Unless something changes soon, Houlton Regional Hospital will become the 10th Maine hospital in a decade to close its birthing unit, leaving only a minority of the state’s 32 remaining community hospitals offering maternity services.

Houlton’s nurses, backed by the Maine Nurses Association and its national affiliate, called a protest meeting that attracted 200, followed by a candlelight vigil and a petition signed by 1,400 people — rare acts of resistance against a relentless trend of eliminating services Mainers relied on for more than a century at each hospital in the state.

Years ago, I was told by a veteran hospital administrator that maternity wards always operate at a loss, like 24-hour emergency rooms at all but the largest hospitals. The reason hospitals offered birthing services was that it was one of the few positive reasons to go to a hospital, which otherwise are inevitably associated with severe illness and death.

Hospitals used revenue from more remunerative services, chiefly surgical in-patient stays, to make up the difference. No one ever talked about making a profit; breaking even was sufficient.

That was then. Now, Maine’s 32 acute care hospitals are largely owned by two corporations — Northern Light in Bangor and Maine Health in Portland — and Northern Light is under severe financial stress. Neither has shown any compunction about closing these popular services, rarely even bothering to justify their decisions.

The new landscape is stunning. All but one county has a single hospital birthing center, while Waldo and Sagadahoc counties have none.

The lone exception is, surprisingly, Aroostook, declining in population from 97,000 in 1980 to 67,000 today. Why does Aroostook County still have birthing centers in both Caribou and Presque Isle?

The reason is obvious: Cary Medical Center is owned by the city of Caribou, the only municipally owned hospital in Maine and among the few in New England.

By contrast, the one hospital serving York County from Biddeford and two from Cumberland County, both in Portland, cover counties with 38% of Maine residents — 543,000 people — or eight times Aroostook’s population.

Public ownership leads to different priorities. Cary operates a “state-of-the-art” birthing center, and recently won the Best Hospital Women’s Choice Award for obstetrics. Somehow, this 63-bed hospital makes it work.

If you’re looking for more bad hospital news, consider the imminent shutdown of Inland Hospital in Waterville, which will end clinical services on May 27 and close shortly thereafter. It celebrated its 80th birthday, with much fanfare, in 2023.

Inland was Maine’s only osteopathic hospital — an alternative but equivalent source of expertise to the more familiar MDs — and a training ground for Maine’s only medical school, the University of New England in Biddeford, which uses an osteopathic curriculum and offers DO degrees.

Inland’s demise will leave Maine with 31 community hospitals, and one wonders how many can survive another decade. In terms of hospital births, those in Farmington, Skowhegan and Dover-Foxcroft are vulnerable. All downsized to 25 beds as “critical access” hospitals to obtain increased federal reimbursements, and have limited staff.

How did we get here, with the community hospital — along with the independent physician practice — an endangered species? It’s been a long and tortuous road.

The usual explanations for birthing center closures are unconvincing. Yes, home births are up but the total is negligible — 97% of Maine women still give birth in hospitals.

And while it’s true Maine’s birth rate, like those of most states. has been declining, it’s recently turned around. Maine, according to the Census Bureau, is now the fastest growing state in New England, and should experience a rise in births.

No, the real reason is that America’s health care system — if it can be called a system — is based not on providing services to the public, but on maximizing revenues, just as private business use their profit margin as a measure of success.

Maine’s hospital corporations are technically nonprofit — charities, under state tax law — but they operate in other respects much like the giant health care corporations that now dominate health insurance and pharmaceuticals. They are unaccountable to the public and even the government.

I keep looking north to Canada, which set up its Medicare system in the 1960s very differently than ours. Rather than revenue, service calls the tune. Services are allocated in response to public need, not the imperative of private companies. Patients get no bills. Doctors can practice independently. The system costs less per capita than ours does. And yes, there are waits for elective surgery, but no one is denied care.

Of all the reasons to fantasize about Maine joining Canada, this is undoubtedly the most substantive.

Correction (May 1, 2025): A previous version of this column misstated the number of hospitals offering birthing services in Cumberland County. There are currently two.