Risk-Appropriate Childbirth Care Among Higher-Risk Pregnant Rural Residents

What proportion of pregnant rural residents receive risk-appropriate childbirth care, and what factors are associated with not receiving risk-appropriate care?In this cross-sectional study of nearly 200 000 pregnant rural residents with higher-risk conditions, as clinical complexity increased, the proportion receiving risk-appropriate care decreased. Identifying as American Indian or Alaska Native or as Hispanic, being younger, having lower educational attainment, having public insurance or no insurance, and living further from a risk-appropriate hospital were factors significantly associated with not receiving risk-appropriate care.These findings highlight the need for reducing distance to local childbirth care and increasing access to subspecialty care for pregnant rural residents.

Corresponding Author: Sara C. Handley, MD, MSCE, Roberts Center for Pediatric Research, Room 19-362, 2716 South St, Philadelphia, PA 19146 (handleys@chop.edu).

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