University of Minnesota researchers report the risks to mothers and newborns rise in remote rural counties that have lost hospital labor and delivery services.

The study said 179 rural U.S. counties lost hospital based obstetric service between 2004 and 2014.

About 40 percent, or 76 of those counties are far from urban areas.

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Most women residents in those remote counties managed to get maternity services elsewhere. But some did not, resulting in an increase of nearly 5,000 potentially risky deliveries in those counties during the study period.

"They're either giving birth out of the hospital, either planned or unplanned," said Katy Kozhimannil, the study's lead author and director of the university's Rural Health Research Center "Or they're giving birth in a hospital that's not really equipped to handle childbirth. That's happening more frequently for residents of rural counties that lose the maternity services that they had."

The rate of out-of-hospital births in affected counties rose from 1 percent to 1.7 percent. The share of births in hospitals without obstetric services rose from about a half a percent to 3.6 percent.

In rural counties adjacent to urban areas births in hospitals without labor and delivery services increased to 2.3 percent. That translates to nearly 6,000 elevated risk births.

Although the percentage changes are relatively small, they are statistically significant.

"These findings should raise concern about immediate and long-term health impacts for mothers and babies," said co-author Carrie Henning-Smith, "especially in the most remote rural areas, which already experience disproportionate economic and health challenges"