The Applied Policy Research Unit (APRU) is pleased to announce the publishing of its latest rapid research review entitled Optimal Perinatal Surgical Services for Rural Women. This detailed synthesis of evidence includes data from over 190 international scholarly articles and policy documents that address the challenges of providing appropriate maternal surgical care for women living in rural and remote areas of BC.
With the closure of 21 small maternity services since 2000, BC’s maternal surgical care has been rapidly centralized. More women are traveling greater distances to care and to date, no single study has brought together evidence on the many factors relevant to this change in health service patterns. Historically, BC has relied on General Practitioners with Enhanced Surgical Skills (GPESS) to provide low-complexity procedural care in rural and remote settings. Currently, there are 39 GPESS in practice in BC, but 90% of the GPESS workforce is over 45 years of age. Enhanced surgical training for rural generalist family physicians is currently being developed in Canadian medical schools, but existing and impending shortages mean further challenges for rural service sustainability.
This report finds that GPESS provide a high-level of care in maternal surgery, and that small volume obstetrics are safe for low-risk birthing. Further, increased distance to care is shown to be associated with worsened outcomes for mothers and babies and an increase in both birth intervention for logistical reasons and accidental, out-of-hospital births.
The fundamental challenge to providing operative backup for deliveries in rural communities is lack of availability of surgical providers. Rural recruitment and retention is paramount to address these rural workforce shortages.
The costs associated with this model of care remains largely unknown despite its importance to policy makers and tax payers in British Columbia alike. There remains considerable need for further primary research in this area.
This comprehensive review of existing international evidence on rural maternal surgical services helps illustrate the efficacy of existing models of rural surgical care while providing clear directions to both policy makers and service programmers to support the sustainability of rural services, and to researchers to fill in persistent evidence gaps.