A string of recent obstetrical program interruptions and closures in rural hospitals of northern Ontario have recast a spotlight on longstanding perinatal health inequities in these communities. Addressing this crisis directly, this paper examines the impacts of health system centralization on rural perinatal care in the diverse geographies of northern Ontario. Content and discourse analysis of key policy documents explore the themes of interprofessional care teams and risk management, interrogating the assumptions embedded in urban-centric policymaking which often originates in southern Ontario. Findings articulate the ways that the concept of geography is deployed discursively by policymakers outside of the discipline, with significant consequences for shaping understandings of perinatal risk and safety in settings throughout the province, which in turn come to bear on the lived experiences of families seeking perinatal care, as well as the practitioners tasked with its implementation and delivery. By mapping the socio-ecological context surrounding local perinatal health services delivery, this research aims to draw attention to the structural and geographical determinants of perinatal health inequities in northern Ontario. Using a place-based lens rooted in critical geographies of health, this work investigates how the organization and governance of perinatal health services delivery in northern Ontario influence opportunities for expanding sustainable perinatal care in rural communities. Scaling this research to the community level aims to elucidate strategies for resilience and innovation which are often deeply informed by and rooted in place, as well as to articulate the complex network of relationships between healthcare providers and organizations in small rural communities and their counterparts in neighbouring communities and larger urban referral centres.