Rural health crisis reshapes maternal healthcare delivery

A sunset over a barn structure
Pre-term births rose nearly 1% due to the loss of hospital-based obstetric services in rural communities, according to a new JAMA study. (Getty/ehrlif)

The loss of rural hospitals and services in recent years has an impact on patient care in tangible ways, according to a new study in the Journal of the American Medical Association.

Researchers at Yale School of Public Health and the University of Minnesota School of Public Health studied nearly 5 million births that took place at hospitals and other providers in nearly 1,100 rural counties between 2004 and 2014, using a database of birth certificates linked to the annual surveys conducted by the American Hospital Association.

Their conclusions: The way those rural residents gave birth changed over the decade.

“In rural U.S. counties not adjacent to urban areas, loss of hospital-based obstetric services, compared with counties with continual services, was associated with increases in out-of-hospital and preterm births and births in hospitals without obstetric units in the following year,” the study observed. “The latter also occurred in urban-adjacent counties.”

In those rural counties that lost hospital-based obstetrical services, non-hospital births increased by nearly 1% in the first year after the loss of services compared to hospitals with continual obstetric services. Births at hospitals without an obstetrics unit rose more than 3%. Births at hospitals without obstetric services at all rose more than 2%. C-sections also rose by nearly 2%. More troubling is that pre-term births rose nearly 1%.

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The pressure on rural healthcare providers has become evident in recent years. Eighty-two rural facilities have closed since 2010, and data from the National Rural Health Association concluded that nearly 700 facilities nationwide are at risk for closing. A JAMA opinion piece that accompanied the study blamed the low reimbursement for obstetrics services as among the reasons many rural hospitals do not offer them.

Last month, the College of Health Information Management Executives asked for increased rural funding for telehealth programs in order to make existing resources more effective.

The study noted that given the trends, providers in these rural counties may need to be more vigilant regarding residents who become pregnant. “Particular attention to plans for backup care (should transfer be required) is especially relevant in these communities,” the study said. “Strengthening relationships between home birth clinicians and local hospital-based clinicians following obstetric closures may facilitate collaboration and appropriate transfers of care, when needed.”