{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:06:31Z","timestamp":1791209191407,"version":"4.1.0"},"reference-count":20,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Centers for Disease Control and Prevention","award":["CDC-RFA-DP22-2207"],"award-info":[{"award-number":["CDC-RFA-DP22-2207"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,9,18]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"\n Background<\/jats:title>\n Rural emergency departments (EDs) increasingly serve as frontline providers of obstetric care due to widespread closures of labour and delivery (L&D) units. Building on a prior study that assessed hospital-level obstetric readiness using the WHO Emergency Obstetric Care (EmOC) Indicators, this study evaluates ED-specific preparedness for obstetric emergencies in a rural US state, with implications for similar settings globally.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional survey was conducted in Autumn 2024 involving ED medical and nursing staff from both birthing and non-birthing hospitals. The survey assessed hospital characteristics, staffing and nine domains related to emergency obstetric care. Descriptive statistics were used to summarise responses from 78 individuals across 45 EDs. Selected comparisons between birthing and non-birthing facilities were evaluated using Fisher\u2019s exact tests.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Most participating hospitals (87%) were in rural areas. Half of the EDs were in non-birthing facilities, many of which had previously had L&D units that closed. Key findings included inconsistent pregnancy screening and triage protocols, limited staff training and inadequate ED discharge and transport procedures. EDs frequently managed early pregnancy complications, postpartum emergencies and, in some cases, active labour and delivery.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Rural EDs function as critical safety nets but demonstrate important gaps in emergency preparedness, workforce readiness and transport systems. This assessment framework provides a practical approach for identifying facility-level vulnerabilities and informing targeted quality improvement, simulation training, referral-network strengthening and policy interventions. Readiness assessments such as this may help health systems improve preparedness for high-acuity, low frequency emergencies and promote equitable access to emergency care in rural and underserved communities.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004491","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:30:21Z","timestamp":1791207021000},"page":"e004491","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Obstetric emergency readiness in rural emergency departments: a cross-sectional survey of birthing and non-birthing hospitals in Montana, USA"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6073-5760","authenticated-orcid":false,"given":"Annie","family":"Glover","sequence":"first","affiliation":[{"name":"Health Policy & Organization, The University of Alabama at Birmingham, Birmingham, Alabama, USA"},{"name":"Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Holman","sequence":"additional","affiliation":[{"name":"Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Nelson","sequence":"additional","affiliation":[{"name":"Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Piskolich","sequence":"additional","affiliation":[{"name":"Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA"},{"name":"School of Social Work, University of Montana, Missoula, Montana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100506301484000_4.4.e004491.1","unstructured":"WHO . Improving maternal and newborn health and survival and reducing stillbirth: progress report 2023. Geneva World Health Organization; 2025. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240073678 [accessed 03 Oct 2025]"},{"key":"2026100506301484000_4.4.e004491.2","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1257\/app.20220341","article-title":"Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the United States","volume":"16","author":"Fischer","year":"2024","journal-title":"Am Econ J Appl Econ"},{"key":"2026100506301484000_4.4.e004491.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-024-06535-7","article-title":"Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States","volume":"24","author":"Fontenot","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026100506301484000_4.4.e004491.4","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0338"},{"key":"2026100506301484000_4.4.e004491.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.1830"},{"key":"2026100506301484000_4.4.e004491.6","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13230"},{"key":"2026100506301484000_4.4.e004491.7","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.24.292287"},{"key":"2026100506301484000_4.4.e004491.8","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/jrh.12539","article-title":"Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services","volume":"37","author":"Kozhimannil","year":"2021","journal-title":"J Rural Health"},{"key":"2026100506301484000_4.4.e004491.9","doi-asserted-by":"crossref","DOI":"10.1111\/jrh.70037","article-title":"Obstetric care in rural critical access hospitals: A domestic application of the World Health Organization Emergency Obstetric Care framework in rural communities","volume":"41","author":"Glover","year":"2025","journal-title":"J Rural Health"},{"key":"2026100506301484000_4.4.e004491.10","unstructured":"Obstetric emergencies in nonobstetric settings. Available: https:\/\/www.acog.org\/programs\/obstetric-emergencies-in-nonobstetric-settings [Accessed 03 Apr 2025]."},{"key":"2026100506301484000_4.4.e004491.11","unstructured":"Alliance for Innovation on Maternal Health (AIM) . Obstetric emergency readiness resource kit. 2023. Available: https:\/\/saferbirth.org\/aim-obstetric-emergency-readiness-resource-kit\/"},{"key":"2026100506301484000_4.4.e004491.12","unstructured":"Critical access hospitals. CMS. Available: https:\/\/www.cms.gov\/medicare\/health-safety-standards\/certification-compliance\/critical-access-hospitals [Accessed 03 Apr 2025]."},{"key":"2026100506301484000_4.4.e004491.13","unstructured":"Emergency medical treatment & labor act (EMTALA). CMS. Available: https:\/\/www.cms.gov\/medicare\/regulations-guidance\/legislation\/emergency-medical-treatment-labor-act [Accessed 03 Apr 2025]."},{"key":"2026100506301484000_4.4.e004491.14","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.1919","article-title":"Trends in Emergency Department Use by Rural and Urban Populations in the United States","volume":"2","author":"Greenwood-Ericksen","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026100506301484000_4.4.e004491.15","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1111\/1475-6773.12441","article-title":"Why Are Obstetric Units in Rural Hospitals Closing Their Doors?","volume":"51","author":"Hung","year":"2016","journal-title":"Health Serv Res"},{"key":"2026100506301484000_4.4.e004491.16","unstructured":"Office USGA . Maternal health: availability of hospital-based obstetric care in rural areas. U.S. GAO; 2022. Available: https:\/\/www.gao.gov\/products\/gao-23-105515 [Accessed 03 Apr 2025]."},{"key":"2026100506301484000_4.4.e004491.17","unstructured":"March of Dimes . Nowhere to go: maternity care deserts across the U.S. 2022 report. Report no.: 3. 2022.35. Available: https:\/\/www.marchofdimes.org\/maternity-care-deserts-report"},{"key":"2026100506301484000_4.4.e004491.18","unstructured":"American Hospital Association . Rural hospital closures threaten access: solutions to preserve care in local communities. 2022. Available: https:\/\/www.aha.org\/system\/files\/media\/file\/2022\/09\/rural-hospital-closures-threaten-access-report.pdf"},{"key":"2026100506301484000_4.4.e004491.19","unstructured":"Southern A , Celik D . Trauma center designation. In: StatPearls. Treasure Island, FL, 2025."},{"key":"2026100506301484000_4.4.e004491.20","unstructured":"StataCorp . Stata statistical software: Release 20. College Station, TX StataCorp LLC; 2027. 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