TOPLINE

Residents of rural and lower‑access counties had a higher risk for induced deliveries than residents of urban and full‑access counties, and these differences were largely explained by county‑level access to maternity care rather than by rurality alone.

METHODOLOGY

• Researchers conducted a cross-sectional study to assess how maternal residence and county-level access to obstetric care were linked to the risk for nonspontaneous delivery.
• They analyzed more than 1.15 million birth records for individuals younger than 35 years of age at the time of pregnancy who had pregnancies that were healthy and low risk, reached term (37-40 weeks of gestation), and involved a single fetus across the US in 2022.
• Maternal residence was classified as urban, suburban, rural city, rural, or most rural. Counties were classified as having full access, moderate access, low access, or no access to maternity care.
• Delivery types were categorized as spontaneous or nonspontaneous (induction or prelabor cesarean delivery) and were analyzed separately at 37-38 weeks and 39-40 weeks of gestation.
• The analysis of the risk for nonspontaneous delivery was adjusted for factors such as maternal age, race and ethnicity, prepregnancy BMI, and cigarette smoking status.

TAKEAWAY

• At 39-40 weeks of gestation, nonspontaneous delivery was more common among residents of suburban and most rural counties than among those of urban counties (adjusted hazard ratio [aHR], 1.22 and 1.42, respectively; P for trend < .01). These differences were mostly explained by access to maternity care.
• At 39-40 weeks of gestation, inductions were more common among residents of suburban and most rural counties than among those of urban counties (aHR, 1.31 and 1.56, respectively) and among residents of counties with lower vs full access to maternity care (P for trend < .01 for both). Residents of rural cities had an elevated risk for inductions regardless of access level.
• Prelabor cesarean deliveries at 39-40 weeks of gestation were less common among residents of rural counties and no-access counties than among those of urban and full-access counties, respectively.
• Most associations were weaker at 37-38 weeks of gestation.

IN PRACTICE

"Clinical and policy efforts aimed at improving rural access — including expanding the obstetric workforce pipeline, optimizing care-delivery models, and increasing Medicaid reimbursement — may help mitigate workforce and financial pressures on lower volume hospitals while improving quality of care and patient satisfaction," the authors wrote.

SOURCE

The study was led by Victoria L. Brown, PhD, MA, of Washington University School of Medicine, and Yu-Ku Huang, DDS, MPH, of the Brown School, Washington University, both in St. Louis, Missouri. It was published online on August 27 in Obstetrics & Gynecology.

LIMITATIONS

Vital records lacked details on indications for delivery and on methods used to induce delivery. Access designations at county level may have changed over time and may not have fully reflected local services.

DISCLOSURES

The study received funding from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases and NIH/National Center for Advancing Translational Sciences. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.