Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services.
childbirth
emergency care
maternity care
obstetrics
rural hospitals
Journal
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
ISSN: 1748-0361
Titre abrégé: J Rural Health
Pays: England
ID NLM: 8508122
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
pubmed:
18
11
2020
medline:
19
8
2021
entrez:
17
11
2020
Statut:
ppublish
Résumé
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. To describe emergency obstetric capacity at rural US hospitals that do not routinely offer childbirth services. 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. 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. 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.
Sections du résumé
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.
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
385-393Subventions
Organisme : Federal Office of Rural Health Policy
ID : U1CRH03717
Informations de copyright
© 2020 National Rural Health Association.
Références
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
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
ACOG Committee Opinion No. 586: Health disparities in rural women. Obstet Gynecol. Published online 2014. https://doi.org/10.1111/1475-6773
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
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
Ely DM, Driscoll AK, Mathews TJ. Infant Mortality Rates in Rural and Urban Areas in the United States, 2014. NCHS Data Brief. 2017 Sep;(285):1-8. PMID: 2915
Maron DF. Maternal Health Care Is Disappearing in Rural America. Scientific American. Published February 15, 2019. https://www.scientificamerican.com/article/maternal-health-care-is-disappearing-in-rural-america/. Accessed May 24, 2020.
Kozhimannil KB, Interrante JD, Henning-Smith C, Admon LK. Rural-urban differences in severe maternal morbidity and mortality in the US, 2007-15. Health Aff (Millwood). 2019;38(12):2077-2085. https://doi.org/10.1377/hlthaff.2019.00805
Kozhimannil KB, Hung P, Henning-Smith C, Casey MM, Prasad S. Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. J Am Med Assoc. 2018;319(12):1239-1247. https://doi.org/10.1001/jama.2018.1830
Beasley JW, Damos JR, Roberts RG, Nesbitt TS. The Advanced life support in obstetrics course: a national program to enhance obstetric emergency skills and to support maternity care practice. Arch Fam Med. 1994;3(12):1037-1041. https://doi.org/10.1001/archfami.3.12.1037
World Health Organization, United Nations Population Fund, Mailman School of Public Health, Averting Maternal Death and Disability, United Nations Children's Fund (UNICEF). Monitoring Emergency Obstetric Care: A Handbook, (7-9). Geneva: World Health Organization; 2009. https://www.who.int/reproductivehealth/publications/monitoring/9789241547734/en/.
US Census Bureau. Office of Management and Budget: Metropolitan and Micropolitan Statistical Areas. The United States Census Bureau. Published April 2020. https://www.census.gov/programs-surveys/metro-micro.html. Accessed September 21, 2020.
Nesbitt TS. Rural maternity care: new models of access. Birth. 1996;23(3):161-165. https://doi.org/10.1111/j.1523-536X.1996.tb00477.x
Kozhimannil KB, Henning-Smith C, Hung P, Casey MM, Prasad S. Ensuring access to high-quality maternity care in rural America. Womens Health Issues. 2016;26(3):247-250. https://doi.org/10.1016/j.whi.2016.02.001
Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. Int J Gynecol Obstet. 2005;88(2):181-193. https://doi.org/10.1016/j.ijgo.2004.11.026
Boerma T, Ronsmans C, Melesse DY, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341-1348. https://doi.org/10.1016/S0140-6736(18)31928-7
Kornelsen J, Iglesias S, Woollard R. Sustaining rural maternity and surgical care: lessons learned. Can Fam Physician. 2016;62(1):21.
World Health Organization. WHO statement on caesarean section rates. WHO. Published 2015. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/. Accessed September 29, 2020.
Kornelsen J, Mccartney K, Mckeen M, et al. Optimal Perinatal Surgical Services for Rural Women: A Realist Review. Report. BC Ministry of Health and Perinatal Services. Published 2014. http://www.perinatalservicesbc.ca/Documents/Resources/SystemPlanning/Rural/OptimalPerinatalSurgicalServicesForRuralWomen.pdf Accessed May 25, 2020.
Grzybowski S, Kornelsen J, Schuurman N. Planning the optimal level of local maternity service for small rural communities: a systems study in British Columbia. Health Policy Amst Neth. 2009;92(2-3):149-157. https://doi.org/10.1016/j.healthpol.2009.03.007
OB/Newborn. CALS Program: Comprehensive Advanced Life Support Rural Emergency Medical Education. Published 2020. https://www.calsprogram.org/courses/ob-newborn/. Accessed May 25, 2020.
Patterson DG, Andrilla CHA, Garberson LA. Preparing physicians for rural practice: availability of rural training in rural-centric residency programs. J Grad Med Educ. 2019;11(5):550-557. https://doi.org/10.4300/JGME-D-18-01079.1
Goldstein JT, Hartman SG, Meunier MR, et al. Supporting family physician maternity care providers. Fam Med. 2018;50(9):662-671. http://doi.org/10.22454/FamMed.2018.325322