title: The safety of Canadian rural maternity services: a multi-jurisdictional cohort analysis.
abstract: BACKGROUND
  Small Canadian rural maternity services are struggling to maintain core staffing and remain open. Existing evidence states that having to travel to access maternity services is associated with adverse outcomes. The goal of this study is to systematically examine rural maternal and newborn outcomes across three Canadian provinces.
  
  
  METHODS
  We analyzed maternal newborn outcomes data through provincial perinatal registries in British Columbia, Alberta and Nova Scotia for deliveries that occurred between April 1st 2003 and March 31st 2008. All births were allocated to maternity service catchments based on the residence of the mothers. Individual catchments were stratified to service levels based on distance to access intrapartum maternity services or the model of maternity services available in the community. The amalgamation of analyses from each jurisdiction involved comparison of logistic regression effect estimates.
  
  
  RESULTS
  The number of singleton births included in the study is 150,797. Perinatal mortality is highest in communities that are greater than 4 h from maternity services overall. Rates of prematurity at less than 37 weeks gestation are higher for rural women without local access to services. Caesarean section rates are highest in communities served by general surgical models.
  
  
  CONCLUSIONS
  Composite analysis of data from three Canadian provinces provides the strongest evidence to date demonstrating that we need to sustain small community maternity services with and without caesarean section capability.
authors.affiliation: University of British Columbia, 300-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada. sgrzybow@mail.ubc.ca.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grzybowski
authors.affiliation: Reproductive Care Program of Nova Scotia, Suite 700-5991 Spring Garden Rd, Halifax, NS, B3H 1Y6, Canada. john.fahey@iwk.nshealth.ca.
authors.forename: John
authors.initials: J
authors.lastname: Fahey
authors.affiliation: University of British Columbia, 300-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada. Barbara.ty.lai@gmail.com.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lai
authors.affiliation: Alberta Perinatal Health Program, Alberta Health Services, 10030-107 Street NW Edmonton, Alberta, T5J 3E4, Canada. Sharon.zhang@albertahealthservices.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Alberta Perinatal Health Program, Alberta Health Services, 10030-107 Street NW Edmonton, Alberta, T5J 3E4, Canada. nancy.aelicks@albertahealthservices.ca.
authors.forename: Nancy
authors.initials: N
authors.lastname: Aelicks
authors.affiliation: Alberta Perinatal Health Program, Alberta Health Services, 10030-107 Street NW Edmonton, Alberta, T5J 3E4, Canada. brenda.leung@albertahealthservices.ca.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Leung
authors.affiliation: School of Population & Public Health, UBC, Vancouver, Canada. kathrin.stoll@midwifery.ubc.ca.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Stoll
authors.affiliation: Reproductive Care Program of Nova Scotia, Suite 700-5991 Spring Garden Rd, Halifax, NS, B3H 1Y6, Canada. rebecca.attenborough@iwk.nshealth.ca.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Attenborough
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008427:Maternal Health Services; D054238:Perinatal Mortality; D011247:Pregnancy; D012042:Registries; D019035:Rural Health Services; D012424:Rural Population; D012449:Safety; D055815:Young Adult