I heard also that rural areas have growing numbers of drug abuse complications, and that's one of the reasons as well,
Hospitals are actually not needed to birth babies, and the concept of births as a 'medical' issue requiring treatment per se (rather than possibly being needed for complications) is a relatively recent one, even in the US. I have 3 babies so far, and have yet to step foot in a hospital. If hospitals get more expensive and distant, I expect some market elasticity to kick in, and some people will just go back to having babies for free.