Wyoming’s maternity care erosion continues with Evanston closure

FROM WYOFILE:

Evanston Regional Hospital will discontinue labor and delivery services on Dec. 30, citing declining demand. It will be the fourth Wyoming unit to close in the last decade.

At five months pregnant, Kemmerer mom Alyssa Vasey had her birth all planned out. When the time came, she was going to make the nearly one-hour drive to Evanston, where her trusted OB-GYN practices, and give birth in the hospital’s labor and delivery ward.

But then on Tuesday, a friend tagged her in a Facebook post about the Evanston hospital’s birthing center closing. She initially balked.

“I thought it was just gossip,” she said.

She called her doctor’s office, however, and the receptionist confirmed the news. The Evanston Memorial Hospital also officially announced the closure Tuesday.

The news left Vasey, a mother of two small children, with few choices and little direction about how to proceed. Kemmerer’s hospital shuttered its maternity ward two years ago. She could have a home birth with a midwife, but she and her husband are nervous about the possibility of complications and a consequent LifeFlight or ambulance ride from their remote Kemmerer home. Another choice is to drive to Utah, where there are plentiful options, but with her due date falling in early March, the likelihood of bad weather is high, which could lead to closed roads or dangerous conditions. Not to mention the costs involved with traveling for prenatal and delivery.

“There’s a few options that we’ve been discussing, but it just seems like they’re all bad options,” she said. “It’s hard to make a good choice when none of the choices are adequate.”

The closure is the latest development in the decade-long erosion of maternity care in the state, where delivery units have shuttered, hospitals have struggled to attract and retain sufficient staff and diminishing care puts pregnant people and their babies at risk as they travel longer distances to find services. The erosion also poses existential threats to communities, as adequate health care is crucial to attracting young families to rural towns, state leaders say. And though lawmakers and health care professionals have been searching for solutions, no single answer has emerged.

“It’s really complicated. There is no silver bullet,” said Jen Simon, who founded the Wyoming Women’s Action Network. “But also, if we want to continue to have strong communities and even a strong economy, that really is predicated on having healthy pregnancies and people knowing where they can go for care — people having options to have babies in the state.”

Declining demand

Evanston Memorial Hospital will become the fourth Wyoming facility since 2014 to close down its labor and delivery unit — leaving a service gap in the state’s southwest corner. In its Tuesday announcement, the hospital cited declining demand. It will discontinue the unit on Dec. 30.

“While this decision was difficult, we remain committed to meeting the needs of our patients,” Hospital CEO Cheri Willard said in a press release. “Over the years, we’ve experienced a steady decline in demand, with an average of six deliveries per month. Patients are choosing to give birth at nearby facilities, and we want to meet those evolving needs in our community.”

Volume matters when it comes to hospitals’ bottom lines, Josh Hannes, vice president of the Wyoming Hospital Association, told WyoFile in 2023. In obstetrics, hospitals staff for capacity, “which entails a certain amount of cost whether you deliver one baby a month or 1,000 babies a month,” he said. “You still bear that burden regardless, and it’s due to the overly complicated way health care is financed.”

OB volume is just one of the factors rural hospitals are struggling with across the country. Attracting and retaining staff is another major challenge — especially when competing with urban facilities that come with more resources and less-onerous on-call schedules. Fewer than half of America’s rural hospitals even offer labor and delivery services.

Wyoming’s other birthing facility closures in the last decade were in Riverton, Kemmerer and Rawlins. The Evanston closure will leave 17 birthing facilities across the state’s 23 counties.

Eleven of 23 counties here also lack a practicing OB-GYN physician, according to the Wyoming Health Department. And even in some of the communities with an OB-GYN, there is only a single provider for a sizable population.

The 2024 State Scorecard on Women’s Health and Reproductive Care, which assesses every state’s health care system based on measures such as maternal mortality, prevention and provider access, ranked Wyoming 42nd. The state came in behind all of its neighbors.

Awareness of Wyoming’s maternal care gaps is on the rise. The Joint Labor, Health and Social Services Committee over the summer studied the various factors contributing to the dearth of maternity care providers and ways to bolster access. A subcommittee of Gov. Mark Gordon’s Health Task Force has also been meeting on the topic over the last year.

At the end of the Labor Committee’s meetings, however, lawmakers did not draft any legislation — citing the many complexities of rural health care.

‘It’s very difficult’

The issue is complicated by everything from high costs of medical malpractice insurance to abortion legislations’ impacts on doctors, liability concerns and barriers for midwives to deliver in hospitals.

During the Labor Committee’s summer meetings on the topic, members discussed solutions ranging from tort reform to creating an onramp to midwifery through training offered by community college nursing programs. But lawmakers did not forge a concrete solution, committee member Rep. Sarah Penn (R-Fort Washakie) said when asked about the issue during a recent candidate forum.

“It’s very difficult,” Penn said. “We’ve been addressing this specifically in the Labor [and] Health Committee this past interim. And I’ll be honest, we did not come up with a decision. We came up with a decision to continue to look into this, because there are so many moving parts here as to what the issues really are.”

Gordon’s task force subcommittee, meanwhile, has been exploring the possibility of creating OB medical fellowships, opportunities to better utilize family physicians, rural OB residency programs and more regionalization of the state’s maternity care.

“Just trying to think of any creative way that we can build some sort of capacity within the providers that we have,” said Jen Davis, Gordon’s health and human services policy director.

There are interesting initiatives happening in Laramie, such as a partnership with Denver Children’s Hospital to provide specialized neonatal care in Ivinson Memorial Hospital, Davis said.

But she called the Evanston news “very concerning.”

“We already had a gap in that area, and now I think that gap is going to be increased,” she said.

Across the border

Mandi Lew, a third-generation Wyomingite who grew up in Rock Springs, set out to deliver babies in southwestern Wyoming as a profession. Instead, she watched maternal health care options deteriorate to such a degree that she took her skills elsewhere.

Lew delivered babies in Kemmerer before that birthing facility shut down in 2022. She also worked as a labor and delivery nurse at the Rock Springs hospital for 12 years, but when she became a nurse midwife, hospital bylaws would not permit her to practice without a supervising physician. Lew began commuting two hours from Rock Springs to deliver babies at Layton Hospital in Utah. Eventually, she and her husband decided to make the move permanent: They are building a home there.

She worries that Wyoming’s maternal and infant mortality rates will climb due to a lack of training, staff and resources. Those were things she wanted to provide, she said, but it was too hard. “It’s really sad for the community of Wyoming,” she said.

Evanston Regional Hospital will continue offering women’s health services like mammograms, gynecological care and hormone treatments, the hospital said in its Tuesday announcement. Additionally, the hospital said it will help labor and delivery patients transition to nearby facilities.

Kemmerer mom Vasey plans to see her Evanston OB and seek direction during that appointment. She knows several other pregnant moms who were planning to deliver in Evanston, and wonders how hospitals can just stop offering such a vital service.

“They close [OB] down like it’s a dermatology clinic or an infusion clinic,” she said, but “there’s always going to be women that need to give birth.”

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

This story was posted on November 1, 2024.