GRAFTON (AP) - The Unity Medical Center here is the latest in a long line of rural hospitals that no longer deliver babies.

Hospital officials say a declining population in rural areas means fewer births, making it tougher to pay for medical staff and insurance.

Laura Satterlund was born in Grafton and gave birth to her 2-year-old son, Tucker, at Unity Medical Center. But when her second baby arrives in mid-February, she and husband, Chad, will need to travel 45 miles to a hospital in Grand Forks.

Unity Medical Center stopped delivering babies in November in Grafton, a town of about 4,500 people.

"I think it's ridiculous that a town the size of Grafton can't offer childbirth," she said.

Fewer births have caused a spiraling effect, both for staffing and the bottom line, said Everett Butler, Unity's chief executive officer.

The hospital was left with only one surgeon to handle cesarean operations, after a retirement last year, Butler said. That meant difficulty in fulfilling the requirement that a surgeon be available on short notice, he said.

A shortage of obstetrical nurses also contributed to the decision to halt baby deliveries, Butler said.

Unity warned expectant mothers last spring that it couldn't guarantee a delivery room. That contributed to Unity dropping from 53 births in 2004 to 20 in 2005.

"In order to allow the staff to keep their skills in delivery, they need to have the opportunity to experience it," Butler said. "We don't have the numbers to keep them adequately trained and efficient."

Unity didn't have enough births to help pay malpractice insurance premiums, Butler said.

"OB was not a moneymaker by a long ways," Butler said. "It was done at an overall loss."

Unity is not alone in scrubbing obstetrics. The last birth in Pembina County Memorial Hospital in Cavalier was about year ago. Hospitals in Langdon, Northwood, McVille, Cooperstown, Hillsboro and Mayville also have stopped obstetrics in recent years.

The hospitals can deliver babies in an emergency. But only 13 of North Dakota's 38 rural hospitals routinely do it.

Cavalier County Memorial Hospital in Langdon hasn't delivered babies for about a decade.

"If you don't have the volume to offset the malpractice premiums, you can't subsidize it with another department," hospital CEO Lawrence Blue said. "At a bigger hospital, you can subsidize one department with another."

Towner County Medical Center in Cando, a smaller town than Grafton, Cavalier and Langdon, has kept obstetrics despite averaging only 15 to 20 births a year.

"We do it because it's an important aspect of trying to provide coverage in rural America," acting CEO Bob Spencer said. "But that's changing. Just because we want to do it doesn't mean we'll be able to continue to do it.

"But we're committed for at least one more year."