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Introduction: The United States is comprised of 75% rural areas and settings (American College of Obstetricians and Gynecologists (2014). Nearly five million women in the US do not have access to maternity care in the county in which they reside (Uribe-Leitz et al., 2022). Purpose: The purpose of this integrative review is to assess the hospitals that provide maternity care in rural settings, the procedures performed in these locations, and the maternal care workforce in the rural obstetric setting. The goal of this research is to identify why there is a lack of maternity care in the rural setting, and how midwives can help to fill the gap in rural maternity care. Methods: Whittemore and Knalf’s updated methodology guided this review (2005). The databases used were PubMed (n = 953), CINAHL (n = 50), and SCOPUS (n = 2,002). The search included the keywords: rural health OR rural health services; AND obstetrics OR midwifery OR maternity care OR birth OR pregnancy; AND workforce OR clinicians OR providers OR personnel. Inclusion criteria for screening were: rural areas, midwifery, obstetrics, workforce, providers, clinicians, maternal care, and United States. Exclusion criteria included: language other than English, not original work, not full text. Relevant articles were classified into four categories: (a) procedures performed in rural obstetric units, (b) closure of rural hospitals and rural obstetric units, (c) perspectives of loss or lack of local obstetric units, and (d) characteristics of the rural obstetric workforce. Results: Rural maternity units are at risk of closure, with 9% of rural maternity units closed from 2004–2014 (Hung et al., 2017). In rural locations where maternity care is still available, unnecessary interventions are more likely to occur. Obstetrician-gynecologists (ob-gyns) are difficult to recruit and retain, therefore family practice physicians tend to practice maternal care in a rural setting (Kozhimannil et al., 2015). Reduced funding, inadequate staffing, and undertrained personnel can lead to increased maternal morbidity and mortality (Kozhimannil et al., 2016). Rural maternal care units are closing at staggering rates and their workforce is inadequate. Very little evidence in this review incorporated certified nurse-midwives (CNMs) in the rural maternal workforce, and how CNMs can close the gap and aid in the rural maternal health crisis, though the reviewer asserts that CNMs are uniquely positioned to add vital care in the rural setting.
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High Elk, T. F. (2023). Rural Maternal Care Crisis & Strained Workforce: An Integrative Review Revealing Factors in the Rural Maternal Care Crisis [Masterʼs thesis, Bethel University]. Spark Repository. https://spark.bethel.edu/etd/970