Rural hospitals face significant challenges, including low demand, difficulty attracting and retaining staff, and socioeconomically disadvantaged patient populations. These issues may be exacerbated for labor and delivery (L&D) services because of declining birth rates and Medicaid’s prominent role in providing insurance coverage for pregnant women in the US. In New Hampshire, nine hospitals have closed their L&D units since 2000, including two in 2018. Using a mixed-methods approach grounded in community-based participatory research principles, this project is exploring what has led to these closures, how they may have affected maternal and infant outcomes, and how the community has responded. The methods include key informant interviews, focus groups with pregnant and postpartum women, and a rigorous analysis of New Hampshire birth certificate data. The results of this research could provide critical information for providers and policymakers focused on maintaining access to high-quality maternity care services for a rural population.