The journey to birth: medical and geographical patterns of births to women of a rural Kentucky county, 1911-1980.
A relative lack of medical services is common in rural areas, and it has been suggested that the number of births in the mother's county of residence reflects both the availability of obstetric services as well as attitudes toward local and nonlocal medical care. In order to better understand these relationships, we analyzed the evolution of medical and geographical patterns of births to women of a rural Kentucky county in the context of both a changing philosophy and a changing availability of medical care. Specifically, using archival data, we assessed the locus (i.e., home versus hospital) and location (i.e., county) of births to Robertson County women from 1911 to 1980. Without a hospital for the entire period and with the number of physicians declining, the percentage of in-county home births increased steadily, reaching virtually 100 percent by 1950. During this same period, the number of physicians practicing there decreased from 22 to 2. Subsequent delivery patterns reflect the acceptance by the physicians and women of the "principle" of hospital delivery formally enounced in 1945. By 1965, home births had been eliminated, and Robertson County women were, of necessity, traveling the 25-30 miles to the several hospitals in contiguous counties. In the past 15 years, a substantial proportion (almost 20 percent) have elected to travel to hospitals even farther (55-60 miles) from Robertson County. Generally, the Robertson County experience reflects the "lag" observed in the rural-urban, home versus hospital birth experience. Nevertheless, since 1966, all recorded births to Robertson County women have occurred in hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)
D001294:Attitude to Health; D036861:Delivery, Obstetric / Q000639:trends*; D005260:Female; D006295:Health Resources / Q000639:trends; D006700:Home Childbirth / Q000639:trends; D006801:Humans; D007629:Kentucky; D011247:Pregnancy; D012423:Rural Health