Temporal Trends in Obstetric Care Availability Among U.S. Hospitals by Region and Hospital Setting

In this serial cross-sectional study of more than 4,500 hospitals identified in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project National Inpatient Sample, the annual number of obstetric care-providing hospitals decreased by 231, from 2,895 to 2,664, corresponding to an 8.0% decrease over the 7-year period from 2016 to 2022 ( Ptrend <.001). The Midwest region (11.2%) had the largest decrease in the annual number of obstetric care-providing hospitals, followed by the West region (9.3%) (both, Ptrend <.001). The annual number of urban nonteaching and rural-setting obstetric care-providing hospitals decreased by 37.5% and 11.2%, respectively (both, Ptrend <.001). In contrast, the annual number of urban teaching obstetric care-providing hospitals increased by 18.8% ( Ptrend <.001). When region and hospital setting were combined, the decrease in obstetric care-providing hospitals was more prominent in urban nonteaching hospitals across the four U.S. regions, ranging 31.6% in the South to 55.7% in the Northeast ( P =.048). Increasing numbers of urban teaching obstetric care-providing hospitals were higher in the West and South regions (23.9% and 22.3%, respectively) compared with the Northeast and Midwest regions (15.2% and 12.9%, respectively) ( P =.017). This nationwide assessment suggests that the decreases in obstetric care-providing hospitals in the United States appear to be more pronounced in the Midwest and West regions. Moreover, the increasing number of urban teaching hospitals possibly implies that care of pregnant people is gradually shifting toward and relying more on obstetric residency program-based practice.