Where have all the doctors gone?

By Katie Klingsporn

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 their maternity ward. 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 the rural hospitals in America even offer labor and delivery services.

Gwenith Wachter has experienced this erosion firsthand. She first gave birth in her hometown of Riverton, Wyoming, 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. 

But with traveling doctors and nurses filling the on-call schedule 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 the 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 received 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 outcome 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 through 2020, 13 Wyoming women died during pregnancy or within one year after the end of their pregnancy, according to the state health department. All six pregnancy-related deaths were deemed preventable. Meanwhile, maternal mortality more than doubled in the United States from 1999 to 2019, putting us far behind other first-world countries.

It’s a fundamental experience for women to have a baby, yet even in the smoothest case, 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.

This column was published in the following newspapers:

01/29/2024 Steamboat Pilot Steamboat Springs CO
01/30/2024 Gallup Independent Gallup NM
01/29/2024 Craig Daily Press Craig co
01/30/2024 Wenatchee World Wenatchee WA
01/31/2024 Montrose Daily Press Montrose CO
01/31/2024 Four Points Press Garryowen MT
01/30/2024 Whitehall Ledger Whitehall MT
01/30/2024 Vail Daily Vail CO
01/31/2024 Greeley Tribune Greeley CO
02/04/2024 KVNF Radio Paonia CO
02/04/2024 Cochise County Herald Review Cochise County AZ
02/02/2024 Laramie Boomerang Laramie WY
01/30/2024 Grand Junction Daily Sentinel Grand Junction CO
01/30/2024 Rock Springs Rocket Miner Rock Springs WY
02/01/2024 Moscow-Pullmand Daily News Moscow-Pullman ID
02/03/2024 Wyoming Tribune Eagle Cheyenne WY
02/02/2024 Denver Post Denver CO
02/02/2024 Big Horn County News Hardin MT
02/03/2024 Aspen Times Aspen CO
02/01/2024 Herald-Journal Logan UT
02/02/2024 Durango Herald Durango CO
02/05/2024 The Daily Yonder Whitesburg Ky
02/03/2024 Aspen Daily News Aspen CO
01/30/2024 Sterling Journal-Advocate Sterling CO
01/31/2024 Fort Morgan Times Fort Morgan CO
02/06/2024 Taos News Taos NM
02/01/2024 Moab Times Independent Moab UT
02/19/2024 Sky-Hi News Granby CO
02/15/2024 Jackson Hole News & Guide Jackson Hole WY
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Chris Gavan
4 months ago

The article just hinted on the fight for women’s control over their bodies via their ability to make their own health choices. These choices need to be decided between the women themselves, their partners, and their doctors. Having been in the medical field for 25 years (although, only on the peripheral of OB/GYN care), I would NEVER put myself in a position to criticize or prevent a woman for making her own personal choices. Why would a legislator, with absolutely no medical experience, put themselves in this position. Shame on them!

And, shame on the hospitals who erode the care (and not just abortion care) they provide women as a cost cutting measures. I guess women are just considered expendable because there is always a 20-something year-old to take their place. However, and here’s the rub, that 20-something may never be born if delivery care isn’t improved. What an irony that would be.

Ken fry
4 months ago
Reply to  Chris Gavan

Chris. Your comment is right on and very informative. Thanks

Ken fry
4 months ago

Katie, thank you for bringing to light the health care concerns of women in rural communities of Wyoming. To me the most relevant sentence in your piece is Wyoming legislators don’t consider abortion health care. It is absolutely abhorrent and pathetic this is going on in our country. I understand that monetary considerations drive a portion of this for medical personnel. My ‘lay’ opinion is that anti abortion drives a large percentage of this exodus. And you can’t blame them.

Edith Lawrence Baker
4 months ago

It would have been more instructive if you had pointed out more openly what is really driving this issue, i.e.women do not have the right to choose their own health care, especially since Roe v. Wade’s demise. Worse still, as Ken points out, “WY legislators don’t consider abortion health care.” How preposterous and just plain stupid! OB/GYNs are seeing what is going on in Red States (like WY) that will put them in legal jeopardy. THAT is what is killing Moms. Call a spade a spade, please.

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