To the Editor.—
I was pleased to read the recent articles by Heim and Ferguson (240:2051, 1978) and Heim (240:2070, 1978) on the quality and cost of obstetric services in rural hospitals. This issue arrived just as I was writing to the New Hampshire Health Systems Agency about the irrelevance of the national obstetric guidelines to obstetric care in New Hampshire. The statistics provided by the authors verify in greater detail my information about New Hampshire.New Hampshire has 28 hospitals with obstetric services. There is a single level 3 unit with 600 deliveries a year located at Dartmouth Medical School, where most high-risk pregnant women are delivered of their children. Most level 1 units have between 300 and 600 deliveries a year.In 1976 the infant mortality was 9.4 per 1,000 deliveries. This was the lowest rate of any state in the United States. Only Sweden (8.7 per 1,000
Singer K. Obstetric Services in Rural Hospitals. JAMA. 1979;241(12):1229–1230. doi:10.1001/jama.1979.03290380013012
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