of revenue for the hospitals and clinics. AHCCCS provides supplemental payments distributed to hospitals to close the gap between the actual cost of care and base Medicaid reimbursement rates.
Legislative changes to federal Medicaid eligibility and funding that passed in 2025 are expected to put additional financial pressure on healthcare providers. Proponents of the legislation – H.R. 1, otherwise known as the One Big Beautiful Bill Act – say the cuts were necessary due to widespread Medicaid fraud.
Arizona is currently dealing with a multibillion-dollar Medicaid fraud crisis. Many of the schemes specifically targeted Native American patients and individuals seeking addiction or behavioral health treatment.
Dr. Daniel Derksen, director of the Arizona Center for Rural Health at the University of Arizona, said more complicated eligibility and enrollment requirements could leave some patients without coverage.
"A person might get kicked off of Medicaid because they didn't know they needed to update their change of address or they had the wrong phone number listed or something like that,” Derksen said. “Then they become pregnant and then they go in to be seen and they are no longer on the Medicaid roll.”
At the same time, changes to supplemental Medicaid payments could reduce revenue that hospitals rely on to sustain services.
For rural hospitals already struggling with staffing costs and financial pressures, those changes could force difficult decisions about which services they can continue to provide.
And the loss of a labor and delivery unit can affect more than the hospital’s bottom line.
It can mean longer drives for expectant parents, additional demands on emergency responders and more patients traveling to hospitals in neighboring communities.
But not every rural community is losing access to maternity care.
Some have gained providers, including physicians who can deliver babies, nurse practitioners and midwives, and efforts are underway to expand the workforce.
April Harris runs Aloha Baby, a keepsake ultrasound studio in Safford. She said her city has come a long way.
"When I had my first child, we actually didn't even have epidurals. Like, that was not an option,” she said. “They’re adding things to make the experience better for moms, I believe."
At the University of Arizona, McMahon is helping train nurse-midwives who could provide prenatal care, attend births and support patients after delivery in communities where recruiting physicians has been difficult.
She believes retaining a workforce starts with recruiting from the communities that need better access.
"We can recruit people into the state of Arizona, but if we want them to stay, the answer really is recruiting from within our communities already."
Those providers could help fill some of the gaps in care. But they also need a healthcare system capable of supporting them, including funding and access to hospitals and specialists when patients develop complications.
The Rural Health Transformation Program, a component of H.R. 1, provided Arizona with $167 million to go toward improving access to rural healthcare in the current fiscal year, $5 million of which is dedicated to maternity care.
"I would have liked to see it be a lot more…” Derksen said. “There is a specific return on investment and we have systems eager to work with rural areas to develop those types of things and use best practices to to really address this problem.”
Danny Smith, Mt. Graham hospital’s community relations director, said the medical center did not receive any funding from the program during its first year, despite submitting grant applications.
Beyond the delivery room
For Ali Jones, the challenges of maternity care have continued even after bringing her youngest daughter home.
“I have had my struggles since having Brooklyn with postpartum depression,” Jones said.
Maternity care encompasses months of prenatal appointments, childbirth and the physical and emotional recovery that follows.
For rural families, finding mental health support, breastfeeding assistance or other postpartum services can present another set of challenges.
Expanding access to maternity care, McMahon said, is about more than ensuring women have a place to deliver their babies. It’s about making healthcare available throughout their lives.
At home in Safford, Jones is raising her children in the community where she has built a life for her family.
For communities like Safford, preserving maternity services means preserving a piece of the infrastructure that allows families to live, work and raise children there.
Looking back on November 2020, Jones said she constantly asked for prayers for the nurses and doctors looking over her.
“My life was very much in the hands of my doctors,” she said. “Ultimately, they're the ones that saved my life and my son's life.”
Arilynn Hyatt's reporting contributed to this article.
WATCH: Far from Delivery | Arizona Illustrated
ABOUT THIS PROJECT
Far from Delivery is a multimedia reporting project from AZPM News examining access to maternal and infant healthcare in rural Southern Arizona. This reporting was produced with support from the USC Annenberg Center for Health Journalism.
