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expert-perspectives

Expert perspective: Who delivers babies in rural hospitals?

Photo: Shanna Riley/CC 2.0/https://flic.kr/p/4Nfnan

Since late January, when the story broke about the upcoming closure of the maternity ward at the Grand Marais hospital, I’ve been thinking a lot about pregnant women, clinicians, and hospital administrators in Grand Marais, and in other rural communities in Minnesota and beyond.  For pregnant women in rural areas and for all individuals seeking care, both access and patient safety are necessary components of effective health care systems. They are not negotiable. In order to better understand how to ensure both access and safety, we need to start with relevant information for understanding both capacity and need for care in rural communities.

Approximately 20 percent of the U.S. population lives in a rural area, but only about 10 percent of the nation’s physicians are practicing in rural areas. Of the 2,050 rural U.S. counties, 77 percent are designated as health professional shortage areas.  A report from the Minnesota Department of Health highlights the workforce challenges and clinician shortages in Greater Minnesota.  And this is important, because rural Americans suffer worse health outcomes than those in urban areas, having higher rates of death, disability and chronic disease.

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expert-perspectives

Thinking differently about measuring quality and improving the use of cesarean delivery

Over the past couple of years, there has been increased media attention to a couple of trends. First, there has been a recognition in the fields of public health and maternal and child health that the rapidly increasing rates of cesarean delivery were concerning. The rate of cesareans hit an all-time high of nearly 33% in 2009, and a number of high profile efforts – including the federal Healthy People 2020 goals – set goals for reversing this trending and reducing rates of both primary and repeat cesareans.

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expert-perspectives

Supporting mothers for better births – doula care for low-income women in Minnesota and beyond

Katy Kozhimannil and her children

It stands to reason that pregnant women with strong, steady support during labor and delivery have better birth experiences. Indeed, a 2012 Cochrane review conclusively finds that continuous labor support is associated with a number of positive outcomes for moms and babies and cites no known adverse effects. These effects are most consistent when labor support is provided by someone who isn’t a friend or family member, and not a member of the hospital staff – someone like a doula.

A doula is a trained professional who provides continuous physical, emotional and informational support to the mother before, during and after birth. Unlike physicians, midwives, and obstetrical nurses who provide medical care, a doula provides support in the nonmedical aspects of labor and delivery.

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