Why Are Obstetric Units in Rural Hospitals Closing Their Doors?

Abstract

Objectives: To understand hospital- and county-level factors for rural obstetric unit closures, using mixed methods.

Data sources: Hospital discharge data from Healthcare Cost and Utilization Project's Statewide Inpatient Databases, American Hospital Association Annual Survey, and Area Resource File for 2010, as well as 2013-2014 telephone interviews of all 306 rural hospitals in nine states with at least 10 births in 2010. Via interview, we ascertained obstetric unit status, reasons for closures, and postclosure community capacity for prenatal care.

Study design: Multivariate logistic regression and qualitative analysis were used to identify factors associated with unit closures between 2010 and 2014.

Principal findings: Exactly 7.2 percent of rural hospitals in the study closed their obstetric units. These units were smaller in size, more likely to be privately owned, and located in communities with lower family income, fewer obstetricians, and fewer family physicians. Prenatal care was still available in 17 of 19 communities, but local women would need to travel an average of 29 additional miles to access intrapartum care.

Conclusions: Rural obstetric unit closures are more common in smaller hospitals and communities with a limited obstetric workforce. Concerns about continuity of rural maternity care arise for women with local prenatal care but distant intrapartum care.

Keywords: Rural hospitals; birth volume; closures; obstetric units; obstetric workforce.

Figure 1

Regression of Obstetric Unit Closures by Annual Birth Volume in 2010 (N=263) Note. Predicted probabilities were calculated by multivariate logistic regression in Table 3, with average values of covariates, including hospital system affiliation, hospital ownership, proportion of noncommercially insured mothers, FTE Registered Nurses per 1,000 inpatient days, birth volume in the nearest hospitals doing obstetrics, and country‐level characteristics