The Availability of Midwifery Care in Rural United States Communities.

Emily C Sheffield, Alyssa H Fritz, Julia D Interrante, Katy Backes Kozhimannil
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Abstract

Introduction: Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities.

Methods: We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics.

Results: Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%).

Discussion: More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.

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美国农村社区助产护理的可用性。
导言:在美国,农村居民获得与妊娠和分娩相关的医疗保健服务受到了医疗卫生劳动力短缺的限制。虽然助产士是怀孕和分娩护理的主要提供者,但人们对农村助产士队伍的现状并不十分了解。这项分析的目的是描述美国农村社区当地助产护理的可用性:方法:我们对目前或最近关闭了分娩服务的美国农村医院进行了一项全国性调查。2021 年 3 月至 8 月,我们对 292 家农村医院的产科经理或管理人员进行了调查,其中 133 家医院做出了回应(回应率为 46%;93 家医院目前提供分娩服务,40 家医院最近关闭了分娩服务)。这项横断面分析描述了目前或之前提供分娩服务的农村医院是否在当地配备了助产士,以及有助产士和没有助产士的农村社区在医院层面和县级层面的特征是否存在差异:在接受调查的医院中,55%的现有医院和 75% 的曾有过分娩服务的医院表示当地没有提供助产护理。在 93 个目前有医院分娩服务的农村社区中,与有助产护理的社区相比,没有助产护理的社区更有可能人口较少(37% 对 33%);大多数人口为黑人、土著人和有色人种(24% 对 10%);至少 50%的分娩由医疗补助资助的医院(77% 对 64%)。相反,在提供助产护理的社区中,有超过 30% 的患者需要前往 30 英里以外的医院接受分娩服务(38% 对 28%):讨论:在接受调查的农村医院中,有一半以上的医院表示当地没有助产护理服务,而且医院和县级医院的助产护理服务情况也不尽相同。确保农村分娩者获得怀孕和分娩护理的努力应包括关注当地助产护理的可用性。
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