Birth Outcomes: Is There a Difference in Women Who Live in Rural Versus Urban New Hampshire USA?

Tuesday, 23 July 2013: 3:50 PM

Lynette A. Hamlin, PhD, RN, CNM, FACNM
Margaret E. Hindman, PhD, APRN, FNP-BC
School of Nursing, University of South Carolina Upstate, Spartanburg, SC

Learning Objective 1: appreciate the role geography plays in access to prenatal care for rural women.

Learning Objective 2: understand the differences in perinatal outcomes in women from ubran versus rural areas in New Hampshire.


 In 2009 hospitals in the North Country New Hampshire began closing their doors to obstetrical services due to rising health care costs. The North County encompasses over 1200 square miles. The southern portion of the state of New Hampshire is an urban area and provides more access to care. The purpose of this research is to examine whether or not there are differences in prenatal and birth outcomes between women who live in the North Country and urban New Hampshire.


The research analysis is with secondary data. Birth data from 2005 to 2012, obtained from the New Hampshire Division of Public Health Services Bureau of Health Statistics and Data Management was used for analysis with SPSS statistical software.


Comparing prenatal and birth outcomes between rural and urban New Hampshire, there were statistically significant differences in Apgar scores, maternal diabetes, maternal hypertension, NICU admission, surfactant use, and method of birth. In comparing demographic factors, there is a difference in place of birth, birth attendant, maternal and paternal educational levels, race, maternal smoking, and payer source. There was no significant difference in very low or low birth weight, use of forceps or vacuum extraction, or prior cesarean section.


The potential implications of this study are at the community health and state policy levels. Nurses who provide prenatal care support, who work in hospital settings, or are advanced practice nurses need to be cognizant of the demography of rural women and the issues rural women face in securing quality prenatal care.