|
 The 18,723 pregnant women in the study all had a low risk of
complications, were being cared for by midwives, and planned to
deliver their babies at home or in birthing centers. Once
researchers adjusted for patient characteristics that can influence
birth outcomes for mothers and babies, they didn’t find the odds of
complications any higher for rural than for urban women.
“With rural healthcare provider shortages, rural hospital closures,
and greater travel distances, it could be expected that there would
be an increased time to seek emergency backup care that would result
in poorer outcomes,” said lead study author Elizabeth Nethery, a
researcher at the School of Population and Public Health at the
University of British Columbia.
“What we found instead is that rural women and their babies do not
appear to have any added risks when planning a birth at home or in a
birthing center compared with nonrural women,” Nethery said by
email.
About 22 percent of women in the U.S. live in rural areas with very
limited access to obstetric care, researchers note in Birth. Despite
declines in hospital-based obstetric services, however, midwifery
care at home and in freestanding birthing centers is available in
many rural communities.
The current study is the first to look at risks for rural versus
urban women who give birth at home or in freestanding birthing
centers in the U.S., Nethery said.
Overall, about 95 percent of rural mothers and 94 percent of urban
mothers in the study had a normal spontaneous vaginal delivery, the
study found.
There wasn’t a meaningful difference in the proportion of women who
had vaginal deliveries aided by instruments like forceps or a
vacuum.
Almost 5 percent of urban mothers had surgical cesarean section
deliveries, compared with less than 4 percent of rural mothers, a
difference that was small but statistically meaningful.
[to top of second column] |
In cities, women were also slightly more likely to have serious
tearing during delivery or require a transfer to a hospital for more
involved medical care. Babies were also more likely stay in the
neonatal intensive care unit after urban births.
Limitations of the study include the reliance on women’s residential
zip codes to decide whether they lived in an urban or rural area and
to estimate how far they might need to travel to a hospital in an
emergency, the authors note. In some cases this estimate might not
be accurate.
The study was also too small to detect slight but clinically
meaningful differences in the chances of rare neonatal
complications, the authors note.
Even so, the findings should reassure women that a home birth or
birthing center delivery doesn’t need to come with any extra risk of
complications, as long as women are appropriately screened for any
medical issues that would make a hospital delivery the safer choice,
said Erin Wright, a midwife and researcher at Johns Hopkins School
of Nursing in Baltimore who wasn’t involved in the study.
“There is a generalized myth about rural communities that tells us
that often care is not at the standard in some areas as opposed to
urban areas which tend to have a large number of teaching
hospitals,” Wright said by email. “This study, specific to these
conditions, dispels that myth.”
SOURCE: http://bit.ly/2AyqliH Birth, online November 13, 2017.
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
