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Rebuilding a rural obstetrical program: a case study.

The rebuilding of an obstetrical department of a small rural hospital (40 beds) in rural Nevada is described. The number of births at the hospital increased from 20 in 1981 to more than 300 for the past four years. The market share of obstetrical patients in the county increased from less than 10 percent in 1981, to an average of 80 percent for the last five years. The five major steps contributing to the success of this rebuilding program are described. Obstetrical malpractice liability insurance and the shaky financial viability of rural hospitals are discussed as the two major threats to rebuilding a rural obstetrical program. The experience in this setting suggests that rural residents want and desire local obstetrical care and that a team approach can rebuild a rural obstetrical capacity in a relatively short time.