Bypassing of nearest labor & delivery unit is contingent on rurality, wealth, and race

• DOI: 10.1111/birt.12712
• Publication Date: 2023-02-08T10:08:46Z
• Authors: Margaret Carrel; Barbara C. Keino; Nicole L. Novak; Kelli K. Ryckman; Stephanie Radke
• Keywords: Rurality; Maternity care

Abstract Patient decisions to bypass the closest labor & delivery (L&D) facility in favor of other birthing locations can have consequences for provision health care rural and micropolitan areas as patient volumes decline payer mixes change. Among 220 589 uncomplicated births Iowa, we document characteristics birth parents who their facility, show how this bypassing behavior results changed travel times facilities across rural/urban divide, indicate parts state where is most prevalent. From 2013 2019, 55.2% deliveries occurred that were further from parents' residences than L&D facility. Bypassing associated with White, non‐Hispanic race/ethnicity, private insurance status. Although least common among parents, group has greatest burden exhibits increasing rates over time. Perinatal quality improvement programs target populations low‐risk be encouraged deliver close home if medically appropriate, particularly small towns areas. This potentially alleviate risk obstetric deserts by ensuring units maintain necessary continue operations.