Deliveries in rural hospitals with lower numbers of birth have poorer outcomes; 'tailored' support needed, study says

In an obstetric suite (MedPage Today photo)

Rural hospitals that have lower numbers of births had "a higher risk for severe maternal morbidity compared with rural hospitals delivering more babies," Rachael Robertson reports for MedPage Today on a study published in the American Medical Association's Health Forum Network. The study "used data from more than 11 million urban births and more than half a million rural births in California, Michigan, Pennsylvania, and South Carolina.” Severe cases were defined by Centers for Disease Control and Prevention parameters “and generally included unexpected outcomes of labor and delivery that result in significant short-term or long-term health consequences, excluding blood transfusion."

Women with low-risk pregnancies, "defined as having none of 27 comorbidities such as advanced maternal age or placenta accreta spectrum, were actually at particularly high risk in rural hospitals with relatively few deliveries," Robertson reports. Co-author Stephanie Leonard, an epidemiologist at Stanford University, told her: "If they gave birth at a low-volume rural hospital, they were at over twice the risk of having severe maternal morbidity as a similar person who delivered at a high-volume rural hospital."

Dr. Shon Rowan of West Virginia University told Robertson, "This study was done on larger states, which shows that this is a nationwide issue. . . . I think it lets us know that we need to maybe divert even more resources to these small hospitals. . . . It's not unheard of for a patient [from an obstetric care desert] to drive two to three hours to a delivering facility. And that's leading to more patients showing up in emergency rooms that don't have the resources."

The study recommended "'a need for tailored quality improvement strategies for lower-volume hospitals in rural communities,'" Robertson reports. Leonard said research should examine differences in prenatal and postpartum care," and the role of people's trace and ethnicity. She said, "It's already been well shown that in rural communities that have substantial populations of Black and Indigenous people, you see the highest rates of severe maternal morbidity. . . [that] certainly is a big area that needs attention."