25 Colorado Counties Are ‘Maternity Care Wastelands’

Getting prenatal care for her first child was a relative breeze, Cheianne Pogline said: The hospital where she would deliver the baby was only about seven minutes from her home.

The process became considerably more difficult with the next three. She and her husband moved from Craig to Parachute in 2019, and the closest options for obstetric care were an hour away, in Glenwood Springs or Grand Junction. When they returned to Craig in 2022, they discovered that Memorial Regional Health had stopped offering maternity care, meaning Steamboat Springs was the closest option.

Women in two of Colorado’s five counties face the same challenge because their communities lack a place to give birth or providers who specialize in pregnancy care. They are more likely to skip prenatal care and have less healthy babies than those who don’t have to go as far. However, reopening hospital birthing units is not a viable solution in many places, so communities must get creative.

Pogline was able to get some care through a UCHealth outreach program in which obstetricians who normally work in Steamboat Springs visit Craig, but still had to make an hour-long trip for her 20-week ultrasound and to meet with the doctor who would perform her C-section. delivery. They have planned the birth, but she and her husband are afraid that the labor will start earlier.

“With babies, you never know when they’re going to come,” she said. “You always have that worry in your head: what happens if I deliver now?”

Twenty-five of Colorado’s 64 counties are “pregnancy care deserts,” Which means they don’t have a hospital where deliveries are performed or a birth center, nor an obstetrician or obstetrician, according to March of Dimes.

A higher percentage of Colorado counties are maternity care deserts than the national average of about a thirdsays Rebecca Alderfer, CEO of the Colorado Perinatal Care Quality Collaborative. The group did not study health outcomes in those counties, but those of the state most recent maternal mortality report found that mothers in the least populated parts of the state, which are often healthcare deserts, are four times as likely to die during pregnancy or the postpartum period as mothers who live in cities. About 2.2 women in cities die per 10,000 births, compared to 8.2 women in the most remote provinces.

While the drive to the hospital is the most dramatic moment, the loss of access to routine care is the bigger problem as the conditions go untreated, Alderfer said. The partnership and others are working together to increase remote patient monitoring, bring midwives to rural areas and train local doctors to manage the physical and mental health of pregnant and postpartum patients, she said. Suicide and overdoses are the leading causes of maternal mortality in Colorado.

“It’s not just about labor and delivery,” she said. “It’s prenatal care and postpartum care, it’s home visiting. It is primarily behavioral health care.”

With few exceptions, pregnant women living in maternity care were more likely to report starting prenatal care five months into pregnancy or later. This is evident from a study by the Regional Economic Development Institute at Colorado State University, which examined the same counties as in the March of Dimes report. They also generally have higher rates of premature birth and infant mortality.

Not all communities will be able to support a labor and delivery unit at a hospital or birth center, but they do need a provider who offers prenatal care at least once a week and transportation options to help families access care that is not available locally , said Dr. Laurie LeBleu, an obstetrician-gynecologist at UCHealth who is based in Steamboat Springs but regularly sees patients in Craig.

In one uncomplicated pregnancythe birthing parent visits a doctor every four weeks for the first 28 weeks of pregnancy, every two weeks through week 36, and once a week through week 40. Women who pass their due date may need more frequent checkups.

Memorial Regional Health in Craig stopped delivering babies about four years ago. When the hospital still had an obstetrics department, UCHealth had a provider from the Steamboat Springs location come in once or twice a week to meet additional demand in the area, said Ryan Larson, director of clinic operations at UCHealth Yampa Valley Medical Center. They have since increased their “outreach” presence to four times a week, he said.

Pregnant patients still have to travel to Steamboat Springs at least twice, LeBleu said. Women with complicated pregnancies may need to make the trip more often so they can get extra supervision, although the system is in the process of installing a machine that could allow more of that to happen in Moffat County, she said.

“At this point, they can eventually run twice a week,” she said.

Caring for patients in rural areas means being proactive and sometimes taking steps that providers in urban areas wouldn’t take, such as scheduling an induction before the due date if a patient might not make it to the hospital on time, LeBleu said. Yet roadside births are an incidental reality. About a month ago, she talked a father through the basics while the family waited for an ambulance.

Some rural hospitals have expressed interest in bringing labor and delivery, or at least prenatal care, back to their communities, said Denise Smith, project director of the Colorado Rural Midwifery Workforce Expansion program. The University of Colorado College of Nursing received a four-year, $2 million grant to fund scholarships for aspiring nurse-midwives who agree to work in rural areas.

In Colorado, certified nurse-midwives can prescribe medications and practice without physician supervision. They can attend deliveries in hospitals or elsewhere, but they cannot perform a caesarean section.

“Our goal is a midwife for every community,” she said.