1. Access to Maternal Health Care in Rural Communities: A Patient's Personal Story



my name is John even odder Lou I've been married to my husband for about will be four years this summer and we've lived here in Sanborn Iowa for the whole four years of our marriage we have two kids we just had one about two and a half weeks ago being in Sanborn Iowa there's not a lot of close hospitals the nearest hospital is in Sheldon Iowa which is 10 miles west of us and they're pretty small the only pregnancies they take in Sheldon are what's considered a normal pregnancy before I got married I found out I had a pulmonary embolism blood clots in my lungs that later on who're going to play a factor in two pregnancies with being on blood thinners and things like that I've been with Mackay now for Oh probably five six years so she's been aware of my history for a while my name is Kimberly McKee I'm an obstetrician gynecologist in Sioux Falls South Dakota and I am the clinical vice president of the ob/gyn service line for a very Health a very health is a health system that covers 72,000 square miles of South Dakota Minnesota and Iowa down into Nebraska and we have about 16 facilities that deliver babies we deliver 6,000 or so 6500 babies a year so we know a lot about rural you know a lot about what goes on in rural medicine 15% of our patients are American Indian about 10% are other nationalities half of our patients have are covered by Medicaid either as a primary or secondary insurance and so you know large geography very diverse patient population care planning for rural patients is is difficult sometimes ideally they're low-risk they have no medical issues they are normal weight they have every resource available to them but as it turns out not very many pregnancies in the United States of America are low-risk so when I looked for different providers near me both places told me that with a condition like mine with a blood disorder that I have they don't have the resources like the blood bank on hand at their hospitals to handle anything that would happen if something were to happen during delivery or during pregnancy so I was referred to Sioux Falls therefore back to dr. McKay in Sioux Falls a tavera prenatal care in general for a low-risk pregnancy is 13 visits 13 days out of that where you take time out of work 13 days where you need to travel for things like ultrasound and lab work add 90 miles a 90 mile drive to that and it makes things extremely complicated geography doesn't pick and choose the low risk and high risk patients the distance is huge I have to travel an hour and a half to an hour and 40 minutes for every doctor appointment and that's just one way so I'm on the road for over three hours for a 30-minute appointment every time that I need go to a doctor's appointment we have a very care which is one of the largest telemedicine networks in the United States we're looking to add more technology to figure out how to keep patients as close to home as possible until they actually need to come into their maternity center to deliver I had really good care the only thing that doctor McKay and I talked about just trying to cut back on some of the distance and the traveling and things like that through video conference calls or whatever just to do some of those would be really helpful I think that would be something that would be great to see happen in the future and the other pieces that Family Practice physicians are and nurse practitioners and pas are extremely important to part about how we provide care they aren't always as comfortable with obstetrics unless they themselves are personally providing that care in their community and so much of what we do in particular through our II care services has helped them feel comfortable with what they're seeing so when I went into labor with my second child I went to work that morning I had contractions on they usually tell you to go in when they're 5 to 7 minutes apart they tell me to come in when they're 10 to 12 minutes apart so I actually went to work that morning because they weren't that close yet but by the time I made it to the hospital I had my daughter within an hour of getting checked into the hospital so it was cutting it really close I'm glad we made it and everything worked out ok but yeah there's just a lot of extra things that we have to plan with you

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