Driving through the little town of Damariscotta, in rural Midcoast Maine, it’s impossible to miss the handmade signs: “SAVE MILES MATERNITY!” They’re in front of cafes and storefronts, tacked to telephone polls, along the side of rural roads, and just outside the entrance to Lincoln Hospital, which locals call Miles. Earlier this year, MaineHealth, the nonprofit health system that runs Lincoln, announced it was considering closing the hospital’s labor and delivery unit. It would be the fifth such closure at a rural Maine hospital in two years and the 12th in a decade.The community is not having it. “Nobody wants this,” said Margaret Reynolds, who lives just a few minutes down the road from the hospital, in Damariscotta, with her husband and two boys.She first learned that Lincoln, or Miles, might be losing its birthing unit in the spring, at her annual gynecologist appointment. “I am 37, about to be 38, and my husband and I are considering a third child,” Reynolds said. “And so I asked, ‘yeah, hey, I'm getting a little bit older, what does it look like to have a third child?” And my midwife said, 'oh well, you know, no big deal at all, of course you can have a third child, but it won't be here.’ And I said, ‘what?’ And she said, ‘the labor and delivery unit will be closing in December, and you'll need to seek care elsewhere.’”That decision has not officially been made. MaineHealth will vote Aug. 6. On Wednesday, Aug. 5, a patient who is pregnant and due in January filed a lawsuit seeking an emergency injunction to prevent the vote.Lincoln Hospital, where MaineHealth has proposed closing the labor and delivery unit. Maine's rural communities have seen 11 such closures in the last decade.Samantha Fields/MarketplaceAs soon as Reynolds learned about the possibility of a closure, she started rallying friends and neighbors to try to do everything they could think of to stop Lincoln from becoming the latest rural Maine hospital to lose its birthing unit. “You know you can only go through so many before women and babies really start to be hurt by the closures,” she said. Since then, the group Reynolds helped rally — now dubbed the Miles Delivers Action Coalition — has gained a lot of traction, both in the community and around the state. Hundreds of people have come out to local listening sessions and rallies, thousands have signed a petition, and local politicians and candidates for statewide office are speaking out against the closure. Last week, Gov. Janet Mills called on MaineHealth to delay the vote for two years. “We have doctors, we have donors, we have their staff, their people, we have all of our towns, all of our people,” Reynolds said. “We have talked to people from the very far right, the very far left, and there is just — it's just one of those unicorn issues. It's just complete support.”Lincoln Hospital President Cindy Wade said she shares their feelings. “Nobody here, including myself, who's been here for 32 years, wants to close that labor and delivery unit,” she said. “What we're trying to do is figure out, can we continue it, and can we come up with other options?”Rural hospitals around the country have been struggling to come up with options to keep their labor and delivery units open, many for financial reasons, others because they cannot find enough staff, some a mix of both.With the nearly dozen Maine hospitals that have closed their birthing units in the last decade, “not every situation was the same.” Wade said. “Some were having significant nursing challenges, could not get nurses. Some had no OB-GYN providers. I mean, there were all kinds of different things. Some, it was straight up financials.”Rural healthcare comes with unique challenges, including, sometimes, providing emergency care for tourists during busy summer months.Samantha Fields/MarketplaceAt Lincoln, she said, it’s a combination of low birth volume and, above all, challenges recruiting OB-GYNs. “That is true. There is truth to that,” said Dr. Valerie Donohue, a family doctor at the hospital who is also certified in obstetrics. In the six years she has been working there, first full-time, now per diem by choice, Donohue said she has watched the hospital struggle to hire. “But I think we've done a really poor job of sort of advertising what it means to be a rural doctor,” she said. “And that our community has different needs than a larger, more urban population like in Portland. And there's pros to not being as busy.”Some of the things MaineHealth says have made it hard to recruit have upsides, in Donohue’s experience. Like being on call, which OB-GYNs at Lincoln would have to do more often than they might elsewhere, is not as intense and demanding as it is at a big city hospital. And the fact that fewer babies are born here, which MaineHealth also cites as a deterrent for many providers, means doctors get more time with their patients. “I think it's a good thing,” she said. “I think we get to develop more of a rapport with them, more of a relationship. We really get to know their medical history.”That relationship is a big part of what Cecilia Ackerman, 39, likes about being a patient at Lincoln. Especially after giving birth to her first child in