Decreasing Hospital Obstetrical Services in Rural New Hampshire

Purpose:

When hospitals began closing their doors to obstetrical services in the North Country, New Hampshire, USA, there was limited access within 1830 square-miles to provide services for pregnant women. Closures were due to expenses associated with providing the specialty services, in addition to decreased reimbursement from Medicaid.

Without convenient options for care, there is concern for the health of both pregnant women and their babies. There have been no studies since these hospitals closed their obstetrical units that have examined exactly how birth outcomes were affected by decreased access to care. Examples of potential birth outcomes that could be affected include birthweight, gestational age, number of prenatal visits, and route of birth. 

The purpose of this study was to examine whether or not decreasing access to inpatient obstetrical services in the North Country affected women’s utilization of prenatal care and birth outcomes.

Methods:

Birth data from 2005 to 2012, obtained from the New Hampshire Division of Public Health Services Bureau of Health Statistics and Data Management is used for analysis using SPSS. 

Results:

Comparing birth outcomes before obstetrical unit closures and after obstetrical unit closures, there was no difference in outcomes between travel distance to birth, maternal weight gain, birth weight, and gestational age, total number of prenatal visits, NICU admissions, and method of delivery. There was a difference in payor source for birth. When comparing demographic differences between women who live in the North Country and women in New Hampshire, there was significant difference in educational level, marital status, and race.  

Conclusion:

The potential benefits of this study are at the community and state level.  Prior research has supported findings that underserved women historically are at risk for decreased access to care for several reasons, so it is not surprising to find that by further decreasing access for a population of underserved women their birth outcomes are not altered.