Traditionally, both families and physicians have considered having or delivering a baby a local event and have expected a maternity unit to be available nearby. In rural states, a significant portion of births continue to take place in small maternity services, and nationwide there is little evidence of consolidation of maternity services or closure of hospital maternity services with small numbers of annual births.1 Small rural maternity services provide the benefit of the social, psychological, and family support of the local community and avoid prolonged hasty travel at the onset of labor. It is these maternity services, provided by local community hospitals, that are the subject of the study by Hein2 published in this issue of The Journal.
Most small maternity units cannot provide the full range of services for high-risk patients. They can provide the necessary services according to the risk status of the mother and the