Eroding Access and Quality of Childbirth Care in Rural US Counties

Shah, Neel

doi:10.1001/jama.2018.1646

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…Both populations of childbearing families in this study, rural/small town and urban/suburban, surpassed national benchmarks for selected quality measures. Although maternal and neonatal health inequities are well documented in rural America, [5][6][7][8][9][10][11][12][13] findings from this project tell a different story-one of population health, strength, and resilience associated with community midwifery care. Controlling for medical risk factors and when matched with the appropriate level of care, rural childbearing families have equal and in some cases better outcomes than those living in urban settings.…”

Section: Discussionmentioning

confidence: 99%

“…Variations in quality by rural/urban location previously published within the literature are not demonstrated within this sample of birth center consumers. [5][6][7][8][9][10][11][12][13] The harmful variations that have been demonstrated to be amplified in populations of low-risk women, including overuse of cesarean birth and neonatal intensive care units, were not demonstrated in this sample. 3,20,[23][24][25] More research exploring the variation in episiotomy rates within this sample of childbearing multiparous people of low medical risk is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Rural resilience: The role of birth centers in the United States

Jolles

Stapleton²,

Wright³

et al. 2020

Birth

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Purpose To explore the role of the birth center model of care in rural health and maternity care delivery in the United States. Methods All childbearing families enrolled in care at an American Association of Birth Centers Perinatal Data RegistryTM user sites between 2012 and 2020 are included in this descriptive analysis. Findings Between 2012 and 2020, 88 574 childbearing families enrolled in care with 82 American Association of Birth Centers Perinatal Data RegistryTM user sites. Quality outcomes exceeded national benchmarks across all geographic regions in both rural and urban settings. A stable and predictable rate of transfer to a higher level of care was demonstrated across geographic regions, with over half of the population remaining appropriate for birth center level of care throughout the perinatal episode of care. Controlling for socio demographic and medical risk factors, outcomes were as favorable for clients in rural areas compared with urban and suburban communities. Conclusions Rural populations cared for within the birth center model of care experienced high‐quality outcomes. Health Policy Implications A major focus of the United States maternity care reform should be the expansion of access to birth center models of care, especially in underserved areas such as rural communities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rural resilience: The role of birth centers in the United States

Jolles

Stapleton²,

Wright³

et al. 2020

Birth

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“…43 The relationship between increased prematurity rates and inadequate access to care after the loss of obstetric units can be appreciated even after adjusting for race/ethnicity, education, and overall health conditions at the county level. 44 Nonurban adjacent counties also saw higher rates of infants with low Apgar scores after obstetrical unit closures, and in the most remote areas across the country, the rate of low birth weight and infant mortality were higher compared with urban communities. 45 In rural Alabama, between 2003 and 2017, counties without obstetric facilities experienced an infant mortality rate of 9.23 deaths per 1000 live births compared with 7.89 deaths in counties with a labor and delivery unit (P = 0.0011).…”

Section: Infant Outcomesmentioning

confidence: 95%

Rural Maternal Health Care Outcomes, Drivers, and Patient Perspectives

Anglim

Radke

2022

Clinical Obstetrics &Amp; Gynecology

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Rural communities are a vital segment of the US population; however, these communities are shrinking, and their population is aging. Rural women experience health disparities including increased risk of maternal morbidity and mortality. In this article, we will explore these trends and their determinants both within and external to the health care system. Health care providers, public health professionals, and policymakers should be aware of these social and structural factors that influence health outcomes and take action to reduce generational cycles of health disparity. Opportunities to improve the health and pregnancy outcomes for rural women and rural populations are highlighted.

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“…Many rural hospitals that remain open have discontinued obstetric services, leaving 54% of rural counties in the U.S. with no hospital obstetric services as of 2014 (American College of Obstetricians and Gynecologists, 2014;Hung et al, 2017). Factors identified with rural hospital closure include financial distress, decline in birth volume, lack of obstetrical providers, and high regional unemployment (Balasubramanian & Jones, 2016;Holmes, Kaufman, & Pink, 2017;Hung et al, 2017Hung et al, , 2016Nelson, 2017;Shah, 2018;Tong et al, 2013).…”

Section: Introduction National Obstetric Care Shortagementioning

confidence: 99%

Labor and Delivery Unit Closures in Rural Georgia from 2012 to 2016 and the Impact on Black Women: A Mixed-Methods Investigation

Daymude

Rochat

2022

Matern Child Health J

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Background. Obstetric provider coverage in rural Georgia has worsened, with nine rural labor and delivery units (LDUs) closing outside the Atlanta Metropolitan Statistical Area from 2012-2016. Georgia consistently has one of the highest maternal mortality rates in the nation and faces increased adverse health consequences from this decline in obstetric care.Objective. This study explores what factors may be associated with rural hospital LDU closures in Georgia from 2012-2016. Methods. This study describes differences between rural Georgia hospitals based on LDU closure status through a quantitative analysis of 2011 baseline regional, hospital, and patient data, and a qualitative analysis of newspaper articles addressing the closures. Results. LDUs that closed had higher proportions of Black female residents in their Primary Care Service Areas (PCSAs), of Black birthing patients, and of patients with Medicaid, selfpay or other government insurance; lower LDU birth volume; more women giving birth within their PCSA of residence; fewer obstetricians and obstetric provider equivalents per LDU; and fewer average annual births per obstetric provider. Qualitative results indicate financial distress primarily contributed to closures, but also suggest that low birth volume and obstetric provider shortage impacted closures. Conclusions for Practice. Rural LDU closure in Georgia has a disproportionate impact on Black and low-income women and may be prevented through funding maternity healthcare and addressing provider shortages.

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Eroding Access and Quality of Childbirth Care in Rural US Counties

Cited by 8 publications

References 11 publications

Rural resilience: The role of birth centers in the United States

Rural resilience: The role of birth centers in the United States

Rural Maternal Health Care Outcomes, Drivers, and Patient Perspectives

Labor and Delivery Unit Closures in Rural Georgia from 2012 to 2016 and the Impact on Black Women: A Mixed-Methods Investigation

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