Making It Work: Models of Success in Rural Maternity Care
Across the U.S. a growing number of rural hospitals are no longer offering obstetric services. The loss of maternity care in rural communities adversely affects maternal and infant health. Rural counties that lose hospital-based obstetric services experience higher rates of births in hospital emergency rooms, and in rural counties that are not adjacent to urban areas, those that lost obstetric services saw increases in preterm birth rates. Preterm birth is a leading cause of infant mortality, and data show higher rates of infant mortality for rural infants, compared with urban infants. With each hospital that closes, or each hospital that discontinues its obstetrics service line, the nearest hospital grows farther away for pregnant rural residents.
Yet, not all rural communities have lost obstetric services. Some rural hospitals are defying these trends, maintaining pregnancy and childbirth services locally and even strengthening this service line and increasing the number of maternity care clinicians and births in their community hospitals. Understanding the factors that underlie successful models of rural maternity care can inform communities and hospitals that struggle to keep this service available locally.Based on American Hospital Association survey data from 2014-2018, we will measure access to hospital based obstetric services in rural communities and compare updated estimates to prior data from 2004-2014 to assess whether trends in services loss have changed. Then, we will identify rural counties that have maintained hospital-based obstetric services and describe characteristics of these counties. To further understand the dynamics of successful models, we will conduct in-depth interviews with hospital administrators, clinicians, and community leaders in four or five rural communities that are successfully providing obstetric care locally.