Across the U.S. a growing number of rural hospitals are no longer offering obstetric services. The loss of maternity care in rural communities adversely affects maternal and infant health. Rural counties that lose hospital-based obstetric services experience higher rates of births in hospital emergency rooms, and in rural counties that are not adjacent to urban areas, those that lost obstetric services saw increases in preterm birth rates. Preterm birth is a leading cause of infant mortality, and data show higher rates of infant mortality for rural infants, compared with urban infants. With each hospital that closes, or each hospital that discontinues its obstetrics service line, the nearest hospital grows farther away for pregnant rural residents.

Yet, not all rural communities have lost obstetric services. Some rural hospitals are defying these trends, maintaining pregnancy and childbirth services locally and even strengthening this service line and increasing the number of maternity care clinicians and births in their community hospitals. Understanding the factors that underlie successful models of rural maternity care can inform communities and hospitals that struggle to keep this service available locally.

Based on American Hospital Association survey data from 2014-2018, we measured access to hospital based obstetric services in rural communities and compared updated estimates to prior data from 2004-2014 to assess whether trends in services loss have changed. Then, we identified rural counties that have maintained hospital-based obstetric services and described characteristics of these counties. To further understand the dynamics of successful models, we conducted in-depth interviews with hospital administrators, clinicians, and community leaders in four or five rural communities that were successfully providing obstetric care locally.

Publications

• Changes in Hospital-Based Obstetric Services in Rural U.S. Counties, 2014-2018
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 07/2020
  In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
• Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2004-2018
  University of Minnesota Rural Health Research Center
  Date: 07/2020
  The purpose of this infographic is to show the loss of hospital-based obstetric services from 2004-2018 and how this differs by county type (micropolitan vs. noncore).
• Making It Work: Models of Success in Rural Maternity Care
  University of Minnesota Rural Health Research Center
  Date: 11/2020
  The goal of this case series is to describe key factors that underlie three successful models of rural maternity care and to inform communities, clinicians, and hospitals that wish to keep obstetric services available locally.