Changes in Labor and Delivery Patterns and Outcomes after Rural Obstetrical Service Closure

Abstract

The number of rural hospitals offering labor and delivery services has been declining across the United States for decades. As a part of this trend, labor and delivery services at Cook County North Shore Hospital in Grand Marais, Minnesota were discontinued in July of 2015. The closure necessitates that patients now travel to Duluth, 110 miles away, for hospital-based delivery services. Partnership between Duluth’s regional campus medical school and this rural community has grown to incorporate researching the effects of this closure on the Cook Country region including the community of Grand Marais. A prior study undertaken evaluated patients’ perspectives on this loss of local obstetrical services. This study was undertaken to better characterize the utilization and clinical outcomes of obstetrical care for patients before and after local labor and delivery services were discontinued. Retrospective chart review was done comparing measures before and after delivery services discontinued locally. Although not statistically significant, patterns since closure include an increased percentage of inductions, home births, and cesarean deliveries for women in Cook County.

Obstetrical Care in Rural Minnesota: Family Physician Perspectives on Factors Affecting the Ability to Provide Prenatal, Labor, and Delivery Care

“…Many others have addressed not only the reasons why obstetrical units are closing, but also the need to reconceptualize perceived risk 2,32‐36 . Although this study does not directly address the perception of risk by family medicine physicians participating, nor the birth outcomes data as shared by others, 11‐15,18‐21 findings in this study do echo the need and desire to provide the best possible local and coordinated care for rural women within the regional landscape of each individual community.…”

“…Many contributions to the medical literature have examined this trend, the factors driving it, the disproportionate effects to rural women in a lower socioeconomic demographic, patient perspectives on this trend, and the resulting needs that currently exist in rural communities 1‐15 . The discussion has been robust in recognizing the state of declining rural obstetrical care as well as the challenges and risks this creates for reproductive aged women living in these communities 11‐26 . County, state, and federal data have been analyzed to contribute to current understanding of regional and country‐wide trends and patterns.…”

Loss of Obstetric Services in Rural Appalachia

“… 4 , 5 Elimination of hospital-based obstetric services in rural areas can also increase out-of-hospital births and births in hospitals without adequate neonatal equipment. 6 – 8 In addition, cessation of rural obstetric care is linked to increases in unplanned inductions and high-risk cesarean deliveries. 2 , 6 – 8 …”

“… 6 – 8 In addition, cessation of rural obstetric care is linked to increases in unplanned inductions and high-risk cesarean deliveries. 2 , 6 – 8 …”