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Background:

Approximately 15% of the 4 million annual US births occur in rural hospitals.

Objective:

To (1) measure differences in obstetric care in rural and urban hospitals, and to (2) examine whether trends over time differ by rural-urban hospital location.

Research Design and Subjects:

This was a retrospective analysis of hospital discharge records for all births in the 2002–2010 Nationwide Inpatient Sample, which constitutes 20% sample of US hospitals (N= 7,188,972 births: 6,316,743 in urban hospitals, 837,772 in rural hospitals).

Measures:

Rates of low-risk cesarean (full-term, singleton, vertex pregnancies; no prior cesarean), vaginal birth after cesarean (VBAC), nonindicated cesarean, and nonindicated labor induction were estimated.

Results:

In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and nonindicated cesarean rates were 16.9% and 17.8%, respectively …