Dive Brief:

• Losing hospital-based obstetric care can harm maternal health in rural communities, according to a new JAMA study.

• The report said losing hospital-based obstetric services is connected to increases in out-of-hospital, preterm births and births in hospitals without obstetric units.

• More rural counties are facing healthcare without hospital-based obstetrics as hospitals struggling with finances often cut more expensive programs that aren't revenue drivers, like obstetrics.

Dive Insight:

Rural hospitals have seen a drop in hospital-based obstetric services. A 2017 report published in Health Affairs said that more than half of rural counties don’t have hospital-based obstetrics. Research showed that 9% of rural counties lost such services between 2004 and 2014. 

Also, an American College of Obstetricians and Gynecologists report from 2016 said women in rural areas have a higher rate of hospitalizations connected to pregnancy complications compared to women in urban areas.

In the new JAMA study, researchers looked at nearly five million births in more than 1,000 rural counties, including 179 rural counties that lost hospital-based obstetric services between 2004 and 2014.

The report found losing hospital-based obstetric care in rural counties that were not adjacent to urban areas led to preterm births compared to counties with continual obstetric services. The study also found that loss of hospital-based obstetrics in rural counties adjacent to urban areas saw an increase in births in a hospital without obstetric services and low prenatal care use. These results show that losing a local rural hospital can harm pregnancies regardless of whether there's a hospital with obstetrics services in the next county. 

“Altogether, the results of this study indicate significant changes in birth location and outcomes immediately following rural obstetric unit closures, with sustained changes over time in rural counties that are not adjacent to urban areas," the authors wrote. "When a rural hospital stops providing obstetric care or closes entirely, the risks associated with the clinical management of childbirth shift from the hospital to local clinics and staff that may not be equipped to provide obstetric services or to distant communities, with whom rural residents may have little connection."