The high cost of birth: New Mexico families travel farther for care

JayLyn Randles, a community health care provider and doula, said her own birth 40 years ago in Gallup inspired her to work with expecting families.

“I almost didn’t make it and neither did my mother,” said Randles.

Today, Randles sees many families in Gallup facing the same barriers her own family faced all those years ago. She helps them navigate pregnancy in a community where the closest labor and delivery unit is now nearly an hour away. She said many parents are forced to make difficult decisions about where they’ll give birth.

“You are not going to be able to be born at home, you have to be born elsewhere,” said Randles.

Randles is not a doctor, but she is part of a program training community health workers to fill the gaps left by the nurse and doctor shortages. The Improving Maternal Health Project is a program of Project ECHO at the University of New Mexico.

Dr. Trevor Quiner is co-medical director of the project. He said expanding access to maternity care will require thinking beyond physicians alone to doulas like Randles and other community health workers.

“If we’re just talking about OB-GYN’s, or family medicine doctors, or midwives, there’s not enough of us to take care of our communities and patients,” said Quiner.

But Randles said while people like her can help fill gaps, the closing of maternity units is creating a perfect storm.

“Much higher rates of postpartum depression, much higher rates of postpartum anxiety, and much higher rates of postpartum substance and alcohol use disorders,” said Randles.

OBGYN Dr. Connie Liu, who practices at Gallup Community Health, said she has seen delays in prenatal care or patients becoming disconnected from their providers as they navigate where they’ll eventually give birth.

“It really changes the decisions that people make about how they want to deliver. You know I do suspect that our patients who are at the highest risk who are the ones who are bearing the brunt of that risk,” said Liu.

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Liu said even when patients receive high-quality care elsewhere, having to leave one’s community is a trauma.

“You may have to spend extra time away from your family. I think that people feel really attached to their communities, especially where we live. And there’s a spiritual harm for our people who aren’t able to deliver close to land and to the community that’s really important to them,” said Liu.

Rehoboth McKinley Hospital officials said the closure was due to severe shortages in doctors and nurses. But Liu said, communities need this service.

When Gallup Community Health opened, Liu said they were hit with a $20,000 malpractice premium in order to bridge the gap and provide maternal care.

Liu said there’s a misconception that the resources are dry in rural communities, but in this case, the community stepped up and raised $24,000 on their own through a GoFundMe set up by a local labor and care delivery nurse.

“We really need to stop treating maternal care as an optional thing or something we provide when there’s enough money. The fact is that communities consider maternal care an essential service,” said Liu.

Liu said in the future she would like policymakers to implement something like EMTALA, a federal law that ensures access to emergency care regardless of ability to pay, for maternal health.

“What I really want is for policymakers to recognize that we really want to provide the care, but we need the help to do it,” said Liu.

Los Alamos Medical Center was just the most recent hospital to discontinue labor and delivery services this past June. It now refers patients to Presbyterian in Española and Christus St. Vincent in Santa Fe.

OB-GYN Dr. Sharon Ransom worked at the Los Alamos facility and has delivered babies at hospitals across northern New Mexico. She said the loss of services means childbirth classes disappeared, staffing dwindled, and patients lost access to around-the-clock support that’s meant to carry them through pregnancy, birth, and the postpartum period.

“I think that the community feels as though the rug has been sort of pulled out from under their feet in terms of the stability and the reliability of the program here at Los Alamos Medical Center,” said Ransom.

Ransom said hospitals often justify closing maternity units because of low birth volumes and the cost of maintaining the service.

But Ransom questions whether there is any number of births that would be enough.

“I don’t think there is a number that will satisfy the bottom line for the objectives focused on, because the objectives are not about how many women in the community can receive care, the objective is how much money does the facility lose with a low delivery rate,” said Ransom.

Quiner with Project ECHO said when local labor and delivery units close, families often face costs that extend well beyond medical bills.

“There’s the financial costs of gasoline, and time away from work, and hotels, and food. And a lot of times they have to take someone with them and so there’s cost for that person’s lost work,” said Quiner.

He added that when communities can’t provide maternity care, it can erode trust in the local health care system and even influence whether families choose to stay.

“If we want vibrant rural communities, they have to keep growing. This is really something that chambers of commerce, and employers, and all these folks should be focused on. Pregnancy care is not an option, it’s really the bedrock of a growing community,” said Quiner.

Quiner said communities should invest in sustainable models that support the full spectrum of maternal care.

This coverage is supported by the W.K. Kellogg Foundation and KUNM listeners like you.