Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure.
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2021-02
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Abstract
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Almost 15% of all US births occur in rural hospitals, yet rural hospitals are closing at an alarming rate because of shortages of delivering clinicians, nurses, and anesthesia support. We describe maternity staffing patterns in successful rural hospitals across North Carolina.Methods
All of the hospitals in the state with ≤200 beds and active maternity units were surveyed. Hospitals were categorized into three sizes: critical access hospitals (CAHs) had ≤25 acute staffed hospital beds, small rural hospitals had ≤100 beds without being defined as CAHs, and intermediate rural hospitals had 101 to 200 beds. Qualitative data were collected at a selection of study hospitals during site visits. Eighteen hospitals were surveyed. Site visits were completed at 8 of the surveyed hospitals.Results
Nurses in CAHs were more likely to float to other units when Labor and Delivery did not have patients and nursing management was more likely to assist on Labor and Delivery when patient census was high. Anesthesia staffing patterns varied but certified nurse anesthetists were highly used. CAHs were almost twice as likely to accept patients choosing a trial of labor after cesarean section (CS) than larger hospitals, but CS rates were similar across all hospital types. Hospitals with only obstetricians as delivering providers had the highest CS rate (32%). The types of hospitals with the lowest CS rates were the hospitals with only family physicians (24%) or high proportions of certified nurse midwives (22%).Conclusions
Innovative staffing models, including family physicians, nurse midwives, and nurse anesthetists, are critical for the survival of rural hospitals that provide vital maternity services in underserved areas.Type
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Carlough, Martha, Ellen Chetwynd, Sarah Muthler and Cristen Page (2021). Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure. Southern medical journal, 114(2). pp. 92–97. 10.14423/smj.0000000000001208 Retrieved from https://hdl.handle.net/10161/31252.
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Martha Carlough
Martha Carlough, MD MPH is family physician and Ignatian trained spiritual director and is the Director of Spiritual Formation for the Theology, Medicine and Culture Initiative. Dr. Carlough is also affiliate faculty in the Duke Global Health Initiative (DGHI) and has more than 30 years of experience in clinical and public aspects of maternal and child health, including a decade of work in Nepal. She is Professor Emeritus at UNC-Chapel Hill where she was on clinical faculty for many years and founded and directed the Office of Global Health Education. Dr. Carlough continues to care for patients and work in community health through Samaritan Health Center in Durham.
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