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Just in time for National Rural Health Day, showcasing the #powerofrural, NEW RESEARCH from our team on emergency obstetric capacity in rural hospitals without obstetric units. cc: @katybkoz @story_tuttle @RHRGateway @PublicHealthUMN https://onlinelibrary.wiley.com/doi/10.1111/jrh.12539
The full paper is available in early view @JRuralHealth, but a few highlights:
1) We know rural hospitals across the country continue to close their obstetric services, but that doesn't mean people in those communities just stop having babies.
1) We know rural hospitals across the country continue to close their obstetric services, but that doesn't mean people in those communities just stop having babies.
2) The plan for these families that remain likely involves travel over longer distances to the next closest OB, or home birth if circumstances allow...BUT we know emergencies happen, and we wanted to know how the local hospitals without OB units could respond in an emergency.
3) Using data from the 2018 AHA Annual Survey, we pulled a random list of rural hospitals without OB services, and talked with emergency department managers at 69 (48% response rate) of them. We used criteria from @WHO to assess capacity to respond to obstetric emergencies.
4) Key findings (good news!): More than 94% of responding hospitals had capacity for blood transfusion, intravenous antibiotics or anticonvulsants, and basic neonatal resuscitation. (3 of the 9 WHO criteria.)
4) Key findings (not so good): Less than one‐fifth had capacity to perform surgery (16%), remove retained products of delivery (17%), or had a plan/policy for emergency cesarean (18%). Almost all reported the need for additional training or resources to handle OB emergencies.
4) Key findings (challenges): Most responding hospitals (65%) were located 30+ mi away from OB services, 28% reported having ER births in the past year, 32% experienced a close call or unanticipated adverse birth outcome, 22% delay in urgent transport for a pregnant patient.
5) To summarize: Many rural hospitals do not have basic capacity to provide emergency obstetric services. Facing serious staffing & financial challenges (even more w/COVID), hospital leaders & clinicians are doing the best they can. More is needed to support them!
5) Policies and programs are urgently needed; some may focus on clinician and staff training, transportation, surgical care, and regional coordination with nearby hospitals that provide maternity care. For further discussion, see our full paper. https://onlinelibrary.wiley.com/doi/10.1111/jrh.12539
