Grant: CIHR Fellowship

Over 40,000 babies are born each year in British Columbia (BC); approximately 15,000 to mothers who live outside the core urban areas of the province. A wave of obstetric service closures over the past 10 years has resulted in increasing numbers of pregnant women having to travel long distances to access maternity services or having to relocate to a referral centre in their third trimester. Recent research from BC shows that women who live in communities without local maternity services experience more stress and anxiety during pregnancy due to the financial and emotional hardship incurred by leaving their communities to access services. Babies of women from BC who live further away from services are also more likely to experience negative outcomes, such as stillbirth or neonatal death. The goal of the proposed research study is to determine how the composition of rural maternity services relates to maternal and newborn outcomes, taking into consideration the characteristics and risk profile of childbearing women. Using data from British Columbia Perinatal Services, and detailed information about the number and mix of maternity care providers (family physicians, obstetricians, midwives etc.) in each of 70 rural hospital catchments (linked to maternal and newborn outcomes via the mother's postal code), I will study outcomes of mothers and babies over a 10 year period (2000-2010). The primary outcome is perinatal mortality; secondary outcomes include newborn intraventricular hemorrhage, meconium aspiration, NICU admissions > 24 hours and maternal outcomes (e.g. mode of delivery, labour interventions, length of hospital stay etc.). In addition, I will examine whether the proportion of women who birth in their home community as opposed to a referral hospital changes with different maternity care provider compositions.