Obstetric services in small rural communities: what are the risks to care providers (original) (raw)

Introduction: In spite of a sharp decline, since 2000, in the number of rural communities in Canada that offer local maternity care, there remain significant numbers of small rural maternity services that provide elective maternity care without on-site access to cesarean section. In communities with an elective maternity service without local access to surgical capability, practitioners must be prepared to respond to obstetrical emergencies and arrange urgent transfer if a cesarean section is indicated. In most cases reasonably safe care can be provided by this model, but the possibility of an unexpected emergency that threatens the fetus or mother always exists. Although there is an emerging understanding of the stressors faced by rural physicians, little is known about the experience of care providers offering maternity care in low-resourced environments. This article considers the experience of rural maternity care providers from the perspective of the social risks they perceive are incurred by practicing in a low-resource environment. Methods: A qualitative exploratory approach was employed, using in-depth interviews and focus groups with care providers in three rural communities in British Columbia, Canada. The transcripts were thematically analyzed in four stages. Results: Twenty-six care providers were interviewed across the three communities, including 15 nurses and 11 physicians. Participants identified elements of personal risk they perceived were assumed by offering intra-partum care in communities without local access to cesarean section back up, and the potential effects of these risks on themselves and their communities. They © JA Kornelsen, SW Grzybowski, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 2 further recognized the unique attributes of maternity care, which, when juxtaposed with other aspects of primary care, led to a heightened sense of social risk in a rural environment. Conclusion: A balanced approach to risk management grounded in a comprehensive understanding of the values that influence decision-making, including acknowledgement of the social risks care providers incur, is a necessary step towards better health services for rural parturient women and their babies. Additional strategies may include community-based identification of the risks and benefits of local care, and programs of professional support for rural obstetrical care providers experiencing stress.

Reconceptualising risk: perceptions of risk in rural and remote maternity service planning

Midwifery, 2016

Objective: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. Design: data collection in this qualitative component of a mixed methods study included 88 semistructured individual and group interviews (n ¼ 102), three focus groups (n ¼22) and one group information session (n ¼17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. Setting: fieldwork was conducted in four jurisdictions at nine sites in rural (n ¼ 3) and remote (n ¼ 6) Australia. Participants: 117 health service employees and 24 consumers. Measurements and findings: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. Key conclusions: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. Implications for practice: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health Contents lists available at ScienceDirect

Rural Women's Experiences of Maternity Care: Implications for Policy and Practice

This research investigated rural maternity care from the perspective of parturient women, care providers, health care administrators and local leaders. We found that women's experiences were bound in the complexity of relationships that were influenced by the attitudes and actions of care providers and the organization of health system services. The study took place within a dynamically changing health care environment in which three of the four study sites ceased offering birthing services during the course of the project. The lack of clearly defined policies supporting rural maternity care was reflected in a tenuous infrastructure for local birthing. This left local services vulnerable to the vagaries of practitioner's attitudes, critical incidents, the variable social and historical context of the community and geography. Literature on risk assessment provides a lens through which some of the findings may be interpreted.

Cultures of risk and their influence on birth in rural British Columbia

BMC Family Practice, 2012

Background: A significant number of Canadian rural communities offer local maternity services in the absence of caesarean section back-up to parturient residents. These communities are witnessing a high outflow of women leaving to give birth in larger centres to ensure immediate access to the procedure. A minority of women choose to stay in their home communities to give birth in the absence of such access. In this instance, decision-making criteria and conceptions of risk between physicians and parturient women may not align due to the privileging of different risk factors. Methods: In-depth qualitative interviews and focus groups with 27 care providers and 43 women from 3 rural communities in B.C. Results: When birth was planned locally, physicians expressed an awareness and acceptance of the clinical risk incurred. Likewise, when birth was planned outside the local community, most parturient women expressed an awareness and acceptance of the social risk incurred due to leaving the community. Conclusions: The tensions created by these contrasting approaches relate to underlying values and beliefs. As such, an awareness can address the impasse and work to provide a resolution to the competing prioritizations of risk.

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