There are differences in obstetrics care provided in rural and urban areas, according to a new study. The scientists found the number of cesarean sections increased over the last decade in both rural and urban hospitals, and that rural hospitals induced labor for no medical reason ("non-indicated" labor induction) more frequently than did urban institutions. The authors of the study said that changes in trends were small but that they could have significant effect on maternal and infant healthcare policies in rural institutions.
Today, about 15 percent of babies are born at rural hospitals, which serve a large percentage of Medicaid users. Medicaid plays an important role in financing childbirth care, and the authors of the study express a hope that Medicaid could use financial incentives to encourage hospitals to follow established guidelines when choosing delivery care.
Researchers from University of Minnesota School of Public Health and associates analyzed information collected in the Nationwide Inpatient Sample, the largest all-payer inpatient care database in the United States. They looked at data from more than 7 million births occurring from 2002 to 2010; approximately 6.3 million occurred at urban hospitals and 840,000 at rural institutions.
The researchers wanted to investigate differences in the rates of non-indicated cesarean sections and inductions, meaning there was no medical reason to perform a C-section or induce labor, between rural and urban hospitals. They focused their study on low-risk pregnancies, usually anticipated to be problem-free and not in need of induced labor or C-section.
Published in the professional journal Medical Care, the study results showed steady increases in C-section rates for low-risk pregnancies at both urban and rural hospitals from 2002 and 2010. The researchers found that, after adjusting the data for factors like age and risk for complications, the rate for non-indicated induction of labor increased five percent per year in rural hospitals and only four percent yearly in urban institutions. Non-indicated C-sections were also high at 16.9 percent at rural institutions and 17.8 percent at urban hospitals.
Source: Health, Wolters Kluwer. "Differing care in obstetrics at rural versus urban hospitals." Medical News Today. MediLexicon, Intl., 18 Dec. 2013. Web. 9 Jan. 2014.