Rural care settings face unique challenges in the provision of safe obstetric care. This study explored whether the presence of family medicine (FM) physicians (who are more likely to attend births in rural settings without access to obstetricians or midwives) impacts safety culture and perinatal outcomes. Researchers surveyed 849 clinicians from 39 hospitals in Iowa and found that FM-only hospitals had a lower risk of cesarean deliveries, more support for vaginal birth, and stronger safety culture compared to hospitals with both FM physicians and obstetricians.