Changes in Labor and Delivery Patterns and Outcomes after Rural Obstetrical Service Closure

Abstract

The number of rural hospitals offering labor and delivery services has been declining across the United States for decades. As a part of this trend, labor and delivery services at Cook County North Shore Hospital in Grand Marais, Minnesota were discontinued in July of 2015. The closure necessitates that patients now travel to Duluth, 110 miles away, for hospital-based delivery services. Partnership between Duluth’s regional campus medical school and this rural community has grown to incorporate researching the effects of this closure on the Cook Country region including the community of Grand Marais. A prior study undertaken evaluated patients’ perspectives on this loss of local obstetrical services. This study was undertaken to better characterize the utilization and clinical outcomes of obstetrical care for patients before and after local labor and delivery services were discontinued. Retrospective chart review was done comparing measures before and after delivery services discontinued locally. Although not statistically significant, patterns since closure include an increased percentage of inductions, home births, and cesarean deliveries for women in Cook County.