As BMI increases, fewer people give birth at their local rural hospital. Strict BMI cut-offs for local births force patients to travel, often creating additional financial, emotional, and safety challenges. In response, rural health care teams are developing local guidelines, practicing emergency drills, and advocating for flexible, case-by-case decision-making rather than following rigid rules.
“’I Am Not Going, So You’re Doing It’: Management of Pregnant People with High BMI at Rural Hospitals in British Columbia” is an interdisciplinary study led by UBC Department of Family Practice researchers, including Dr. Kathrin Stoll and Dr. Jude Kornelsen. Published in the Australian Journal of Rural Health, the paper draws on administrative and interview data generated through the Rural Surgical and Obstetrical Networks (RSON) of BC evaluation, which is a program of the Rural Coordination Centre of BC (RCCbc), funded by the BC Joint Standing Committee on Rural Issues (JSC).
The article summarizes administrative and interview data relevant to the care of pregnant people with high BMI in rural British Columbia. It articulates five key findings.
Fewer local births as BMI increases
People with higher body mass index (BMI) were much less likely to give birth at their local rural hospital. For example, about 73% of those with normal BMI delivered locally, but only 35% of those with BMI over 40 did. This means many had to travel far from home for care.
No strong link between BMI and poor outcomes in rural hospitals
Although women with higher BMI had slightly more complications, the study did not find a significant increase in serious problems for those who gave birth in rural hospitals. This suggests that rural hospitals can provide safe care for many patients with high BMI.
Travel for birth is hard and risky
When women are told to deliver at a distant hospital, it can be expensive, stressful, and even dangerous, especially in bad weather. Some women decline to travel and insist on giving birth locally, even if it means higher medical risk.
Strict BMI rules create challenges
Current guidelines often require women with high BMI to go to bigger hospitals. Providers said these rules don’t always make sense for rural areas and can cause stress for families. In response, some rural hospitals made their own rules or decided on a case-by-case basis instead of using a “one-size-fits-all” approach.
Local teams are finding solutions
Two rural hospitals created their own guidelines to manage high-BMI pregnancies, in which they recommend early planning, extra consultations, and special equipment. Teams also practice emergency drills to stay prepared for complications like heavy bleeding or difficult deliveries.
“Without clear clinical indicators for safe, quality care for rural birthers with elevated BMI, we risk relocating those that could safely deliver in their home community, which increases the social and financial consequences of giving birth,” says lead author Dr. Kathrin Stoll, Senior Researcher at the Birth Place Lab within the UBC Department of Family Practice. “This relocation can also be socially and emotionally disruptive to the birther and to their families.”
“On the flip side, birthing in smaller communities can mitigate some of the volume burden in larger hospitals, allowing them to attend to patients within their catchment and those with more acute health care needs. It’s a win-win situation,” adds co-author Dr. Jude Kornelsen, Director of the Centre for Rural Health Research and Academic Faculty in the UBC Department of Family Medicine.
Findings from this study provide tentative first steps towards a discussion of appropriate location for birth for rural women with high BMI, one that meets the needs of everyone involved, including the birther and their family, rural health care providers, as well as regional hospitals.
“All sectors must be actively involved in this conversation to determine appropriate and sustainable models of rural maternity care,” says Stoll. “To this end, our goal in publication is to evoke deliberative dialogue about how we can best meet rural birthers’ needs within the context of service sustainability and cost efficiency.”
Click here to read “’I Am Not Going, So You’re Doing It’: Management of Pregnant People with High BMI at Rural Hospitals in British Columbia”.