Rural maternity care services under stress: the experiences of providers.

INTRODUCTION Between 2000 and 2004, 17 small rural maternity care services in British Columbia (BC) closed or were placed under moratoria. This paper explores the experiences of care providers in 4 rural BC communities that have lost or are at risk of losing their local maternity services. METHODS We conducted qualitative, semistructured interviews and focus groups with 27 health care providers (doctors and nurses) and 3 administrators. The analysis used modified grounded theory. We chose 4 rural communities to include a diversity of characteristics, including community size, geography, distance to the nearest hospital capable of performing cesarean section, and cultural and ethnic subpopulations. RESULTS Care providers identified significant stressors related to the provision of maternity care services, including the development and maintenance of competency in the context of decreasing birth volume, the safety of local maternity care without cesarean section and the desire to balance women's needs with the realities of rural practice. CONCLUSIONS Maternity care providers in small rural communities are experiencing stress due in part to the absence of evidence-based policy and planning for rural maternity care services. This stress may contribute to challenges in the retention of rural maternity care providers, thus risking the future of small rural maternity services.