title: Factors influencing cessation of pregnancy care in Oregon.
abstract: OBJECTIVE
  Anecdotal evidence suggests that many providers who previously delivered babies are no longer doing so, both in Oregon and nationally. This study determined the proportion of pregnancy care providers who have stopped or are planning to stop providing this care in Oregon and identified the important factors influencing such practice changes.
  
  
  METHODS
  We mailed a survey in October and November 2002 to all obstetrician-gynecologists, family physicians, general practitioners, and certified nurse midwives practicing in Oregon. The survey inquired about whether they currently perform deliveries. If they did not do so, or if they did so but planned to stop, further questions were asked about reasons for not providing this care.
  
  
  RESULTS
  A total of 2,158 surveys were mailed; 1,232 were returned (58% adjusted response rate), and 1,069 had sufficient information to be included in our analysis. Of respondents, 511 (47.8%) currently perform deliveries. Of these, 157 (30.7%) indicated that they planned to stop doing so in 1 to 5 years, with cost of professional liability insurance (59%) and fear of lawsuits (43%) most frequently cited as major reasons. A total of 367 (34%) respondents had previously stopped performing deliveries. Providers who stopped providing this care since 1999 were significantly more likely to cite cost of medical liability insurance and low reimbursement as major reasons, compared to providers who stopped earlier.
  
  
  CONCLUSIONS
  Our study suggests that as many as half of clinicians who previously performed or currently perform deliveries in Oregon are planning to stop or have already stopped providing this service, raising concern about access to pregnancy care services for women in the state.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, 97239, USA. smitsa@ohsu.edu
authors.forename: Ariel K
authors.initials: AK
authors.lastname: Smits
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Clark
authors.forename: Mark
authors.initials: M
authors.lastname: Nichols
authors.forename: John W
authors.initials: JW
authors.lastname: Saultz
mesh_terms: D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007351:Insurance, Liability; D007357:Insurance, Physician Services; D008297:Male; D009721:Nurse Midwives / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D009774:Obstetrics / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D009922:Oregon; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*