Monitoring delivery and birth outcomes in rural areas

Background

The Department of Family Medicine and Biobehavioral Health (FMBH) within the University of Minnesota Medical School in Duluth has been studying labor and delivery patterns and birth outcomes in rural obstetrics over the past few years after multiple rural hospitals stopped offering labor and delivery services. In particular, in July 2015, Cook County North Shore Hospital in Grand Marais, MN stopped offering labor and delivery services forcing pregnant women to travel 110 miles to Duluth for hospital-based delivery services.

In 2017, faculty and medical students from FMBH conducted a retrospective medical chart review comparing delivery patterns and birth outcomes for women who attended the Grand Marais local clinic for prenatal care. The clinicians wanted to know if this discontinuation has led to more inductions or cesarean sections, more at home births, more delivery complications, lower gestational age, lower birth weight, and more NICU transfers. After deciding on their research questions and collecting their data, FMBH contracted with PDA for statistical analysis support.

Approach

After receiving data from FMBH, PDA reviewed the dataset for outliers and missing data. Demographics and characteristics of the patients and pregnancies were summarized. Because some mothers had multiple deliveries in the dataset, correlated data analysis methods were used to look at the change in delivery patterns and birth outcomes from before to after discontinuation of services. The analysis was conducted in SAS v.9.4 (SAS Institute, Cary, NC), and a report was produced with results tables and supporting text to interpret findings. PDA met with the FMBH clinicians to discuss the results and supported a poster presentation for a research conference and a manuscript submission to a peer-reviewed journal.

Results

Although not statistically significant, the results suggest a slight increase in the percentage of inductions, home births, and cesarean deliveries for women in Cook County after the discontinuation of labor and delivery services. Birth outcomes remained consistent. The results of this project helped to bring awareness to the need for future monitoring of delivery and birth outcomes for pregnant women that live in rural areas.

An abstract was presented by the FMBH clinicians as a poster at the Minnesota Academy of Family Physicians Research and Innovation Forum in 2018. Shortly after, a manuscript was published in the Journal of Regional Medical Campuses.

Link to published manuscript/abstract:

Pearson, J., Friedrichsen, S., Olson, L. (2018) Changes in labor and delivery patterns and outcomes after rural obstetrical service closure. Journal of Regional Medical Campuses, 1(4)