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State Variations in the Rural Obstetric Workforce

Hung, P., Kozhimannil, K.B., Casey, M.M., Henning-Smith, C., Prasad, S.

The overall frequency and the increasing rate of obstetric units closures in rural hospitals raises concerns about access to obstetric care among rural women, who experience poorer health outcomes than their urban counterparts. Rural hospitals face obstetric unit staffing challenges due to day-to-day variability in the census of obstetric patients, and as well as challenges with retention, recruitment, training, and scheduling of obstetric clinicians. Many types of staff are necessary to successfully run an obstetrics unit. Across both urban and rural settings, there is regional variation in the types of clinicians attending deliveries.

This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado (CO), Iowa (IA), Kentucky (KY), New York (NY), North Carolina (NC), Oregon (OR), Vermont (VT), Washington (WA), and Wisconsin (WI).

Key Findings:

  • The obstetric care workforce in rural hospitals varies substantially across states. Most of these differences are driven by the variability in hospital infrastructure size and birth volume.
  • Across rural hospitals in this study, the percentage with at least one obstetrician atending births ranged across states from 50% to 100%. The percentage of rural hospitals with at least one family physician attending births ranged from 11% to 81%.
  • Certified nurse midwives were less prevalent in states with a higher proportion of Critical Access Hospitals (CAHs). General surgeons did not attend births in any rural hospitals in five states and were infrequently used in two states; however, they attended births in over half of the rural hospitals in the remaining two states in our study.
  • States with a higher frequency of CAHs were more likely to have CRNAs as the sole anesthesia care provider. In these same states, up to half of rural hospitals have labor and delivery nurses that work exclusively in maternity and newborn care.

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