Patient perspectives on loss of local obstetrical services in rural northern Minnesota

Abstract

Choices and opinions about obstetric care have significantly changed from 1990 to 2016 in rural Minnesota. Understanding these changes can help address shifting risks and costs to rural communities here and elsewhere in an effort to support and sustain healthy, viable rural communities.

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

“…One striking finding was the commitment and success in providing prenatal care to local residents, regardless of whether L&D services were available locally. The ability to offer local prenatal care can limit the travel costs and dangers to patients, diminish patient stress, and support the care of babies and families within the local community both before and after the birth 5,26 . In communities that do not offer local L&D services, and as voiced elsewhere, optimizing relationships with the regional referral centers in which local parturient women will deliver is essential 32,33 .…”

“…Up to 40% of all US counties, most of them rural, lack a qualified childbirth provider 4 . 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 .…”

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

“…Others have discussed the changing risk and cost to communities and individual parturient patients when local delivery is no longer an option. 1,3,10,[15][16][17][18][19] The risks and costs to an individual community such as Grand Marais can thus start to be more easily articulated and calculated if these trends continue. The local change in services produced ripple effects observed at a regional level as birth location shifted to hospitals in Duluth.…”

“…A prior study, which also grew out of the RMSP preceptorship in Grand Marais, looked at patients' perspectives as a result of the loss of local obstetrical care. 10 The present study's purpose is to add to the initial study by characterizing obstetrical care utilization and obstetrical care clinical outcomes for patients before and after local labor and delivery service discontinuation. By taking a unique opportunity to observe these characteristics in one rural community before and after local obstetrical unit closure, we aim to better understand the changes resulting from local closure and whether prior patient concerns voiced are being actualized.…”

Using the Blueprint for Advancing High‐Value Maternity Care for transformative change

“…15,16 One half of the United States counties do not have an obstetrician, and many small hospitals and rural hospitals are rapidly eliminating maternity services. 16,17 There are indications that when midwifery care is less integrated at the state level or when scope of practice laws is more restrictive, maternal and infant outcomes suffer. 18,19 Critical steps must be taken to achieve optimal maternity care workforce composition, including enhancing diversity, retaining and optimally deploying obstetricians as active maternity care practitioners, increasing family physician provision of maternity care, expanding the midwifery workforce, achieving the potential of laborists, and developing effective models to ensure access to care in rural and underserved areas.…”