Chicago a couple of years ago. “To me it's so important to have met the people that you're going to be with for birth,” she said.She also likes that the hospital is just 15 minutes from her house. Ackerman is currently in her third trimester, due to deliver her second baby at Lincoln in October, just two months before the proposed closure. “I'm lucky in that I'm still able to choose the hospital,” she said. Though she worries about what could happen if MaineHealth votes this week to close labor and delivery in December. Cecilia Ackerman and her husband Ari Conterato live about 15 minutes from Lincoln Hospital, where Ackerman is due to deliver their second baby in October.Samantha Fields/Marketplace“My first question was, who's going to be staffing the labor and delivery unit in October, in November, when they're getting close to closing?” Ackerman said. “The staff is wonderful here and they're incredibly dedicated. But obviously, if they think that the unit is going to close, they're going to start looking for jobs elsewhere.”And the next-closest hospital to her is at least 40 minutes away, and that’s on a good day, without winter weather or tourist traffic. It feels too far for comfort. “I definitely would not want to be sitting in Route 1 traffic when there's, like, literally no other alternate route,” she said. This part of Maine is rural and coastal. Lots of people live down long peninsulas, where there’s only one road in and out. It can take a long time to get places. When Moira Rose Richards, who helped Reynolds start the Coalition, was pregnant with her first son, in 2021, her doctors encouraged her to deliver at Mid Coast Hospital in Brunswick, an hour away from where she lives, down at the end of the Bristol peninsula. So she did, figuring she’d likely be in labor for hours, and the drive would be no big deal. Instead, her contractions started so intense and fast she barely made it to the hospital. “He came out so quickly that the floor manager almost had to birth him,” Richards said. “But she couldn't because his umbilical cord was wrapped around his neck a couple of times, and we were losing his vitals really quickly.” Her son was OK, in the end. So was she. But it was traumatizing. So when Richards got pregnant again, she decided to deliver at Lincoln, 20 minutes from her house. It was the right choice; her second son came even faster. “It's unbelievable to even think about not having access to a local labor and delivery unit,” she said. That is increasingly the reality in much of Maine. Nearly half of all hospitals in the state now lack labor and delivery. And Lincoln could be next. Dr. Tim Fox, the hospital’s chief medical officer, said it’s just a reality that there are certain services rural hospitals cannot always provide. “There are a lot of emergency conditions that small hospitals just don't take care of, and they require transfer to a tertiary care center like Maine Medical Center in Portland, and we've been doing that for years,” he said. “It's part of living in a rural community. Would it be ideal to have an emergency department with an [operating room] attached on every street corner? Sure, but it's not feasible.” And that may be the case for labor and delivery services, too. Dr. Donohue is not convinced that has to be the case. Or that it’s safe to keep reducing the number of places in the state that deliver babies. “In labor and delivery, and with birth, obstetrical emergencies can come on very suddenly,” she said. “Even a 30- or 40-minute drive to the next nearest hospital that can do obstetric care can mean life or death, and that's really scary.”Driving through Damariscotta, there are signs everywhere protesting the proposed closure.Samantha Fields/MarketplaceShe is also not convinced the remaining hospitals in the region — Mid Coast, down in Brunswick, and Pen Bay up in Rockport — will be ready and able to accommodate all of the patients who are no longer able to deliver at Lincoln if it shuts down in December.When another hospital in the region shut its labor and delivery unit down last spring, she heard from colleagues that the next-closest hospital was not ready to absorb all of the additional patients. “I know people who work up at Pen Bay who were like, ‘yeah, we were not prepared for that,’” Donohue said. “And it's really unfortunate, and I'm afraid that's going to happen here as well.”Margaret Reynolds, and many of her fellow Miles Delivers Action Coalition members, are determined to do everything they can to prevent that from happening.“When I started this,” Reynolds said, “I thought, OK, there's no way. We're not going to stop this. We can just make them see what they're doing as this happens. And now, dare I say it, I am a little optimistic.”Even if MaineHealth does vote to close labor and delivery at Lincoln, she said the group has no intention of giving up. Instead, she has a vision of raising enough money to create a whole new rural center for maternal and infant health. “This is not just about Maine. This is a trend that is happening countrywide,” Reynolds said. “Why not make this the test case?And instead of closing, try something new that could be a model for rural areas around the country.