August 18th 2024.
Cheianne Pogline, a mother of four children, shared her experience with getting prenatal care for her first child. She said it was relatively easy as the hospital where she would deliver was only a short seven-minute drive from her house. However, things became significantly harder with her next three pregnancies. In 2019, she and her husband moved to Parachute from Craig, and the closest options for obstetrical care were now an hour away in either Glenwood Springs or Grand Junction. This meant longer and more inconvenient trips for prenatal appointments and delivery. When they moved back to Craig in 2022, they were shocked to find out that the hospital where they previously had their first child had stopped offering maternity care. This meant their only option for delivery was now in Steamboat Springs, which was quite a distance from their home.
Unfortunately, Cheianne is not the only woman facing this challenge in Colorado. In fact, two out of five counties in the state do not have a place for women to give birth or specialized providers for pregnancy care, making it difficult for them to access proper prenatal care. As a result, these women are more likely to skip prenatal appointments and have less healthy babies compared to those who have easier access to care. However, reopening hospital birthing units is not always a feasible solution, so communities have to get creative in finding other ways to address this issue.
For Cheianne, she was able to receive some care through a program offered by UCHealth, where doctors from Steamboat Springs would visit Craig to provide obstetrical care. However, she still had to make the hour-long trip for important appointments like her 20-week ultrasound and to meet with the doctor who would perform her cesarean delivery. This added stress and worry for Cheianne and her husband, as they feared going into labor early and not being able to make the long journey to the hospital in time.
According to March of Dimes, 25 out of 64 counties in Colorado are considered "maternity care deserts" where there are no hospitals or birthing centers, and no obstetricians or midwives available. This is higher than the national average, which is about one-third of counties facing the same challenge. While the collaborative has not yet studied the health outcomes in these counties, the state's most recent maternal mortality report found that mothers in rural areas, which often have limited access to care, are at four times higher risk of dying during pregnancy or the postpartum period compared to urban mothers. This is a concerning statistic and highlights the importance of finding solutions to address this issue.
The loss of access to routine care is the biggest problem for women living in maternity care deserts, as conditions can go untreated without proper monitoring and treatment. To combat this, the Colorado Perinatal Care Quality Collaborative is working on increasing remote monitoring of patients, bringing midwives to rural areas, and training local doctors to handle pregnant and postpartum patients' physical and mental health. This is especially important as the state's most recent maternal mortality report found that suicide and overdoses are the top causes of maternal mortality in Colorado.
Dr. Laurie LeBleu, an obstetrician-gynecologist with UCHealth, who regularly sees patients in Craig, emphasizes the importance of having a provider offering prenatal care at least once a week in these communities. This is crucial in uncomplicated pregnancies, where the birthing parent would see a doctor every four weeks for the first 28 weeks, every two weeks until week 36, and then once a week until week 40. However, for women who go past their due dates, they may need more frequent monitoring, which can be challenging if they have to travel long distances.
Due to the closure of the obstetrics department at Memorial Regional Health in Craig four years ago, UCHealth had to increase their outreach presence in the area, with doctors now visiting Craig four times a week. However, pregnant patients still need to travel to Steamboat Springs at least twice, and those with complicated pregnancies may need to make the trip more often for additional monitoring. To address this issue, the system is working on installing a machine that would allow more of that monitoring to happen in Moffat County.
Caring for rural patients means being proactive and taking steps that providers wouldn't typically take in urban areas. For example, scheduling an induction before the due date if a patient may not make it to the hospital in time. However, even with these precautions, roadside births are an occasional reality. Denise Smith, project director for the Colorado Rural Midwifery Workforce Expansion program, highlights the interest shown by some rural hospitals in bringing back labor and delivery or at least prenatal care to their communities. The University of Colorado's College of Nursing received a $2 million grant to fund scholarships for aspiring nurse-midwives who agree to work in rural areas. This is part of their goal to have a midwife in every community.
However, the challenge remains in recruiting obstetricians to these rural areas. Smith suggests a combination of midwives, general practitioners with obstetrics training, and an on-call general surgeon to perform cesarean births as a potential solution. Ultimately, the most crucial factor is ensuring that hospitals are financially stable and receive enough reimbursement for births to not lose money. This is where Colorado's limits on the growth of state spending come into play, as it prevents the state from significantly increasing Medicaid rates for births. While this may save taxpayers money, it also means that families bear the costs of paying for gas, lost work time, and possibly missed care.
In conclusion, the lack of access to maternity care in rural areas is a pressing issue in Colorado. It not only affects the health outcomes of both mothers and babies but also poses financial and logistical challenges for families. While there is no easy solution, it is essential for communities to get creative and work together to find ways to address this issue, whether it is through increasing remote monitoring, bringing midwives to rural areas, or training local doctors. Every woman deserves access to proper prenatal care, regardless of where they live.
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