Mayo Clinic will stop scheduling baby deliveries and inpatient pediatrics services and surgeries at its hospital in Fairmont early next year, extending a statewide trend of declining rural health care access.

The health system, despite its famous name and reputation, is suffering the same fate as others across Minnesota: an inability to recruit physician specialists to rural hospitals, where aging populations are changing medical needs.

Fairmont was down to one full-time obstetrician, and covering baby deliveries for two years with Mayo doctors from other communities as well as costly temporary physicians. Lately, even temps were hard to find — and birth numbers are rapidly declining there, said Dr. James Hebl, vice president of Mayo Health System's southwest Minnesota operations.

"The obstetrical demand is projected to decline even further in the coming years," he said, "partly as more and more pregnancies are becoming high-risk pregnancies that are not eligible to be delivered on our Fairmont campus."

The cuts won't take effect until March but were announced Monday so Mayo could comply with Minnesota's newly strengthened law that requires six months' notice of hospital reductions or closures. Shortages already had forced Mayo Fairmont to temporarily divert some women in labor to other hospitals, and to only schedule surgeries on three days per week.

Roughly 30 Minnesota hospitals have stopped scheduling baby deliveries since 2011, including Mayo New Prague and Essentia Health's hospital in Fosston, where town leaders fought the decision but lost in an arbitrated dispute.

But Fairmont is bigger, with 57 beds and service to a community of 10,000 people, and the loss in obstetrics services also comes with a loss of inpatient surgery and pediatrics. Hebl said Fairmont recently lost two surgeons, and that 60% of local residents already are opting to travel 50 miles to Mayo's larger hospital in Mankato when they need procedures.

Some community leaders saw the cuts as a self-fulfilling prophecy, because of a lack of investments and strategic decisions over the past decade that could have cemented Mayo Fairmont as a regional hospital for southwest Minnesota. In 2014, Tom Hawkins joined with hundreds of Fairmont residents at a community meeting to voice concerns that cuts would turn the hospital into a "Band-Aid station" and hurt the local economy.

On Monday, the former city council member said those predictions appear to be coming true.

"It's a sad thing for the community," Hawkins said, though the United Hospital District in nearby Blue Earth has softened the blow by opening a clinic in Fairmont and maintaining obstetrics and other services.

Hebl said Mayo has made investments to increase in-demand services in Fairmont, upgrading its emergency department and expanding its cancer care and infusion services. The hospital will maintain its 24-7 ER and provide more than 80% of the care that patients in the community have sought in the past. Patients will receive surgical consultations locally, as well as prenatal and postnatal care.

"We have invested literally millions of dollars in the Fairmont campus," he said.

Fairmont has been a drag on Mayo's finances, posting a 2% loss on hospital operations in 2022, the most recent year for which public data is available. However, the cuts are not financially motivated, and are necessitated by staffing shortages that have only worsened since the COVID-19 pandemic, said Dr. Prathibha Varkey, president of Mayo Clinic Health System, a network of about 17 hospitals and 50 clinics in Minnesota, Wisconsin and Iowa.

The Mayo health system is trying to hire seven obstetricians, but there are more than 60 such openings across Minnesota hospitals right now, she said.

"This is not a financial decision," she said. "This really is an issue related to staffing challenges and the safety of patients."

Baby deliveries and surgeries have declined in recent years, and the Fairmont hospital only admitted 10 patients to its pediatric beds last year. Such low volumes present safety concerns because doctors and nurses don't have enough experience to keep their skills sharp, she said.

Minnesota has maintained a rural network of small hospitals far longer than many states, in part because providers used the special critical access designation to boost federal payment rates to facilities with no more than 25 beds. While Mayo Springfield closed in 2019, other hospitals have stayed open, sometimes by trimming declining services.

Minnesota led the nation with 22 hospitals closing obstetrical units from 2011 through 2021, according to a report earlier this year by the Chartis Center for Rural Health.

Routine births at Mayo Fairmont dropped from 252 in 2018 to 167 in 2022, which is below the 200 threshold that is commonly recommended in order to keep labor and delivery units well-trained and financially viable. Nurses at Fairmont might only participate in six deliveries per year at the current rate, Hebl said.

Births at low-volume hospitals can raise risks for expecting mothers and their babies, according to a recent literature review by University of Minnesota public health researchers, but a lack of local access can be problematic as well. Studies have found that a lack of local hospital-based obstetric care can result in more births outside hospitals or in emergency rooms, the review showed. One study in Pennsylvania associated longer distances to birth centers with worse maternal outcomes and more admissions of newborns to intensive care.

Cuts have hardly been limited to rural Minnesota. North Memorial Health Hospital in Robbinsdale shuttered a special-care nursery amid declining births while Allina Health consolidated its surgery and intensive care services at Mercy Hospital to its Coon Rapids campus and stopped providing inpatient pediatric care.

Allina also is in the process of cutting fewer than five nursing jobs from Owatonna Hospital, which it owns. The health system in a prepared statement said the cuts are due to a pullback on surgical services by Mayo, which provides physician staffing for surgeries and other services at the hospital. Mayo, however, has offered a different explanation, saying it is actively working to replace a general surgeon who recently resigned.

Christopher Snowbeck contributed to this story.