title: Impact of discontinued obstetrical services in rural Missouri: 1990-2002.
abstract: OBJECTIVE
  This study examines the potential relationship between loss of local obstetrical services and pregnancy outcomes.
  
  
  METHODS
  Missouri Hospital Association and Missouri Department of Health birth certificate records were used as sources of information. All member hospitals of the Missouri Hospital Association that were located in cities of 10,000 or less were identified and surveyed by telephone.
  
  
  RESULTS
  Frequency of low birth weight babies originating from service areas where hospitals closed services was statistically increased in the first year after service closures. This effect was transient.
  
  
  CONCLUSIONS
  Transient increases in the rate of lower birth weights may reveal difficulties in service access after closure. These outcomes merit further investigation into the consequences of disruptions in access to maternity care in rural communities.
authors.affiliation: Cox Family Medicine Residency, Springfield, MO 65802, USA. daniel.sontheimer@coxhealth.com
authors.forename: Dan
authors.initials: D
authors.lastname: Sontheimer
authors.forename: Larry W
authors.initials: LW
authors.lastname: Halverson
authors.forename: Laird
authors.initials: L
authors.lastname: Bell
authors.forename: Mark
authors.initials: M
authors.lastname: Ellis
authors.forename: Pamela Wilbanks
authors.initials: PW
authors.lastname: Bunting
mesh_terms: D001719:Birth Certificates; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008923:Missouri; D009775:Obstetrics and Gynecology Department, Hospital / Q000600:supply & distribution*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012424:Rural Population