Barriers and Facilitators to Obstetric Care in Rural Wisconsin Communities.

BACKGROUND AND OBJECTIVES: As many rural hospitals continue to close their labor and delivery units and the gap between the demand for and supply of physicians practicing obstetrics continues to grow, this study seeks to understand the barriers and facilitators to delivering obstetric care in rural Wisconsin communities. METHODS: We conducted interviews with rural-based family medicine and OB-GYN physicians to glean their perspectives on challenges and opportunities that they face in the provision of high-quality obstetrical care and used thematic analysis techniques to generate results. RESULTS: We interviewed 21 physicians that currently practice or have practiced obstetrics in rural Wisconsin hospitals, consisting of 11 family medicine physicians and 10 OB-GYN physicians. Key themes emphasized 1) Patient Safety Programs and Training, 2) Staffing, and 3) Physician Involvement in Hospital Changes. CONCLUSIONS: Future considerations in rural obstetric care will involve hands-on education for obstetric teams, agreements with larger hospitals, and retention of a strong obstetric team committed to the community. Implementing training programs to supplement lower annual deliveries and creating a network of support among colleagues and health systems are imperative to sustain and build rural obstetric care.