Grant: Operating Grant: Maternal and Child Health

Across rural Canada over the past ten years there has been a significant erosion of small rural maternity services. Closures have occurred for a number of reasons including difficulty recruiting maternity care providers, concerns about the quality of maternal and newborn outcomes in small facilities, and an emphasis on regionalization and consequent centralization of rural services which has swept across Canada. A comprehensive review of policy at both provincial and national levels does not find evidence of a systematic approach to planning rural maternity service delivery. The safety of small rural maternity services with and without caesarean section is not well researched, though on balance the evidence suggests that even without local caesarean sections, small maternity services can provide good care and that it is likely better to have even a limited service than no local intrapartum service at all in a rural community. The goal of this proposal is to expand the work that has been done on a provincial level across selected rural Canada jurisdictions, including those provinces with perinatal databases amenable to integration with B.C.¿s dataset. The objectives of this study are to: 1. Establish rural population catchment areas within one hour of maternity services and linked to postal codes, 2. Define hospital service levels for all rural hospitals to be included in the study, 3. Link population catchments to local rural hospitals with intrapartum services and stratify hospital catchments by level of service, and 4. Analyze newborn outcomes and selected maternal outcomes and compare results across service levels adjusting for aboriginal ethnicity and socioeconomic status at catchment level. This work will contribute to our understanding of the safety of rural maternity services in Canada. At the Centre for Rural Health Research, a study is currently in analysis examining provincial rural population maternal and newborn outcomes.