Approximately half a million babies are born each year in rural U.S. hospitals. A new study from the University of Minnesota School of Public Health finds rural hospitals with fewer than 240 births per year were more likely to rely on family physicians and general surgeons to perform deliveries, while those with a higher birth volume were more likely to have obstetricians and midwives attending deliveries.
Lower birth volume hospitals were also more likely to have labor and delivery nurses who were not specialized in obstetrics—that is, nurses who also worked in other areas of the hospital.
The study findings were published online in the Journal of Rural Health.
Lead author and School of Public Health Assistant Professor Dr. Katy Kozhimannil and her colleagues surveyed obstetric unit managers at all 306 rural hospitals that do births in nine states (Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin).
“The rural hospitals we surveyed were eager to talk with us about their work taking care of pregnant women in their communities,” said Dr. Zozhimannil. “They were clearly committed to providing high-quality obstetric care, and reported a range of different models for doing so.”
Key findings include:
“Our analysis highlights the need to tackle the challenges of obstetric care workforce and provision in rural hospitals under the Affordable Care Act, especially for low-birth-volume hospitals,” said Dr. Kozhimannil. “We would recommend utilization and expansion of federal, state, regional, and hospital-systems level approaches to increase access to appropriate training during medical education and in clinical practice through programs including simulation training, telehealth, and interprofessional education.”