The diffusion of obstetric technology into rural U.S. hospitals

Differences in fertility patterns between urban and rural women in Washington State, 1983-1984 to 1993-1994

We use data on Washington State abortions and births for 1983-1984 and 1993-1994 to analyze trends for urban and rural women, using the demographic measures total abortion and total fertility rates. These express pacing of childbearing in a single number which is simple to calculate and interpret, and is age-standardized. We find significant urban-rural differences. Total abortion rates decline and total fertility rates increase in both areas. However, the relative magnitudes of pacing decreases in abortions for rural women and increases in births for urban women are striking. The demographic measures are useful interpretive tools, and can be applied to a broad range of questions.

Differences and trends in obstetric interventions at term among urban and rural women in New South Wales: 1990-1997

The aim of this study was to compare the management of term births among rural and urban women, including the effect of indigenous status and out-of-area-birth for rural women. Data were obtained from the NSW Midwives Data Collection (MDC), on 619,298 women who gave birth to a live, singleton infant at term (37-45 weeks gestation) from 1 January 1990 to 31 December 1997. Compared with urban non-indigenous women, rural women and indigenous women had lower rates of obstetric interventions both before birth (induction of labour, planned Caesarean section and epidural) and at the time of birth (Caesarean after labour, instrumental delivery and episiotomy). This was especially true for rural women giving birth in the their local area. The differing pregnancy risk profile of rural women did not explain the differences in intervention rates but differences were partly explained by higher rates of epidural anaesthesia in urban areas.

Rural maternity care: new models of access

Despite huge health care expenditures, many rural areas of the United States are without adequate access to basic maternity services. Hospital closures and changes in reimbursement have created new threats, even in areas with functional systems of delivering maternity care. New models of care must be developed that take advantage of attributes of low-volume rural maternity units, increase the number of collaborative practices among various providers of maternity services, and judiciously apply new technologies to bring perinatal expertise into the rural hospital when appropriate. Local access to maternity care in rural communities is essential to improve birth outcomes and lower costs. Standardization of management of obstetric emergencies and advances in telecommunication technology may make these low-technology, isolated communities safer than they have been in the past. Changes in health care financing, particularly managed care with capitation, may further support these changes.