Family physicians in rural hospitals and their impact on cesarean delivery rates

Background and goal: The U.S. is experiencing a maternal health crisis, particularly in rural areas. This issue is compounded by rising rates of severe maternal morbidity and mortality. Family physicians often fill critical gaps in care in rural areas where obstetricians are scarce. This study examined how the presence of family physicians in rural hospitals impacts cesarean delivery rates and the overall quality of care during childbirth.

Study approach: The study analyzed data from rural hospitals in Iowa and collected survey responses from clinicians about their attitudes and practices related to childbirth. Researchers linked these responses with hospital data on cesarean delivery rates, patient demographics, and other factors. The study compared hospitals where only family physicians provide care, hospitals with both family physicians and obstetricians, and hospitals with only obstetricians.

Main results: A total of 849 clinicians from 39 hospitals completed the survey: 13 family medicine-only, 11 obstetrician-only, and 15 hospitals with both. All family medicine-only hospitals were rural with fewer than 1,000 annual births.

• Family medicine–only hospitals had a 34.3% lower risk of cesarean deliveries compared to hospitals with both family physicians and obstetricians.

• Nurses at family medicine–only hospitals reported a stronger culture of support for vaginal births and a safer environment for patients.
• Hospitals with family physicians were more likely to be in rural areas with limited access to pregnancy care and had lower delivery volumes.

Why it matters: The findings of this study suggest that family physicians in rural areas where access to specialized obstetric care is limited contribute to lower cesarean delivery rates and a supportive culture for vaginal births, which are key indicators of maternal care quality.