Rural maternity care.
OBJECTIVE
To provide an overview of current information on issues in maternity care relevant to rural populations.


METHODS
Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed.


RESULTS
This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1.  Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2.  The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3.  Rural maternity care services should be supported through active policies aligned with these recommendations. 4.  While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5.  The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6.  Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7.  Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in rural settings. Remuneration models should facilitate interprofessional collaboration. 9. Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care. 10. Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported. 11. Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery. 12.  All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met. 13.  Quality improvement and outcome monitoring should be integral to all maternity care systems.  14.  Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.
Almonte ON.
Katherine J
KJ
Miller
Garden Village Nippising First Nation ON.
Carol
C
Couchie
Nanaimo BC.
William
W
Ehman
Sudbury ON.
Lisa
L
Graves
Vancouver BC.
Stefan
S
Grzybowski
Kingston ON.
Jennifer
J
Medves
D002170:Canada; D036861:Delivery, Obstetric; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D016239:MEDLINE; D008427:Maternal Health Services; D011247:Pregnancy; D011787:Quality of Health Care; D019035:Rural Health Services; D012424:Rural Population