Women residing in rural areas Canada had higher rates of potentially life-threatening complications when giving birth or soon after, compared with urban mothers, and rural newborns were also at higher risk of serious illnesses needing hospitalization, according to a new study in CMAJ (Canadian Medical Association Journal).
"Severe morbidity at childbirth is rare in Canada; however, we found that some serious complications such as eclampsia and obstetric pulmonary embolism were more common among women residing in rural areas," states Dr. Sarka Lisonkova, BC Women's Hospital, Vancouver, BC.
‘Prevention of life-threatening complications like eclampsia can be gained by clinical management of pre-eclampsia through careful maternal and fetal monitoring for worsening of symptoms and providing timely access to advanced obstetric care.’
Between 2000 and 2012 one-fifth of all births in Canada (excluding Quebec) were to women living in rural and remote areas. However, many maternity centers in these areas have been closed in past years and 17% of rural women must travel more than two hours to a health center to give birth.
The study conducted by researchers from the University of British Columbia, BC Women's Hospital, Vancouver, BC, and the University of Ottawa, Ottawa, Ontario included all births (256 220 in hospital or at home) in British Columbia, Canada, between 2005 and 2010.
Mothers in rural areas were younger, more likely to have smoked or consumed drugs or alcohol during pregnancy, had more previous children and fewer prenatal visits, more likely to have high-blood pressure and to have a midwife involved in prenatal care.
Almost 90% of women lived in urban areas (230 365) with the remaining 10% of women residing in rural areas.
The researchers found that rural mothers were twice as likely to have potentially life-threatening conditions such as eclampsia (serious seizures in women during pregnancy or childbirth), obstetric shock and rupture or tearing of the uterus (or breakdown of a uterine scar) compared with their urban counterparts.
"The 2-fold increased risk of eclampsia is particularly concerning, because the rates of pre-eclampsia were similar between the rural and urban groups," the authors write. "Clinical management of pre-eclampsia involves careful maternal and fetal monitoring for worsening of symptoms prompting delivery to prevent eclampsia and adverse fetal or infant outcomes. Thus, the lack of appropriate clinical management or timely access to advanced obstetric care may have contributed to the higher rate in the rural group."
Babies born in rural areas were also more likely to be preterm and to have lower Apgar scores, a score reflecting overall appearance of wellbeing at birth, although the admission rates to the neonatal ICU were less than half of rates in urban areas.
Few studies have looked at maternal outcomes in rural areas as most focus on the health of the newborn.
The researchers used postal codes to determine where mothers lived at time of birth. With the closures of rural maternity units, health care providers need to be vigilant in monitoring women during and after pregnancy.
"In the wake of maternity unit closures in rural areas, the emphasis should remain on monitoring for potentially life-threatening maternal and perinatal complications requiring advanced obstetric and neonatal care," state the authors. A more in-depth look at the reasons why there are more complications is the next step.