Radke, Smeins, Ryckman, & Gruca: Delivering Rural Babies
In recent work in the Journal of Rural Health, authors Stephanie M. Radke (Obstetrics and Gynecology, University of Iowa Hospitals and Clinics), Laurel Smeins (Internal Medicine, University of Iowa Hospitals and Clinics), Kelli K. Ryckman (Epidemiology and Pediatrics, University of Iowa), and Thomas S. Gruca (Business, University of Iowa), examine the availability of hospital-based obstetrical care in rural areas and the effect such availability has on prenatal care.
Rural populations often face reduced access to hospitals and a variety of other medical care. Closures of specialized care units in hospitals have a particularly significant impact. In this work, the authors look specifically at closures of labor and delivery units in rural hospitals in Iowa. Of the forty-seven rural counties that had a dedicated labor and delivery unit, seven of those units closed between 2017 and 2019. The authors collected data—including sociodemographic and health characteristics of birthing parents and delivery characteristics—from both subsets of counties and compared the impact of a labor and delivery unit closure on prenatal care.
Overall, the authors mentioned no statistically significant difference in birth statistics. However, patients in counties that experienced the closure of their only labor and delivery unit had fewer adequate prenatal visits than those with a dedicated labor and delivery unit. While this number only varied between populations by a few percentage points, among Medicaid recipients, there was an increased risk of both reduced prenatal care and delayed initiation of prenatal care in the event of labor and delivery unit closure.
Although the article does not demonstrate major effects on the impact of birth statistics, it does provide the first comprehensive study regarding the impact closure of these units may have on the population they served. New research should examine the impact that additional closures may have, as well as longer-term studies examining the actual impact of lessened prenatal care on children and mothers.
