Association of prenatal stress with distance to delivery for pregnant women in Western North Carolina

Woodward, R. P.; Mazure, Emily; Belden, Charles M; Denslow, Sheri; Fromewick, Jill; Dixon, Suzanne; Gist, William; Sullivan, Margaret H

doi:10.1016/j.midw.2022.103573

Cited by 7 publications

(7 citation statements)

References 32 publications

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“…[2][3][4][5][6] Travel distance and time can be significant barriers to accessing health care in rural areas. [7][8][9] Rural birthing people often have to travel fur-ther to reach hospitals with maternity services, and this can lead to delays in care and increased rates of adverse outcomes. Perinatal care guidelines have suggested the regionalization of maternity and neonatal care within individual regions or reasonable catchment areas in such a manner that there is concentration of care for high-risk pregnant women and their fetuses and newborns in need of high-acuity care.…”

Section: T He White House Blueprint For Addressing the Maternal Healthmentioning

confidence: 99%

“…10,11 Because of the well-documented loss of hospital-based maternity services throughout the United States, there is increasing concern about access to maternity care, particularly in rural communities. 3,8,12,13 Telehealth and other innovative digital models of care delivery may hold promise for addressing some of the challenges associated with rural maternity care because of several advantages. [14][15][16][17] First, telehealth may be an acceptable substitute for some, but not all, in-person prenatal and postpartum supervision care.…”

Section: T He White House Blueprint For Addressing the Maternal Healthmentioning

confidence: 99%

“…Geographic disparities in access to maternity care have been exacerbated by rural hospital‐based maternity unit closures, impeding access to maternity care for many underserved women and other pregnant, birthing, and postpartum persons 2–6 . Travel distance and time can be significant barriers to accessing health care in rural areas 7–9 . Rural birthing people often have to travel further to reach hospitals with maternity services, and this can lead to delays in care and increased rates of adverse outcomes.…”

mentioning

confidence: 99%

“…Perinatal care guidelines have suggested the regionalization of maternity and neonatal care within individual regions or reasonable catchment areas in such a manner that there is concentration of care for high‐risk pregnant women and their fetuses and newborns in need of high‐acuity care 10,11 . Because of the well‐documented loss of hospital‐based maternity services throughout the United States, there is increasing concern about access to maternity care, particularly in rural communities 3,8,12,13 …”

mentioning

confidence: 99%

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Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020

HUNG,

GRANGER,

BOGHOSSIAN

et al. 2023

Milbank Quarterly

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Policy Points The White House Blueprint for Addressing the Maternal Health Crisis report released in June 2022 highlighted the need to enhance equitable access to maternity care. Nationwide hospital maternity unit closures have worsened the maternal health crisis in underserved communities, leaving many birthing people with few options and with long travel times to reach essential care. Ensuring equitable access to maternity care requires addressing travel burdens to care and inadequate digital access. Our findings reveal socioeconomically disadvantaged communities in the United States face dual barriers to maternity care access, as communities located farthest away from care facilities had the least digital access.ContextWith the increases in nationwide hospital maternity unit closures, there is a greater need for telehealth services for the supervision, evaluation, and management of prenatal and postpartum care. However, challenges in digital access persist. We examined associations between driving time to hospital maternity units and digital access to understand whether augmenting digital access and telehealth services might help mitigate travel burdens to maternity care.MethodsThis cross‐sectional study used 2020 American Hospital Association Annual Survey data for hospital maternity unit locations and 2020 American Community Survey five‐year ZIP Code Tabulation Area (ZCTA)–level estimates of household digital access to telecommunication technology and broadband. We calculated driving times of the fastest route from population‐weighted ZCTA centroids to the nearest hospital maternity unit. Rural‐urban stratified generalized median regression models were conducted to examine differences in ZCTA‐level proportions of household lacking digital access equipment (any digital device, smartphones, tablet), and lacking broadband subscriptions by spatial accessibility to maternity units.FindingsIn 2020, 2,905 (16.6%) urban and 3,394 (39.5%) rural ZCTAs in the United States were located >30 minutes from the nearest hospital maternity units. Regardless of rurality, these communities farther away from a maternity unit had disproportionally lower broadband and device accessibility. Although urban communities have greater digital access to technology and broadband subscriptions compared to rural communities, disparities in the percentage of households with access to digital devices were more pronounced within urban areas, particularly between those with and without close proximity to a hospital maternity unit. Communities where nearest hospital maternity units were >30 minutes away had higher poverty and uninsurance rates than those with <15‐minute access.ConclusionsSocioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access. To optimize maternity care access, ongoing efforts (e.g., Affordable Connectivity Program introduced in the 2021 Infrastructure Act), should bridge the gaps in digital access and target communities with substantial travel burdens to care and limited digital access.

