# Bridging the Gap: A Mixed-Methods Evaluation of a New Rural Maternity Care Center Amid Nationwide Closures

## TL;DR

This study shows that reopening a rural maternity care center improves access to care and patient satisfaction without compromising safety.

## Contribution

The study provides a model for delivering quality rural maternity care using family physicians and midwives.

## Key findings

- Reopening a rural maternity center reduced travel distance by half and improved access to timely care.
- Clinical outcomes at the rural center were comparable to a suburban hospital, with high patient satisfaction.
- The center used a resource-appropriate model with midwives and family physicians, reducing NICU use.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Rural maternity unit closures exacerbate geographic and racial/ethnic inequities in maternal and neonatal health outcomes; this study examines the impact of restoring local access to maternity care.By evaluating both clinical outcomes and patient experiences after the reopening of a rural maternity care center, this work addresses a critical gap in understanding how service restoration affects access, quality, and patient-centered care.

Rural maternity unit closures exacerbate geographic and racial/ethnic inequities in maternal and neonatal health outcomes; this study examines the impact of restoring local access to maternity care.

By evaluating both clinical outcomes and patient experiences after the reopening of a rural maternity care center, this work addresses a critical gap in understanding how service restoration affects access, quality, and patient-centered care.

Public health significance—Why is this work of significance to public health?
Findings demonstrate that reopening a rural Level I Maternity Care Center can maintain safe and comparable labor and delivery outcomes while reducing travel burden by half, thereby improving access to timely, equitable perinatal care.The study highlights a resource-appropriate maternity care unit of family physicians and midwives that provides a model for delivering quality rural maternity services in underserved regions nationally.

Findings demonstrate that reopening a rural Level I Maternity Care Center can maintain safe and comparable labor and delivery outcomes while reducing travel burden by half, thereby improving access to timely, equitable perinatal care.

The study highlights a resource-appropriate maternity care unit of family physicians and midwives that provides a model for delivering quality rural maternity services in underserved regions nationally.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Researchers and practitioners should explore scalable, multidisciplinary staffing models and community-informed implementation strategies to expand high-quality rural perinatal care where maternity care services have been lost.To sustain rural maternity care, health systems and policymakers must invest resources to increase reimbursement for these services, incentivize practice in rural areas, and ensure ongoing training and interprofessional development for rural maternity and newborn teams.

Researchers and practitioners should explore scalable, multidisciplinary staffing models and community-informed implementation strategies to expand high-quality rural perinatal care where maternity care services have been lost.

To sustain rural maternity care, health systems and policymakers must invest resources to increase reimbursement for these services, incentivize practice in rural areas, and ensure ongoing training and interprofessional development for rural maternity and newborn teams.

The closure of rural maternity units in hospitals across the United States contributes to health inequities; however, little is known about the effects of reopening maternity services in this context. We conducted a mixed-methods study to characterize labor and delivery outcomes and patient experiences associated with the reopening of a rural Level 1 Maternity Care Center (MCC) at a critical access hospital. We compared clinical outcomes and distance to care for patients who gave birth at the rural MCC in the three years after its opening with outcomes from a similar low-risk and geographically located sample who gave birth at a large suburban academic medical center in the same hospital system in the three years before the MCC reopened. We also conducted in-depth interviews with patients who gave birth at the MCC. Labor and delivery outcomes were similar across both groups, with significantly more care provided by family physicians and midwives and lower neonatal intensive care unit use at the MCC. The opening of the MCC halved the distance patients traveled to give birth, and patients reported high rates of satisfaction. Rural maternity care centers can improve access to quality care closer to home using a resource-appropriate model.