Where have all the doctors gone?
Shortage of obstetrics in rural areas puts women at risk
There’s never been enough doctors in rural Wyoming, where I live, but a shortage of obstetricians is now increasing the risks for pregnant women across the state – and the nation.
In the last decade in Wyoming, three hospitals have closed maternity wards. That includes Rawlins, where pregnant moms now have to risk travel on Interstate 80 – notorious for weather-related closures – to deliver their babies in Laramie, 100 miles away.
But Wyoming isn’t the only state to face inadequate maternal care: Less than half of rural hospitals in America offer labor and delivery services.
Gwenith Wachter has experienced this erosion firsthand. She first gave birth in her hometown of Riverton, Wyo., back when the local hospital was a bustling place with a well-seasoned staff. By 2016, the for-profit hospital’s owner had closed its labor and delivery unit. Five years later, when her last child was arriving, she had to travel 26 miles to Lander, the closest birthing facility.
Today, her county of Fremont, a New-Hampshire-sized area home to 40,000 people, has gone from two birthing hospitals and many obstetricians, to one delivery facility and a single pregnancy doctor for the general population. The trend prompts women in increasing numbers to travel out of the county to give birth – an expensive and logistically challenging option. “I just think it’s insane,” Wachter said. “It puts women at risk.”
The statistics bear out her observation. Women who live farther from delivery hospitals are more likely to experience adverse medical outcomes, such as requiring neonatal intensive care.
With traveling doctors and nurses filling the on-call gaps, Fremont County has it better than some other rural counties, because at least it has a birthing facility. Keeping one going is complicated by factors like the unprofitable nature of deliveries for hospitals and burnout of medical staffers.
In an unfortunate “Catch-22,” robust health care is a key ingredient in creating local jobs and tax revenue that, in turn, drive patient volume and support the economics of rural communities. Worse, said University of Wyoming professor and midwife Esther Gilman-Kehrer, without enough staff, “I would envision that at some point we’ll see deaths.”
Women who receive no prenatal care at all are showing up already in labor at Fremont County general hospitals, according to nursing staff. Add that to the prevalence of risk factors like diabetes, substance abuse and high rate of travel, and the chance of a bad outcomes grows.
Wyoming’s maternity-care gap, however, is not the state’s issue of highest concern – not by a long shot. It competes with other challenges such as high suicide rates and declining coal mining revenues. Many lawmakers also appear more interested in hot-button social issues like school library policies. People outside of the childbirth realm express shock when I tell them that health care for women has sharply deteriorated.
The state has begun to take notice. An obstetrics subcommittee of Gov. Mark Gordon’s Health Task Force is working to gather data on doctor shortages. An effort to create a maternal health strategic plan could spring from a University of Wyoming program. What’s known is that many factors, including more livable schedules and the chance for better pay offered at city hospitals, make it difficult to attract promising medical professionals.
Another issue is a pair of abortion bans held up in litigation. The Wyoming Legislature argues that while the State Constitution guarantees residents the freedom to make health care choices, those choices don’t include abortion because “abortion is not health care.”
Will good solutions come fast enough? From 2018-20, 13 Wyoming women died during pregnancy or within one year after the end of their pregnancy, according to the state health department. Six pregnancy-related deaths were deemed preventable. Meanwhile, maternal mortality more than doubled in the United States from 1999-19, putting us far behind other first-world countries.
It’s a fundamental experience for women to have a baby, yet even in the smoothest cases, there are lasting implications for women’s bodies. It’s time to stop shrugging the matter off and start treating maternity care with the gravity it deserves. The health of moms is absolutely central to healthy families and thriving communities.
Katie Klingsporn is a contributor to Writers on the Range, writersontherange.org, an independent nonprofit dedicated to spurring lively conversation about the West. She lives in central Wyoming and recently wrote a series about Wyoming’s maternal care shortage for WyoFile. ?
- Lights, camera, action
- By Missy Votel
DIFF returns for 19th year with something for everyone
- Read More
- We met at The Ranch
- By Missy Votel
Finding true love at El Rancho does happen ... a lot
- Read More
- A trail to somewhere
- By Jonathan Romeo
Grassroots effort launched to build Durango-to-Hermosa trail
- Read More
- Crying wolf
Since 10 wolves were reintroduced to northern Colorado this winter, there have been more than 50 reported sightings via an online form on the Colorado Parks and Wildlife website. Seeing as how it’s been a hot minute, or never, since most Coloradoans have seen a wolf, some reports have proven more helpful than others.
- Numb nuts?
Tired of saddle sores and chamois chafe? Well, settle in, because we’re about to have a really uncomfortable conversation. About bike seats.
- The long haul
Clocking in at 1.45 miles and 30 minutes of ducking and weaving through wall-to-wall people, shlepping from one end of DIA’s B Concourse to the other is no cake walk. But now, DIA travelers have someone to commiserate with. Apparently, Salt Lake City International Airport also has a B concourse with a death march from hell.
- Sun's out, buns out
For an upcoming girls ski weekend at Sunlight Mountain Resort, you can leave your boots on – but not much else. On March 29-30, the small, privately owned resort near Glenwood Springs will host the all-female “Boot Tan Fest,” complete with an end-of-day naked ski lap.