Rural maternity care services under stress: the experiences of providers.
BACKGROUND
Between 2000 and 2004, 17 small rural maternity care services in British Columbia (BC) closed or were placed under moratoria. This paper explores the experiences of care providers in 4 rural BC communities that have lost or are at risk of losing their local maternity services.


METHODS
We conducted qualitative, semistructured interviews and focus groups with 27 health care providers (doctors and nurses) and 3 administrators. The analysis used modified grounded theory. We chose 4 rural communities to include a diversity of characteristics, including community size, geography, distance to the nearest hospital capable of performing cesarean section, and cultural and ethnic subpopulations.


RESULTS
Care providers identified significant stressors related to the provision of maternity care services, including the development and maintenance of competency in the context of decreasing birth volume, the safety of local maternity care without cesarean section and the desire to balance women's needs with the realities of rural practice.


CONCLUSIONS
Maternity care providers in small rural communities are experiencing stress due in part to the absence of evidence-based policy and planning for rural maternity care services. This stress may contribute to challenges in the retention of rural maternity care providers, thus risking the future of small rural maternity services.
Grzybowski
Stefan
S
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
Kornelsen
Jude
J
Cooper
Elizabeth
E
D001291:Attitude of Health Personnel; D001955:British Columbia; D002585:Cesarean Section; D003627:Data Interpretation, Statistical; D005260:Female; D017144:Focus Groups; D005544:Forecasting; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000639:trends; D009726:Nurses; D010820:Physicians; D011247:Pregnancy; D011295:Prenatal Care; D019035:Rural Health Services / Q000639:trends; D012449:Safety