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Women giving birth in rural Canada have higher rates of maternal morbidity than urban women

Pregnant women who live in rural areas are more likely to have obstetrical emergencies or serious health problems when giving birth than women who live in urban areas, results from a new Canadian study show.

Previous research has compared childbirth outcomes in infants born in rural and urban areas, but this study looked carefully at outcomes in mothers as well, looking at severe maternal morbidity as well as maternal death, which is rare in industrialized countries like Canada.

Severe maternal morbidity includes conditions like eclampsia, obstetric trauma, postpartum hemorrhage that requires blood transfusion, liver or kidney failure, and peripartum cardiomyopathy (a rare from of heart failure). The study also looked at problems affecting infants such as perinatal death, admission to neonatal intensive care unit (NICU), very small or very large babies, and low five-minute Apgar score.

The study looked at all births in British Columbia from 2005 through 2010. Of the 256,220 women included, 10.1 per cent lived in rural areas.

The results showed that rural women were 15 per cent more likely than urban women to experience severe maternal morbidity or death.

In particular, rural women had almost triple the rate of eclampsia compared to urban women, even though rates of preeclampsia were similar in the two groups. Rural women also had more than double the rate of obstetric embolism, and almost twice the rate of uterine rupture or dehiscence (complete or partial rupture of a previous cesarean scar). However, antepartum hemorrhage was significantly less common in rural women than urban women.

Conditions affecting infants, such as severe neonatal morbidity, preterm birth, and low five-minute Apgar score were also significantly more common in rural areas. Despite these higher rates, rural infants had far lower NICU admission rates, which suggests that rural babies may face barriers to care in NICUs, which are often located in larger centres.

Rural and remote areas may have less access to advanced pregnancy and delivery care, according to background information given in the study, although approximately 20 per cent of pregnant women in Canada live in these areas. The study authors also note that some factors that increase pregnancy risks, such teen pregnancy, smoking, obesity, socioeconomic disadvantages, and chronic health conditions are more common in rural areas. For about one in six rural women, the travel time to give birth was over two hours.

The authors note that these results highlight the importance of identifying rural women with high-risk pregnancy, and monitoring them closely in order to provide timely care and manage complications.

The study, which was led by Dr. Sarka Lisonkova of the University of British Columbia, was published in CMAJ on Dec. 6, 2016.

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  • A publication of:
  • Women's College Hospital