‘I pack two birth bags’: women’s accounts of preparing for hospital or roadside birth during maternity unit closures in rural northern Sweden

BACKGROUND: Intermittent closures of rural maternity units in northern Sweden disrupt access to essential sexual and reproductive health services, making intrapartum care unpredictable for local women. While long travel distances have been linked to adverse outcomes, less is known about how women view the closures and prepare for birth when local services are unavailable. Hence, the aim of this study is to analyse how women make sense of and negotiate the meaning of their pregnancy and childbirth in relation to intermittent maternity unit closures in rural contexts. METHODS: Semi-structured interviews were conducted with 20 women who were pregnant or had given birth between May 2024 and August 2025 and lived in the catchment area of a rural maternity unit with repeated closures. Interviews were conducted in Swedish in September-November 2025, transcribed verbatim and analysed using discourse psychology to identify interpretative repertoires and subject positions. RESULTS: The closures created a discursive gap in which established expectations about where and how birth should take place no longer functioned as stable points of reference. Three interpretative repertoires were identified: equity and legitimacy, where women framed rural living as a chosen life yet treated secure maternity care as non-negotiable; moral responsibility, where risk management shifted from system-level preparedness to women's own planning, including preparing for both hospital and roadside birth; and bodily vulnerability and dignity, where distance, admission thresholds and travel reshaped bodily labour, dignity and help-seeking, sometimes leading women to delay or avoid contacting healthcare services despite their concerns. CONCLUSION: Intermittent closures disrupt access to maternity care and shift the responsibility for managing uncertainty and risk from the healthcare system to women themselves. Access to sexual and reproductive health services is more than a matter of geographical availability; it is shaped by how responsibility and legitimacy are negotiated in practice. Maternity services function as a clinical service and as a condition for whether family life feels possible and sustainable in rural communities.