Case studies
What has happened in rural maternity care
These are published studies and reports, not Catchment Maternity engagements. We will add our own results here only when a hospital has approved them. Each entry says what it found and what it does not show.
Why local births leave
Iowa: more than half of families drove past the nearest unit
- What it found
- Researchers followed 220,589 uncomplicated births in Iowa from 2013 to 2019. In 55.2% of them the family delivered at a facility farther away than the closest labor and delivery unit. Families in small towns carried the heaviest travel burden, and their rate of bypassing was rising over time. The authors recommend quality improvement programs aimed at rural and small-town populations to keep obstetric facilities viable.
- What it does not show
- It is an observational study of one state. It does not test any particular program, and it does not say why each family chose as they did.
Carrel M, Keino BC, Novak NL, Ryckman KK, Radke S. Bypassing of nearest labor & delivery unit is contingent on rurality, wealth, and race. Birth 2023;50(1):5-10. doi:10.1111/birt.12712
A unit that came back
A critical access hospital reopened maternity care after 30 years
- What it found
- A 25-bed critical access hospital in a North Carolina town of about 8,000 reopened a maternity unit in September 2020, staffed by family physicians and certified nurse-midwives. The evaluation compared 392 births there with 593 low-risk births from the same area at a suburban academic center. Outcomes for low-risk patients were similar, and patients traveled a median of 16 miles instead of 27.
- What it does not show
- It is one site, and the comparison group is a different hospital in an earlier period. The unit is led by family physicians working with midwives, so it is not a midwife-led unit. Some of the authors lead the unit.
Wouk K, Chetwynd E, Sheffield EC, et al. Bridging the gap: a mixed-methods evaluation of a new rural maternity care center amid nationwide closures. Int J Environ Res Public Health 2026;23(1):102. doi:10.3390/ijerph23010102
What leaders say matters
Two hospitals that added midwives, and what they credit
- What it found
- A university rural health research center interviewed leaders at two hospitals: a small critical access hospital in California that now has a nurse-midwife providing prenatal and postpartum care, and a regional hospital in Montana where four nurse-midwives work alongside nine obstetrician-gynecologists. Both credit the same things: midwife autonomy, physician support, and a state scope-of-practice law that lets midwives practice fully.
- What it does not show
- It rests on two interviews, one per site, with no outcome data. The California hospital has not restarted deliveries, and the Montana hospital is a regional center, not a small rural hospital.
Fritz AH, Thorsen M, Sheffield EC, Kozhimannil KB. Midwifery care at rural hospitals in Montana and California. University of Minnesota Rural Health Research Center case study, 2024 (HRSA-funded). rhrc.umn.edu
The evidence on Centering
Group prenatal care: what is well supported, and what is not
Centering is the best-known model of group prenatal care. A group of about eight to ten patients due around the same time meets with a clinician for ten visits of 90 to 120 minutes, which gives patients far more time with their care team and with one another than a standard visit allows. We have summarized the research as we read it, including the parts that do not favor the model.
Well supported
Group prenatal care is safe: neither the Cochrane review nor ACOG found evidence of harm. Patients rate it highly. Some trials found that participants more often received adequate prenatal care. A small matched study at one rural hospital found birth outcomes no worse than individual care.
Not shown
An early trial in young, low-income urban patients found fewer preterm births (9.8% versus 13.8%). Later and larger trials did not repeat it: 10.1% versus 10.1% in a New York City trial of 1,148 adolescents, and 10.4% versus 8.7% in a South Carolina trial of 2,350 patients. The Cochrane review and CMS’s Strong Start evaluation also found no significant preterm-birth difference.
The practical risk
Attendance. Participants in the large trials attended about half of the ten sessions on average, and roughly a fifth to a quarter of those assigned to group care attended none, even with childcare and incentives. Some patients prefer one-to-one visits, so individual care must stay available.
ACOG describes group prenatal care as an option to offer alongside individual care, not a mandate. The American College of Nurse-Midwives supports it, though its statement predates the largest trial. That is how we approach it: we help a hospital offer group prenatal care for what it does well, plan for attendance from the first day, and measure what happens, without promising a clinical result the trials have not shown.
Centering Group Prenatal Care
- Ickovics JR et al. Obstet Gynecol 2007;110(2):330-339 (full text).
- Ickovics JR et al. Am J Public Health 2016;106(2):359-365 (full text).
- Crockett AH et al., the CRADLE trial. Am J Obstet Gynecol 2022;227(6):893.e1-e15 (full text).
- Catling CJ et al. Group versus conventional antenatal care for women. Cochrane Database Syst Rev 2015;(2):CD007622 (abstract).
- CMS Strong Start for Mothers and Newborns, final evaluation of prenatal care approaches (report).
- Jones TH et al. Matern Child Health J 2023;27(4):575-581 (abstract).
- ACOG Committee Opinion 731, Group Prenatal Care (acog.org). ACNM, Models of Group Prenatal Care (position statement).