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. 2021 Mar;37(2):385-393.
doi: 10.1111/jrh.12539. Epub 2020 Nov 17.

Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services

Katy B Kozhimannil  1 , Julia D Interrante  1 , Mariana S Tuttle  1 , Mary Gilbertson  1 , Kristin DeArruda Wharton  1
Affiliations

Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services

Katy B Kozhimannil et al. J Rural Health. 2021 Mar.

Abstract

Background: Rural hospitals are closing obstetric units, and limited information is available about local emergency obstetric preparedness and capacity in rural communities where hospitals do not routinely provide this care.

Objective: To describe emergency obstetric capacity at rural US hospitals that do not routinely offer childbirth services.

Methods: Data from the 2018 American Hospital Association Annual Survey were used to identify a random sample of rural hospitals that did not offer obstetric services. A survey was developed based on World Health Organization criteria for obstetric emergencies. With data collected from 69 rural hospital emergency departments (48% response rate), we analyzed local capacity to support childbirth.

Results: Most responding hospitals (65%) were located 30 or more miles away from a hospital with obstetric services. Some reported having emergency room births in the past year (28%), an unanticipated adverse birth outcome (32%), and/or a delay in urgent transport for a pregnant patient (22%). More than 90% of responding hospitals had capacity for blood transfusion, intravenous antibiotics or anticonvulsants, and basic neonatal resuscitation. However, less than one-fifth had capacity to perform surgery (16%), remove retained products of delivery (17%), or had a policy for emergency cesarean (18%). Almost all respondents (80%) reported the need for additional training or resources to handle emergency obstetric situations.

Conclusion: Many rural hospitals do not have basic capacity to provide emergency obstetric services. Programs and policies to improve this may focus on surgical care, clinician and staff training, transportation, and coordination with nearby hospitals that provide obstetric services.

Keywords: childbirth; emergency care; maternity care; obstetrics; rural hospitals.

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References

    1. Hung P, Henning-Smith CE, Casey MM, Kozhimannil KB. Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004-14. Health Aff (Millwood). 2017;36(9):1663-1671. https://doi.org/10.1377/hlthaff.2017.0338
    1. Hung P, Casey MM, Kozhimannil KB, Karaca-Mandic P, Moscovice IS. Rural-urban differences in access to hospital obstetric and neonatal care: how far is the closest one? J Perinatol. 2018;38(6):645-652. https://doi.org/10.1038/s41372-018-0063-5
    1. ACOG Committee Opinion No. 586: Health disparities in rural women. Obstet Gynecol. Published online 2014. https://doi.org/10.1111/1475-6773
    1. Kozhimannil KB, Interrante J, Tuttle MS, Henning-Smith C. Changes in hospital-based obstetric services in rural US countries, 2014-2018. J Am Med Assoc. 2020;324(2):197-199. https://doi.org/10.1001/jama.2020.5662
    1. Grzybowski S, Stoll K, Kornelsen J. Distance matters: a population based study examining access to maternity services for rural women. BMC Health Serv Res. 2011;11(147):1472-1693. https://doi.org/10.1186/1472-6963-11-147

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