Nearly half of Wyoming counties lack an OB-GYN. Will lawmakers respond?

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Dr. Jan Siebersma retired from his obstetric practice in 2023 after 14 years in Fremont County. Without sufficient fellow OBs, he felt unsupported and stretched thin. (Katie Klingsporn/WyoFile)

FROM WYOFILE:

A recent health department assessment highlights declines in maternity care access. Advocates want lawmakers to take on the issue.

Eleven of Wyoming’s 23 counties do not have a practicing OB-GYN, a recent Wyoming Department of Health assessment found, which means residents of towns from Torrington to Rawlins and Sundance must look elsewhere for prenatal and delivery care.

Roughly 16,300 women of reproductive age in Wyoming live in a county without an obstetrician, data from the health department shows. And even in some of the communities with an OB-GYN, there is only a single provider for a sizable population.

Meanwhile, six of Wyoming’s 23 counties lack a delivery facility, the same assessment notes, resulting in longer drives for pregnant mothers seeking care.

The assessment is one more signal that Wyoming’s maternity care landscape is eroding, leaving families, mothers and babies at higher risk for dangerous complications related to pregnancy and childbirth.

Gov. Mark Gordon’s Health and Human Service Policy Director Jen Davis believes it’s time lawmakers consider the issue. She requested the Legislature’s Labor, Health and Social Services Committee make access to OB care an interim topic, which means the panel would study potential legislative fixes related to it.

“We have a real problem in Wyoming with lack of OB care,” she told the committee last week, adding that among other things, it impairs economic development. “It’s very hard to recruit business workforce, especially young families, if you can’t have a baby and grow your family.”

The Legislature’s Management Council hasn’t yet set interim topics, but lawmakers indicated they are concerned about the issue.

“It’s not going in the right direction in our state, certainly in the last five years,” Rep. Dan Zwonitzer (R-Cheyenne) said.

Three Wyoming birthing facilities closed in the last decade — in Riverton, Kemmerer and Rawlins. That leaves 18 birthing facilities across the state’s 23 counties.

In addition, communities are losing obstetricians — doctors who are required to be on call for Wyoming hospital births in case of cesarean sections or other surgeries — due to a combination of factors. Rural OB work often comes with onerous on-call schedules, recruitment is tough and many longtime OBs are reaching retirement age.

Though some families are able to see nurse midwives, family practice doctors or other providers, the situation has prompted many families to travel elsewhere for care. But as distance from care grows, so do risks. Women and babies who live farther from delivery hospitals are more likely to experience adverse medical outcomes.

An OB Subcommittee of Gordon’s Health Task Force is working on gathering information on the issue. The health department’s recent assessment of maternity care access was part of that work.

The study found that just 14 Wyoming towns have practicing OB-GYNs, while eight towns have certified nurse midwives. Some towns have both and some have neither.

It also breaks down the state’s population of women of childbearing age and how many providers they have access to (excluding certified nurse midwives without a nursing license, doulas, family practice physicians and others who care for pregnant women.) In Uinta County, where 3,786 women of childbearing age reside, there is a single provider, according to the report. In Natrona County, home to 15,467 such residents, there are eight OB-GYNs.

The study also looks at the use of EMS services for OB-GYN and neonatal services — which “may indicate lack of accessible obstetric or labor and delivery care.” In 2023, there were 640 such requests. (Wyoming usually tallies more than 6,000 births a year.)

The vast majority of those requests, 95%, sought EMS transporting agencies for reasons like labor and delivery, premature labor and premature rupture. In other words, women in labor calling for an ambulance to take them to a hospital.

This EMS reliance stood out to Davis, she told WyoFile. “I didn’t anticipate that being that high,” she said.

Eroding EMS is another critical issue in Wyoming, she noted.

“I think that only just continues to elevate that conversation of, you know, we have these collapsing systems, both OB and EMS, and two systems that are very fragile but very heavily relying on each other and why that’s problematic,” Davis said.

Adjusted for population size, 2023 EMS service requests were highest in Niobrara, Converse and Fremont Counties, according to the study.

Some 101 patients were transported to out-of-state hospitals, meanwhile; 76 by air and 26 by ground vehicle.

The issue is not isolated to Wyoming. More than half of U.S. rural hospitals no longer offer birthing services, a new study by the Center for Quality Healthcare and Payment Reform, a national policy center, found. The problem is expected to accelerate.

“Hundreds more communities are at risk of losing maternity care because of the serious financial and workforce challenges rural hospitals are facing,” the report reads. “It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action.”

Getting noticed?

Though not at the center of legislation, maternity care access arose tangentially during the recent legislative session.

During a discussion on House Bill 148, which would place more regulation on abortions, Sen. Cale Case (R-Lander) argued that moving toward restricting abortions will only continue to push providers out.

In Fremont County, Case said, the health care situation has become so dire that Riverton locals organized to build a community-owned hospital. He read from a letter penned by a constituent who had to travel to another state to have her second child.

“This poor woman is in Idaho,” Case said. “A good friend of mine recently had her baby in Teton County.” Though his son was born in Lander, he said, his grandchildren may never even be born in Wyoming.

House Bill 148 passed the House and Senate and is awaiting the governor’s signature.

‘Critical’

In their pitch to lawmakers for interim work, Davis and fellow advocates laid out the situation: shuttered facilities, long distances, heavy use of emergency services.

There’s also the realities of winter travel, which comes with “additional risk to life for mother and baby in light of road closures in winter months,” a related memo read. “Interstate 80 was closed 66 times from October 1, 2022-May 31, 2023 and I-25 was closed 42 times during that same period of time.”

Executive Director of the Wyoming Medical Society Sheila Bush called the access issue “critical.” Wyoming can, however, look to other states for ideas and best practices, Bush said.

Davis told WyoFile she doesn’t see obvious catch-all solutions. “I think it’s gonna be a little bit of thinking outside of the box.”

Regardless of interim topics, the OB subcommittee under Gordon’s Task Force will continue its work. It will soon send out a survey to hospitals to help flesh out its understanding of provider numbers and access.

WyoFile is an independent nonprofit news organization focused on Wyoming people, places and policy.

This story was posted on March 15, 2024.