356: Maternal care matters: An analysis of hospital Cesarean delivery rates in Michigan

Ebott, Jasmine; Abshire, Chelsea; Kamdar, Neil; Syrjamaki, John; Low, Lisa Kane; Morgan, Daniel M.; Langen, Elizabeth S.

doi:10.1016/j.ajog.2019.11.372

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“…39 The lowest rates (27%-29%) were in four hospitals, all of which fell in the mid-range of total births and none of which consistently billed TOLAC births. Our descriptive study could not provide a reason for this finding, but future studies might explore possible nonclinical influences on rural cesarean births, including differing practitioner attitudes, 40 hospital culture, 39,41,42 use of birth professionals such as doulas, 43 or the impact of using delivery practitioners associated with lower cesarean rates such as midwives or family physicians. [44][45][46] This study has several limitations.…”

Section: Discussionmentioning

confidence: 88%

Access to maternity and prenatal care services in rural Michigan

Wendling

Taglione

Rezmer

et al. 2021

Birth

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Background:The United States physician shortages affect rural health care access, including maternity care. Project aims were to identify and characterize prenatal and delivery care in Michigan's rural counties and to explore access to trial of labor after cesarean (TOLAC) services for women in rural Michigan. Methods: Descriptive, cross-sectional design used 2015 Medicaid claims data and public health plan information to identify maternity care services provided within Michigan's rural counties. Publicly available health plan information was used to identify rural maternity hospitals and prenatal care practitioners; findings were verified by Internet searches and telephone interviews. Medicaid claims data were used to determine services provided. High-risk geographic areas were defined as those where women needed to travel >30 miles for maternity-related care. Expected TOLAC rate was determined based on published national birth data; rural hospitals were stratified based on whether they met the expected TOLAC rate, delivered 20%-60% of expected rate, or billed ≤1 TOLAC birth to Medicaid in 2015. Results: In Michigan's 57 rural counties, only 29 hospitals provide maternity care.Geographic high-risk areas were identified in the Upper Peninsula and northeast Lower Peninsula of Michigan. Only two rural hospitals billed for the expected rate of TOLAC births; six delivered at a lower rate, and the remaining 21 hospitals provided no TOLAC services, resulting in large areas of the state where women were not offered this option locally. Conclusions: Maternity care services are limited for many rural Michigan women.Findings can be used to target specific strategies to improve access to care for these women. Similar analyses, exploring patterns of maternity care delivery in other rural regions worldwide, may uncover similar or additional inequities.

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