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Section: T He White House Blueprint For Addressing the Maternal Healthmentioning

confidence: 99%

Section: T He White House Blueprint For Addressing the Maternal Healthmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020

HUNG,

GRANGER,

BOGHOSSIAN

et al. 2023

Milbank Quarterly

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“…5,6 Lack of access to obstetric services is associated with adverse maternal outcomes, adverse neonatal outcomes, and prenatal stress. [7][8][9][10][11] Recent findings suggest a lack of access and disparities in geographic access will persist unless facility-level infrastructure is expanded. 12 However, geographic access to obstetric care is measured in several ways, which causes uncertainty about how to optimally invest in infrastructure to expand access.…”

Section: Introductionmentioning

confidence: 99%

The implications of using maternity care deserts to measure progress in access to obstetric care: A mixed-integer optimization analysis

Meredith,

Steimle,

Radke

2023

Preprint

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BackgroundAmong the factors contributing to the maternal mortality crisis in the United States is a lack of risk-appropriate access to obstetric care. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access.MethodsWe formulated two facility location optimization models to determine the number of new facilities required to minimize the number of reproductive-aged women living in obstetric care deserts. We define deserts as either “maternity care deserts”, designated by the March of Dimes to be counties with no obstetric care hospital or obstetric providers, or regions further than 50 miles from critical care obstetric (CCO) services. We gathered information on hospitals with obstetric services from Georgia Department of Public Health public reports and estimated the female reproductive-age population by census block group using the American Community Survey.ResultsOut of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 (7.9%) reproductive-aged women live further than 50 miles from CCO services, and 38,202 (2.0%) live in both “maternity care desert” and further than 50 miles from CCO services. Our optimization analysis suggests that 16 new obstetric facilities (a 19% increase from the current 83 facilities) are required to reduce the number of reproductive-aged women living in “maternity care deserts” by 50% (from 104,158 to 51,477). At least 56 new obstetric care facilities (a 67% increase) would be required to eliminate maternity care deserts in Georgia. Meanwhile, expansion of 2 obstetric care facilities to offer CCO services would reduce the number of reproductive-aged women living further than 50 miles from CCO services by 50% (from 150,563 to 57,338), and 8 facilities would ensure all women in Georgia live within 50 miles of CCO services.ConclusionsCurrent measures of access to obstetric care may not be sufficient for evaluating access and tracking progress toward improvements. In a state like Georgia with a large number of small counties, eliminating maternity care deserts would require a prohibitively large number of new obstetric care facilities. This work suggests that additional measures and tools are needed to estimate the number and type of obstetric care facilities that best match practical resources to obstetric care needs.

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Assessing prenatal and early childhood social and environmental determinants of health in the HEALthy Brain and Child Development Study (HBCD)

Cioffredi,

Yerby,

Burris

et al. 2024

Developmental Cognitive Neuroscience

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Association of prenatal stress with distance to delivery for pregnant women in Western North Carolina

Cited by 7 publications

References 32 publications

Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020

Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020

The implications of using maternity care deserts to measure progress in access to obstetric care: A mixed-integer optimization analysis

Assessing prenatal and early childhood social and environmental determinants of health in the HEALthy Brain and Child Development Study (HBCD)

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