Study: Rural hospitals without OBs need more training in emergency pregnancy care


For women in rural areas, having a baby is more risky.

But emergency obstetrics training in rural hospitals could improve the odds, according to a new guidance note from the Rural Health Research Center at the University of Minnesota. The study found that hospital administrators and nurse managers want more training to reduce risks to mothers and their babies.

Maternal mortality across the country has increased over the past 30 years. According to the Centers for Disease Control and Prevent, maternal mortality rates increased 143% between 1987 and 2017. By the late 1980s, the maternal mortality rate was just over 7 maternal deaths per 100,000 births. alive. In 2017, the maternal mortality rate was 17.3 deaths for every live birth.

Around the world, however, maternal mortality rates are steadily declining. In the UK, maternal mortality rates have fallen to 9 deaths per 100,000 live births, while in Italy, Denmark and Finland maternal mortality is 4.2 or less.

In rural America, the rates are much worse. In 2018, Georgia’s maternal mortality rate was 46.2 deaths per 100,000 live births. In Louisiana it was 44.8 and in Arkansas it was 34.8.

In these regions, non-Hispanic black women, Native Americans, and Native Alaskans face higher maternal mortality, as do low-income women.

And according to the CDC, more than 60% of these deaths are preventable.

In a report from maternal mortality committees in nine states, researchers found that while some deaths could be attributed to patient or family factors, such as not knowing when to seek help, others could be specifically linked to health care providers misdiagnosing or ineffective treatment. .

“While the nine committees most often identified patient-related factors, the identified patient-related factors often depend on providers and systems of care… Here are the most common recommendation themes that the nine committees also felt to have the most. great potential for population-level impact if implemented: adopt maternal levels of care, improve policies regarding prevention initiatives, enforce policies and procedures related to obstetric bleeding, and improve policies related to patient management The committees wrote in their policy document.

The authors of the Rural Health Research Center article say that lack of access to facilities may also be a contributing factor.

“In 2014, 54% of rural counties in the country did not have inpatient obstetrics units. This downward trend continued; between 2014 and 2018, about three percent lost hospital obstetrics units. Hospitals that remain open after obstetric services close may have difficulty providing emergency deliveries or managing other obstetric complications, ”the group wrote.

To combat this, rural health care providers need training in emergency obstetrics. By interviewing hospitals in rural areas of the country, the researchers found that healthcare providers say they need hands-on simulations of different obstetric services such as labor and delivery, cesarean sections and neonatal resuscitation training.

“Many respondents indicated that emergency obstetric situations rarely occur and in this case clinicians rely on past experiences of childbirth. Newer clinicians may not have this experience, and simulation training and basic childbirth skills have been cited as beneficial for these cases. Respondents also cited emergency situations, such as assistance with delivery in a parking lot or inside a car, as a reason for needing hands-on simulation training, ”said Mary Gilbertson, lead author of the dossier.

This training, Gilbertson said, could save lives.

While nearly 70 of those surveyed said there was training available for emergency obstetric care, nearly 80 percent said more training and resources are needed to manage emergencies. According to the brief, this could include simulations, which in turn require equipment such as mannequins and ways to share resources with other facilities.

Researchers found that although training is available to hospitals, survey respondents said training was either offered virtually, inconsistently, or too infrequently, or that hospitals did not. funds or time dedicated to commit to the training offered.

But the authors of the brief point out that some of those respondents said it would be good to have some training.

“It should be noted that a substantial number of rural hospitals responded that” any obstetric training “or” basic childbirth skills “would better prepare them to provide emergency obstetric services, showing the need for an increase in delivery. basic obstetric training in general, ”the report says. noted.

“Overall, responses suggest that rural hospitals need more frequent and accessible obstetric training to better manage emergency obstetric situations. This is particularly critical given the continuing trend of closures of inpatient obstetrics units in rural communities across the country. ”

Gilbertson said their research also found that rural facilities sometimes lack the surgical capacity to handle an emergency delivery.

“One of the troubling elements of the investigation was the limited surgical capacity in rural facilities, where surgery during childbirth is sometimes a necessity. Our study was based on the (World Health Organization) guidelines for emergency obstetric situations, and only 11% of our respondents met the basic standards of the WHO guidelines for appropriately managing childbirth situations. emergency, ”Gilbertson said.

For rural residents facing pregnancy, training could mean life before death.

“To ensure that pregnant residents, regardless of geography or demographics, can have a safe and healthy delivery, rural hospitals without obstetric units must have access to training that helps clinicians provide these services safely. », Indicates the document.

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