Impact of a family physician-staffed maternity center on obstetric services in a rural region.

In the past few years rural hospitals have found obstetric care increasingly difficult to provide. A trend toward family physicians abandoning the practice of obstetrics has been a major obstacle for these hospitals. Malpractice cost and pressures, professional isolation, and inadequate training have all been cited as reasons that family physicians in rural areas have stopped delivering babies. Faced with a large number of women giving birth without prenatal care, a hospital in eastern Kentucky began a regional primary care obstetric unit to assure that obstetric care would be available to all patients who needed it. The hospital chose to staff the maternity center with family physicians so it could offer a family-centered obstetric program and newborn care. Since the opening of the maternity center in 1985, hospital deliveries have increased over 30%, while the percentage of patients who give birth without prenatal care has fallen from 3.0% to 0.7%. This report describes the factors behind the creation of the maternity center, its effect on the hospital, and its effect on the family physicians who serve on its staff.