Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure

Area of Science:

• Maternal Health
• Rural Health Disparities
• Healthcare Management

Background:

• Rural hospitals face closure due to clinician shortages, impacting maternity care access.
• Approximately 15% of US births occur in rural settings, highlighting their importance.
• Successful rural hospital maternity staffing models are not well-documented.

Purpose of the Study:

• To describe maternity staffing patterns in successful rural hospitals in North Carolina.
• To identify factors contributing to the viability of rural maternity services.

Main Methods:

• Survey of North Carolina hospitals with ≤200 beds and active maternity units.
• Categorization of hospitals into critical access, small rural, and intermediate rural.
• Qualitative data collection through site visits at selected hospitals.

Main Results:

• Critical access hospitals (CAHs) showed flexible nursing roles and higher acceptance of trial of labor after cesarean (TOLAC).
• Certified nurse anesthetists were widely utilized for anesthesia.
• Hospitals with family physicians or certified nurse midwives had the lowest cesarean section (CS) rates.

Conclusions:

• Flexible and innovative staffing models are essential for rural hospital sustainability.
• The integration of family physicians, nurse midwives, and nurse anesthetists supports vital maternity services.
• Addressing staffing shortages is key to preserving rural maternity care access.