(Photo illustration, "Check up with Midwife" (source:Wikimedia Commons)

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When labor begins, a baby doesn’t care whether the local hospital has closed its obstetrics unit. Women in emergencies who can’t make it to the nearest maternity ward may have to use the local ER. 

The staff at such rural hospitals worry that lack of training, experience, and equipment could hurt their chances of managing emergency births safely, according to a new report.

The report was released by the Rural Health Research Gateway at the University of Minnesota Rural Health Research Center.

Researchers at the Rural Health Research Center asked staff at 144 rural hospitals that have closed their obstetrics units about their concerns over emergency births and what they think they need to improve their odds of keeping mothers and babies healthy.

More than a third of the respondents said their biggest concern was the lack of specialty care for mothers and babies if problems developed during an emergency birth. Deficiencies they listed included a lack of obstetricians, pediatric specialty care, and surgical capacity.

A quarter of the survey participants worried that they lacked the equipment necessary for an emergency delivery. 

“Respondents brought up insufficient medical equipment as a major concern,” the report said. “This was sometimes named broadly, while other respondents brought up concerns for specific items they lacked.”

Rural residents can have difficulties getting maternity care. In 2014, less than half of rural counties had a hospital that provided obstetric care. Between 2014 and 2018, another 52 rural counties lost obstetric services. 

According to the Centers for Disease Control and Prevention  (CDC), infant mortality rates are higher in rural counties than in more urbanized counties. In 2014, the CDC reported that rural counties saw 6.55 infant deaths per 1,000; compared to 5.2 infant deaths per 1,000 in large urban areas. The research showed that neonatal deaths and postneonatal deaths also decreased as areas grew more urban. 

Additionally, rural America is more likely to see maternal deaths than urban areas. The CDC found in 2015 that rural parts of the U.S. have a 60% higher maternal mortality rate – 29.4 deaths per 100,000 live births in most rural areas, compared to 18.2 per 100,000 live births in large metropolitan areas. 

One respondent to the survey said their hospital lacked the capacity to “perform emergency C-sections, we do not have vacuums, we do not have fetal monitors…”

Others expressed concerns over the safety of the mother and baby if clinical complications arose. 

“The greatest concern would be if it isn’t a smooth delivery and mom hemorrhages, we only have two units of blood here,” one respondent wrote. “Also, again, if an infant was born and we’re unable to resuscitate, … we don’t have an infant bed draft warmer.”

The solution, most of the hospitals said, was continued training and access to those with obstetric skills via telemedicine. 

“Respondents referred to the need for training in emergency obstetric skills such as neonatal resuscitation and basic delivery, the report said. “While respondents noted the importance of ‘hands-on’ training, they also acknowledged the need for support through telemedicine.” 

Notably, while some respondents worried about keeping obstetric skills up to date, one respondent said they hadn’t needed to use those skills to date. In the 12 years since their hospital had ceased providing obstetric services, they said, they had not had a single birth at the hospital.