Cheyenne Pogline said her prenatal care for her first birth was relatively easy because the hospital where she would give birth was only about seven minutes away from her home.
With the next three, the process got significantly more difficult. She and her husband moved from Craig to Parachute in 2019, but the closest options for maternity care were in Glenwood Springs or Grand Junction, an hour away. When they moved back to Craig in 2022, the closest option was in Steamboat Springs, because Memorial Regional Health stopped offering maternity care.
Women in two of five Colorado counties face the same problem because their area doesn’t have a place to give birth or a provider that specializes in pregnancy care. These women are more likely to miss prenatal care and have unhealthy babies than women who don’t have to travel that far. But reopening hospital birthing units isn’t a practical solution in many areas, so communities have had to get creative.
Pogline was able to get some care through a UCHealth outreach program, where an obstetrician who normally works in Steamboat Springs visited Craig, but she still had to travel an hour to get an ultrasound at 20 weeks and meet with the doctor who would perform the C-section. She has scheduled the delivery, but she and her husband are worried that labor will start too early.
Cheyenne Pogline, a mother of four, poses for a portrait in front of her home in Craig, Colorado, on Friday, Aug. 9, 2024. (Photo by Hyun Chang/Denver Post)
“You never know when the baby is going to come,” she says, “and there’s this constant worry in your mind of what it would be like if you gave birth now.”
According to the March of Dimes, 25 of Colorado’s 64 counties are “obstetric care deserts,” meaning they lack hospitals or birth centers where births can be performed and they lack obstetricians and midwives.
The percentage of Colorado counties that are maternity care deserts is about one-third higher than the national average, said Rebecca Alderfer, CEO of the Colorado Perinatal Care Quality Collaborative. While the group doesn’t track the health of those counties, the state’s most recent maternal mortality report found that mothers in the state’s most sparsely populated areas — which often are care deserts — are four times more likely to die during pregnancy or after birth than mothers who live in urban areas. Urban women die about 2.2 times per 10,000 births, compared with 8.2 women in the most remote counties.
While the drive to the hospital is the most dramatic moment, Alderfer said, missing out on routine care because symptoms go untreated is a bigger problem. Her organization and others are working together to increase remote monitoring of patients, send midwives to rural areas and train local doctors to address the mental and physical health of pregnant and postpartum patients, she said. Suicide and overdoses are the leading causes of maternal deaths in Colorado.
“It’s not just delivery,” she said, “it’s prenatal care, postnatal care, home visiting, and especially behavioral health.”
A study by the Colorado State University Institute for Regional Economic Development that looked at the same counties as the March of Dimes report found that, with a few exceptions, pregnant women living in maternity care deserts were more likely to report starting prenatal care after the fifth month of pregnancy. These areas also generally had higher rates of premature births and infant mortality.
Not every community can support a hospital delivery room or birth center, but they do need providers who offer prenatal care at least once a week and provide transportation so families can get care they can’t get locally, said Dr. Laurie LeBleu, a UCHealth obstetrician-gynecologist based in Steamboat Springs who regularly sees patients in Craig.
If the pregnancy is uncomplicated, expecting parents should see their doctor every four weeks until 28 weeks of pregnancy, every two weeks until 36 weeks, and then weekly until 40 weeks. Women past their due date may need more frequent monitoring.
Memorial Regional Health in Craig stopped delivering babies about four years ago. When the hospital still had an obstetrics unit, UC Health sent health care workers from Steamboat Springs to the hospital once or twice a week to meet increased demand in the area, said Ryan Larson, director of clinic operations at UC Health Yampa Valley Medical Center. Since then, the center has increased the frequency of its “outreach” visits to four times a week, he said.
Pregnant patients will have to make at least two trips to Steamboat Springs, LeBleu said. Women with complicated pregnancies may need to drive more frequently to get additional monitoring, but she said Moffat County is working to install machines to make that possible more often.
“For now, they’ll be driving twice a week,” she said.
Caring for patients in rural areas means being proactive, sometimes taking steps that wouldn’t be taken in urban areas, like scheduling an induction of labor before the due date if the patient might not be able to get to the hospital before the due date, Leblou said. Still, roadside births are a reality and sometimes happen. About a month ago, while the family waited for an ambulance, she walked the father through the basics of childbirth.
Some rural hospitals have expressed interest in bringing births, or at least prenatal care, back to their communities, said Denise Smith, project director for the Colorado Rural Midwife Workforce Expansion Program. The University of Colorado School of Nursing received a four-year, $2 million grant to fund scholarships for aspiring midwives who agree to work in rural areas.
In Colorado, certified midwives can prescribe medicine and provide medical care without medical supervision, and they can attend births in hospitals and other locations, but they cannot perform C-sections.
“Our goal is to have a midwife in every community,” she said.
Smith said while it’s unlikely she’ll be able to hire an obstetrician in the area, hospitals could restart their birth programs with a combination of midwives, obstetrically trained general practitioners and on-call general surgeons who perform C-sections. But ultimately, she said, the most important factor is that hospitals are financially stable and get reimbursed enough for births that they don’t at least go into the red. Private insurers pay an average of $9,700 for an uncomplicated vaginal birth, while Medicaid, which covers 40 percent of births in the state, pays $3,200.
Because Colorado limits the growth of state spending, it can’t significantly raise Medicaid fees for childbirth, saving taxpayers money, Smith said, but the loss of services would leave families footing the bill for gas, missed work and possibly lost health care, he said.
“The cost cutting is going to mean someone is going to pay some costs,” she said.
First published: August 18, 2024, 6:00 AM
