August 18th 2024.
Cheianne Pogline, a mother of four, shared that her experience with receiving prenatal care for her first child was relatively easy. The hospital where she planned to deliver was conveniently located just seven minutes away from her home. However, the process became significantly more difficult with her next three pregnancies. In 2019, she and her husband moved from Craig to Parachute, which left them with limited options for obstetrical care. Their closest options were an hour away in either Glenwood Springs or Grand Junction. When they eventually moved back to Craig in 2022, they were disappointed to find out that Memorial Regional Health had stopped offering maternity care. This meant that they would have to travel to Steamboat Springs for their closest option.
Unfortunately, Cheianne is not alone in facing this challenge. In fact, two out of every five counties in Colorado do not have a proper facility or specialized providers for pregnancy care. As a result, many women in these areas are more likely to skip prenatal care and have less healthy babies than those who are able to access care more easily. While reopening hospital birthing units may seem like a solution, this is not always a viable option for many communities. Therefore, it is important for these communities to get creative in finding alternative solutions.
In Cheianne's case, she was able to receive some care through a UCHealth outreach program where obstetricians from Steamboat Springs would visit Craig. However, she still had to travel an hour for her 20-week ultrasound and to meet with the doctor who would perform her cesarean delivery. While they were able to schedule the birth, Cheianne and her husband still worried about the possibility of going into labor early.
Rebecca Alderfer, CEO of the Colorado Perinatal Care Quality Collaborative, shared that about one-third of Colorado's counties are considered "maternity care deserts," which means they lack a hospital performing deliveries, a birthing center, and specialized providers. This is a higher percentage than the national average. The collaborative has not specifically studied the health outcomes in these areas, but a recent maternal mortality report found that mothers in the least-populous parts of the state have a higher risk of dying during pregnancy or the postpartum period compared to urban-dwelling mothers. In fact, the risk is four times higher.
While the drive to the hospital may be the most dramatic aspect of this challenge, the lack of access to routine care is a bigger issue. Conditions and health concerns often go untreated in these areas. As a result, the collaborative, along with other organizations, is working towards increasing remote monitoring of patients, bringing midwives into rural areas, and providing training for local doctors to handle pregnant and postpartum patients' physical and mental health. This is especially important as suicide and overdoses are the top causes of maternal mortality in Colorado.
According to a study from Colorado State University, pregnant women living in maternity care deserts are more likely to delay starting prenatal care or not receive it at all. They also have higher rates of premature birth and infant mortality. While not all communities may be able to support a hospital labor and delivery unit or a birthing center, it is crucial for them to have access to prenatal care at least once a week and transportation options to reach care that is not available locally.
Dr. Laurie LeBleu, an obstetrician-gynecologist with UCHealth, shared that in an uncomplicated pregnancy, the birthing parent should see a doctor every four weeks for the first 28 weeks, every two weeks through week 36, and once a week until week 40. However, women who go past their due dates may need more frequent monitoring. Since the Memorial Regional Health in Craig stopped delivering babies four years ago, UCHealth has increased their outreach presence to the area from once or twice a week to four times a week. This has helped to provide some level of care for pregnant patients in the area, but they still need to travel to Steamboat Springs at least twice. For women with complicated pregnancies, the drive may be even more frequent.
Caring for rural patients requires a proactive approach, and sometimes this means taking steps that may not be necessary in urban areas. For example, scheduling an induction before the due date may be necessary if a patient may not make it to the hospital in time. However, roadside births are still a reality, and Dr. LeBleu shared that she recently talked a father through the basics while waiting for an ambulance.
Some rural hospitals have expressed interest in bringing back labor and delivery, or at least prenatal care, to their communities. Denise Smith, project director for the Colorado Rural Midwifery Workforce Expansion program, shared that the University of Colorado's College of Nursing has received a grant to fund scholarships for aspiring nurse-midwives who agree to work in rural areas. This is an important step towards achieving the goal of having a midwife in every community.
Recruiting obstetricians to rural areas may be challenging, but hospitals could potentially restart their birthing programs by utilizing a combination of midwives, general practitioners with obstetrics training, and an on-call general surgeon for cesarean births. However, financial stability is a key factor in making this a reality. Hospitals need to receive enough reimbursement for births so that they do not lose money. Medicaid, which covers 40% of births in Colorado, only pays $3,200, while commercial insurers pay an average of $9,700 for an uncomplicated vaginal birth. While this may save taxpayers money, families bear the costs of traveling for care, lost work time, and missed appointments.
In the end, the lack of access to maternity care in rural areas is a complex issue that requires creative solutions and collaboration between various organizations. It is important for communities to have access to prenatal care and transportation options to reach care that is not available locally. While not every community may be able to support a hospital labor and delivery unit, it is crucial for them to have access to care to ensure the health and well-being of expecting mothers and their babies.
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