Risk-Appropriate Childbirth Care Among Higher-Risk Pregnant Rural Residents.

Area of Science:

• Obstetrics and Gynecology
• Rural Health
• Health Services Research

Background:

• Rural hospital obstetric care is declining, potentially limiting access to risk-appropriate care for pregnant individuals.
• Higher-risk pregnancies require specialized or subspecialty obstetric care, which may be scarce in rural settings.

Purpose of the Study:

• To determine the proportion of higher-risk pregnant rural residents receiving risk-appropriate childbirth care.
• To identify factors associated with inadequate access to risk-appropriate obstetric care in rural areas.

Main Methods:

• Cross-sectional study utilizing linked vital statistics and hospital discharge data from four US states (2010-2020).
• Included nearly 200,000 higher-risk pregnant rural residents with hospital births.
• Analyzed birth hospital's maternal level of care against patient's clinical condition requirements.

Main Results:

• Over half of higher-risk rural pregnancies did not receive risk-appropriate care, with rates as high as 72.5% for Level IV care needs.
• American Indian/Alaska Native and Hispanic individuals, those with public or no insurance, younger age, lower education, and greater distance to facilities faced higher rates of inadequate care.
• Adjusted incidence rate ratios indicated significant disparities, particularly for those living furthest from appropriate care facilities (aIRR, 23.86).

Conclusions:

• Lack of risk-appropriate care is prevalent among higher-risk pregnant rural residents.
• Disparities linked to race, ethnicity, insurance status, education, and geographic distance underscore critical access barriers.
• Findings highlight the urgent need to improve access to specialized obstetric care for rural populations.