Practical Implications: Opioid-Affected Births to Rural Residents
A dire consequence of the U.S. opioid epidemic has been its effect on reproductive-age women and their infants. Hospitalizations involving opioids for reproductive-age women increased 75% from 2005-2015. At the same time, a growing number of infants were being diagnosed with opioid withdrawal after birth—also known as neonatal abstinence syndrome (NAS). From 2004-2013, the incidence of both maternal opioid use disorder (OUD) and NAS increased more rapidly in rural counties than in urban counties. Approximately 1 in 4 pregnant rural residents give birth in non-local hospitals, usually because they have clinical complications that require high acuity care not available in many rural communities. Pregnant patients with OUD may be referred to urban teaching hospitals, which tend to have greater resources and capacity to diagnose and treat complex conditions, both generally and during childbirth. Whether rural residents with maternal OUD give birth in rural or urban settings, or in teaching or non-teaching hospitals, likely affects the care they receive and the clinical support available.
We examined rates of diagnosis of maternal OUD and infant NAS at the time of childbirth for rural residents, based on the type of hospital where the birth occurred—rural hospital, urban non-teaching hospital, or urban teaching hospital. We also asked two physicians who care for both rural and urban patients at urban teaching hospitals, and specializing in maternal fetal medicine, and neonatology, respectively, to offer interpretations of these findings.