Monday, April 17, 2017

Lack of rural birthing units, long drives, putting pregnant women, babies at risk

The hospital in Grand Marais closed
its birthing unit. (Best Places map)
Closures of rural hospitals with birthing units is putting pregnant women and babies at risk, Casey Ross reports for Stat, the national health-and-science website of The Boston Globe. A study by the University of Minnesota’s Rural Health Research Center found that from 2000-2014 "financial pressures, insurance problems, and doctor shortages forced more than 200 hospitals to close their birthing units."

"That’s left millions of women of reproductive age facing longer drives to deliver babies—who sometimes arrive en route," Ross writes. "The long drives, understandably, increase anxiety. They also make mothers and babies less safe; studies show these distances bring with them increased rates of complications and infant deaths, as well as longer stays in neonatal intensive care units."

A 2011 study in rural British Columbia of 50,000 births "found that infant mortality rates increased by as much as three times for women who had to travel several hours to get to the hospital," Ross reports. "It also found that more travel was associated with longer stays in intensive care units and that unplanned, out-of-hospital deliveries were highest for mothers located one to two hours from the hospital."

In Texas, for example, "just 70 of the state’s 162 rural hospitals still deliver babies," Ross writes. "More than two-thirds of rural counties in Florida, Nevada, and South Dakota do not have obstetric services. Sixteen percent of Minnesota’s rural counties lost those services in just the past decade."

Some rural hospitals lack the same updated technology as urban hospitals farther away, Ross reports. For instance, Cook County North Shore Hospital in Grand Marais, Minn.—population 1,350—has 53 beds and an emergency room, but it's delivery unit wasn’t high-tech, it didn’t have the staff to offer epidurals for pain relief, or an operating room to provide C-sections, leading many patients to travel farther away to Duluth. As a result, North Shore Hospital, which only delivered 10 of the roughly 45 babies born in the county each year, closed its birthing unit in 2015.

North Shore's "biggest issue was that it could not provide its patients with a C-section within 30 minutes, a guideline established by the American College of Obstetricians and Gynecologists," Ross writes. An administrator told Ross meeting the guideline "would have required the hospital to build an operating room, hire both a surgeon and an anesthesiologist and provide new equipment and training for nurses. Operating expenses alone would top $1 million a year," which wasn't feasible "for a hospital that was already barely breaking even, with an annual budget of about $14.4 million."

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