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Perinatal outcomes for rural obstetric patients and neonates in rural-located and metropolitan-located hospitals



To compare rural obstetric patient and neonate characteristics and outcomes by birth location.


Retrospective observational cohort study of rural residents’ hospital births from California, Pennsylvania, and South Carolina. Hospitals in rural counties were rural-located, those in metropolitan counties with ≥10% of obstetric patients from rural communities were rural-serving, metropolitan-located, others were non-rural-serving, metropolitan-located. Any adverse obstetric patient or neonatal outcomes were assessed with logistic regression accounting for patient characteristics, state, year, and hospital.


Of 466,896 rural patient births, 64.3% occurred in rural-located, 22.5% in rural-serving, metropolitan-located, and 13.1% in non-rural-serving, metropolitan-located hospitals. The odds of any adverse outcome increased in rural-serving (aOR 1.27, 95% CI 1.10–1.46) and non-rural-serving (aOR 1.35, 95% CI 1.18–1.55) metropolitan-located hospitals.


One-third of rural obstetric patients received care in metropolitan-located hospitals. These patients have higher comorbidity rates and higher odds of adverse outcomes likely reflecting referral for higher baseline illness severity.

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Fig. 1: Unadjusted and adjusted odds of adverse perinatal outcomes by hospital-serving status.

Data availability

Data generated and analyzed during the current study are not publicly available due to data use agreements, but may be available from the senior author on reasonable request.


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Authors and Affiliations



SCH conceptualized and designed the study, interpreted the data, and drafted the manuscript. MP completed the data analysis, interpreted the data, and critically revised the manuscript. JDI interpreted the data and critically revised the manuscript. KBK participated in the design of the study, interpretation of the data, and critically revised the manuscript. SAL contributed to study conceptualization, interpretation of the data, and critically revised the manuscript.

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Correspondence to Sara C. Handley.

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Handley, S.C., Passarella, M., Interrante, J.D. et al. Perinatal outcomes for rural obstetric patients and neonates in rural-located and metropolitan-located hospitals. J Perinatol (2022).

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