Journal article
Bypassing of nearest labor & delivery unit is contingent on rurality, wealth, and race
Birth (Berkeley, Calif.), Vol.50(1), pp.5-10
03/2023
DOI: 10.1111/birt.12712
PMID: 36752116
Appears in UI Libraries Support Open Access
Abstract
Patient decisions to bypass the closest labor & delivery (L&D) facility in favor of other birthing locations can have consequences for the provision of health care in rural and micropolitan areas as patient volumes decline and payer mixes change. Among 220 589 uncomplicated births in Iowa, we document characteristics of birth parents who bypass their closest birthing facility, show how this bypassing behavior results in changed travel times to delivery facilities across the rural/urban divide, and indicate the parts of the state where bypassing behavior is most prevalent. From 2013 to 2019, 55.2% of deliveries occurred in facilities that were further from birthing parents' residences than the closest L&D facility. Bypassing is associated with White, non-Hispanic race/ethnicity, and private insurance status. Although bypassing is least common among micropolitan birth parents, this group has the greatest travel burden to birthing facilities and exhibits increasing rates of bypassing over time. Perinatal quality improvement programs can target locations and populations where low-risk birthing parents can be encouraged to deliver close to home if medically appropriate, particularly in small towns and rural areas. This can potentially alleviate the risk of obstetric deserts by ensuring L&D units maintain patient volumes necessary to continue operations.
Details
- Title: Subtitle
- Bypassing of nearest labor & delivery unit is contingent on rurality, wealth, and race
- Creators
- Margaret Carrel - University of IowaBarbara C Keino - University of IowaNicole L Novak - University of IowaKelli K Ryckman - University of IowaStephanie Radke - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Birth (Berkeley, Calif.), Vol.50(1), pp.5-10
- DOI
- 10.1111/birt.12712
- PMID
- 36752116
- NLM abbreviation
- Birth
- eISSN
- 1523-536X
- Publisher
- Wiley
- Grant note
- Health Resources and Services Administration (HRSA) State Maternal Health Innovation Program
- Language
- English
- Electronic publication date
- 02/08/2023
- Date published
- 03/2023
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Obstetrics and Gynecology; Public Policy Center (Archive); Interdisciplinary Programs; Community and Behavioral Health; Geographical and Sustainability Sciences; Internal Medicine
- Record Identifier
- 9984366050402771
Metrics
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