Distance to Hospital: Does it make a difference for pregnant women?

Below you will find a very interesting article about the cycle of induction and fast-tracked birthing.  I kept thinking about my own experience when I was reading this and it is so very real.  I was very uncomfortable at home and my contractions were almost always 5 minutes apart with some varying.  I had to travel 30 minutes to the hospital in my case and I was told to make sure I was at the hospital early enough to receive two doses of antibiotics for the Group B Strep and was very nervous about that.  So when I garbed up and they checked my cervix, I was only dilated to 3 and they told me "if your body doesn't start showing harder contractions, we might discharge you" and explained that would have to walk around Walmart (or something) until my contractions became more intense.  I think something between brain and body connected because within a minute (they gave me 3 minutes to prove I was in hard labor) my body pumped out some serious contractions and they decided to hook me up to the IV.  It's a good thing we stayed because I think it took them a good hour to get the IV in, they had to call a pediatric nurse to get the IV in correctly.  That seemed to last forever, but I'm glad I didn't have to have any pitocin prior to giving birth to my baby.  However, they did pump me full of it once the baby was out and they impatiently ripped the placenta from my body.  Sorry to be graphic but the words capture my feelings toward the unnecessary actions taken in my very real birthing experience.  I hope this article is beneficial to understanding the complications that induction can cause and many women (and families) may not be aware of prior to giving birth.
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Distance to Hospital: Does it make a difference for pregnant women?
Posted: 22 Feb 2011 07:44 PM PST

A recent study published in BJOG: An International Journal of Obstetrics and Gynaecology concluded that women who travel more than 20 minutes to the hospital while in labor are at greater risk of birth complications or even death. 
Dr Anita Ravelli, the principal investigator of the study said:
“In critical circumstances where the travel time is long, this may lead to complications for the baby including hypoxemia, asphyxia and intrapartum or neonatal death.”
This seems to be a no-brainer.  Anyone in “critical circumstances” who has a long travel time to a hospital is likely at greater risk of an adverse outcome.  This is why many midwives who practice in home birth settings recomend or even require that the home be within a few minutes of a hospital.
In the Netherlands, a two-tier system of midwifery is practiced.  Those who are low risk are cared for by midwives, those who are high risk are referred to obstetricians.  If the woman wants a hospital birth, but is low risk, she is often attended at home by a midwife until she is well into labor.  The authors of the study suggest that women who were higher risk, and proceeded to the hospital in early labor, actually had better outcomes than lower risk women who did not travel to the hospital until labor was well established.
What implications does this have for American women who give birth in hospitals?  at home?
The problems with early admission in labor in the US involve the cost of beds in hospitals.  Labor units make money by getting babies delivered and emptying beds so new patients can be admitted.  Most labor nurses get very nervous when a patient in early labor is walking the halls with a smile on her face, rather than in bed being “pitted” (receiving pitocin to hasten the birth).  Patients who are walking and comfortable are still assigned to a nurse who cares for them, but who otherwise could be assigned elsewhere.  This leads to the “cascade of interventions“, where one small intervention intended to improve labor leads to another, which leads to another, and so on. . .   If women who planned hospital births could be admitted early in labor and left alone, perhaps only checking in with the nurse when they felt a need, or at intervals to listen to the baby’s heartbeat, we might make a case for the benefit of early admission.  Unfortunately, early admission actually turns into an induction, because the mother is not even in established labor yet.  Normal labor may stop and start, off and on for days.  The cervix is not ready to respond to active labor contractions during the beginning hours of labor, yet women’s bodies are often forced into an early labor in order to “get things going”.
In my next post we will further analyze this study and its implications for American women.