title: Does distance matter? Increased induction rates for rural women who have to travel for intrapartum care.
abstract: OBJECTIVE
  Although there has been a devolution of local rural maternity services across Canada in the past 10 years in favour of regional centralization, little is known about the health outcomes of women who must travel for care. The objective of this study was to compare intervention rates and outcomes between women who live adjacent to maternity service with specialist (surgical) services and women who have to travel for this care.
  
  
  METHODS
  The BC Perinatal Database Registry provided data for maternal and newborn outcomes by delivery hospital for 14 referral hospitals (selected across a range of 250-2500 annual deliveries) between 2000 and 2004. Three hospitals were selected for sub-analysis on the basis of almost complete capture of the satellite community population (greater than 90%) to avoid referral bias.
  
  
  RESULTS
  Women from outside the hospital local health area (LHA) had an increased rate of induction of labour compared with women who lived within the hospital LHA. Sub-analysis by parity demonstrated that multiparous women had increased rates of induction for logistical reasons.
  
  
  CONCLUSIONS
  Rural parturient women who have to travel for care are 1.3 times more likely to undergo induction of labour than women who do not have to travel. Further research is required to determine why this is the case. If it is a strategy to mitigate stress incurred due to separation from home and community, either a clinical protocol to support geographic inductions or an alternative strategy to mitigate stress is needed.
authors.affiliation: Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver BC.
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
authors.forename: Shiraz
authors.initials: S
authors.lastname: Moola
authors.forename: Stefan
authors.initials: S
authors.lastname: Grzybowski
mesh_terms: D000328:Adult; D000367:Age Factors; D002170:Canada; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data*; D008427:Maternal Health Services / Q000706:statistics & numerical data* / Q000639:trends; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data* / Q000639:trends; D014195:Travel; D055815:Young Adult