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

Abstract

Purpose With decreasing access to rural obstetrical care, this study aimed to identify factors that contribute to the ability of Minnesota's rural communities to continue to offer obstetrical services locally. The study also sought to characterize attributes that differentiate rural communities that continue to offer obstetrical care from those that do not. Methods Family medicine physicians practicing in communities of fewer than 20,000 people were interviewed through a phone survey that included multiple choice and open‐ended questions. Quantitative and qualitative analyses were performed on data collected from the responses. Findings Within the Minnesota communities represented (N = 25), prenatal care was provided broadly, regardless of whether labor and delivery services were available. For the communities providing local labor and delivery (N = 17), several factors seemed to be key to sustaining these services: having a sufficient cohort of delivering providers, having surgical backup, having accessible confident nurses and nurse anesthetists, sustaining a sufficient annual birth volume at the hospital, and having organizational and administrative support. In addition, supporting anesthesia and analgesic services, access to specialist consultation, having resources for managing and referring both newborn and maternal complications, and sustaining proper equipment were also requisite. Conclusions Rural Minnesota family medicine physicians practicing in communities providing local labor and delivery care emphasized several essential components for sustainable provision of these services. With awareness of these essential components, rural health care providers, administrators, and policy makers can focus resources and initiatives on efforts that are most likely to support a sustainable and coordinated rural labor and delivery program.

System interventions to support rural access to maternity care: an analysis of the rural surgical obstetrical networks program

“…Although quality care can be provided without immediate access to caesarean section [ 16 ], the burden of isolation and lack of immediate support for potential complications compounds the stressors of providing care and can lead to burn-out and, in some instances, attrition of health care providers [ 18 ]. Pearson et al (2020) interviewed family physicians practicing in two types of rural communities: those that offer obstetrical care and those that do not [ 19 ]. All 8 physicians in the study cited surgical backup as a key factor in sustaining obstetrics.…”

System Interventions to Support Rural Access to Maternity Care: An Analysis of the Rural Surgical Obstetrical Networks program

“…(2020) interviewed family physicians practicing in two types of rural communities: those that offer obstetrical care and those that do not (22). All 8 physicians in the study cited surgical backup as a key factor in sustaining obstetrics.…”

“…High quality, safe maternity care is contingent on highly functioning teams, with registered nurses (RNs) and midwives as key members. The impact of the world-wide nursing shortage is increasingly recognized as a key contributor to lack of maternity care sustainability (23) with evidence from rural Australia and the United States nding lack of retention of nurses being a primary predictor of service closures (22,24). Shortages are also implicated in poor patient outcomes.…”