Moms and babies navigate risks in Wyoming maternity care desert

Wyoming women have quietly shouldered a health care dilemma for years: A growing scarcity of obstetric resources has made pregnancy, labor and childbirth increasingly tricky in widening swaths of the state. 

Gwenith Wachter experienced the erosion first-hand through 23 years and five pregnancies. She gave birth to her first three children in her hometown of Riverton, back when the local hospital was a bustling place staffed with veteran nurses and doctors who worked well together, she said. 

By the time her fourth came along in 2016, however, “none of those same nurses were still there anymore,” she said. “And that experience wasn’t super great. And then they quit delivering babies shortly after, like literal weeks after.”

With the Riverton hospital’s labor and delivery unit shuttered, Wachter had to drive 26 miles to Lander to deliver her fifth child in 2021. The doctor and nurses there were professional and capable, she said, (they may have saved her life following a dangerous hemorrhage) but traveling nurses were essentially strangers to her.

Having watched the decline of Fremont County’s resources — from two hospitals and several obstetricians to one labor and delivery facility and a single OB — Wachter believes the current situation is unacceptable. 

“We absolutely have to have OB services over here [in Riverton],” she said. “I just think it’s insane. It puts women at risk.”  

Wachter’s fears bear out in the numbers. More than 15% of Wyoming women had no birthing hospital within 30 minutes of home in 2022, compared to 9.7% of women nationally, a report by the March of Dimes shows. Such distance from care comes with real risks. Women who live farther from delivery hospitals are more likely to experience adverse medical outcomes. Babies are more likely to require a stay in the neonatal intensive care unit.  

West central Wyoming is not unique, but with one obstetric practice, one midwife and one birthing hospital serving the general population of Fremont County — a New Hampshire-sized area that’s home to nearly 40,000 people — the situation here offers a window into the challenges, and consequences, of limited maternal health services.  

(Patients on the Wind River Indian Reservation have arguably better access via doctors who contract with tribal health services to deliver babies, which will be examined later in this series.) 

To be clear, a woman laboring in Fremont County can deliver 24/7 in SageWest Hospital in Lander, but she would likely do so with a traveling doctor she’s never met. That possibility, along with the hospital’s poor reputation among locals, is prompting many Fremont County women to go elsewhere — Thermopolis and Jackson, Billings, Salt Lake and Denver. 

Traveling, of course, requires money, childcare, work flexibility and other resources that not everyone has. And then there’s the issue of winter travel in Wyoming, where icy storms regularly close roads and ground air ambulances. 

“Who wants to travel to a different state at the end of their pregnancy?” Wachter asked. “To give birth, especially in the wintertime? So yeah, that I think is ridiculous, and puts you at way greater risk for complications.”

The OB shortage is not isolated to Fremont County. Hospitals in Rawlins and Kemmerer stopped offering delivery services in recent years. Other counties like Sublette and Weston don’t have birthing facilities at all. 

“It’s a huge problem,” Jen Davis, Gov. Mark Gordon’s senior policy advisor on health and human services, said of the dearth of maternal health care.

And it’s one with dire circumstances, according to University of Wyoming Professor and midwife Esther Gilman-Kehrer, who delivered babies in Laramie for many years. 

“I think the fears are that women are going to die,” Gilman-Kehrer said. “I would envision that at some point, we’ll see deaths related to you know, we didn’t have enough people. We didn’t have enough people to look after this person.” 

The challenge also raises existential questions for precarious communities. How, after all, can a community survive, much less thrive, without being able to reliably protect mothers or bring babies into the world?

In the coming weeks, WyoFile will examine the facets of this complicated problem — the economics of rural OB-GYN practice, the hurdles to attracting and retaining providers, the roles of powerful institutions — and explore potential solutions. 

For all its players and complexity, at heart, the challenge is borne by women undergoing the most simple and fundamental of human experiences. 

So that’s where we’ll begin, with the moms. 

Trauma and fears 

When she became pregnant with her second child earlier this year, Lander farmer and attorney Bailey Brennan chose to seek maternal health care out of state. 

The trauma of her first delivery largely drove her decision.  

It was the spring of 2021, and more than a month before her due date, when Brennan awoke one morning to discover she was bleeding. 

She had experienced complications before, including an earlier pregnancy that ended in miscarriage, and felt something was very wrong. She called her Jackson midwife, who instructed Brennan to get to the hospital in Lander — deeming it too dangerous to drive to Jackson, where Brennan had grown up and planned to deliver. 

Brennan would learn later that two related complications had developed, putting both she and the fetus at serious risk. 

But at the Lander hospital that day, after staff ran Brennan through tests and informed the obstetrician on call of the situation, he prescribed bed rest at home, she said. When the nurse told her she was being released, she grew furious. “I was like, ‘I need [the obstetrician] to come in, I need a second opinion and I need him to know I’m a lawyer.’”

She paused. “That’s the only time I’ve ever done that.”

The doctor arrived, she said, and discovered she was going into labor. A helicopter soon flew her to Salt Lake City. Days later, after doctors discovered the baby was in distress, her daughter was delivered via cesarean section. She was five weeks early.

The bleeding, the flight, the physical exhaustion of laboring, the shock of caring for a premature newborn — it shook Brennan. When she and her husband started thinking about having another baby, Brennan said, she knew her risk would be elevated. And when she started calling around in Fremont County, she found only two OB-GYNs were accepting patients. 

She ultimately decided Salt Lake City was the best option despite it being nearly 300 miles and multiple mountain passes away. They found a maternal-fetal medicine doctor there and saw a provider in Thermopolis for prenatal care. In October, the family moved into an Airbnb in Salt Lake City to await her due date. On Oct. 27, Brennan had a successful vaginal birth after cesarean, delivering a daughter. Most Wyoming hospitals, including Lander’s, do not allow mothers to try for VBACs, as they are commonly known, due to risk of rupture. (That’s despite the positive health benefits of vaginal births). 

Brennan wishes there were better options in Fremont County. “It didn’t really occur to me when we decided to move to Lander that availability of medical services would be a question,” she said. 

A luxury not all can afford

Brennan’s discovery of her scant options echoes many Fremont County families’ stories. 

By the time Kristen Gunther started thinking about a second pregnancy, less than two years after the birth of her son, she found that none of the four providers previously available through her clinic were still delivering. “So now it’s like ‘oh, now we kind of start from scratch,’” the Lander resident said.

Gunther’s first pregnancy went smoothly until she hit 39 weeks. That’s when her blood pressure spiked, and doctors diagnosed her with preeclampsia, a leading cause of maternal deaths worldwide. 

In the flurry that followed, doctors induced Gunther’s labor, gave her magnesium to prevent preeclampsia-related seizures and administered an epidural. After several hours of labor, she delivered her son. 

The high-risk designation that comes with her age and medical history has had a strong influence on her family’s decision making about her second pregnancy. 

Gunther is due in March. After much consideration, she and her husband are now planning to fly to Maryland to stay with her parents for the birth and postpartum period.  

She would love to have the baby in Wyoming, she said, but has to weigh the medical risks along with the logistics of travel and childcare for her toddler son. She considers herself fortunate to have enough work flexibility to make Maryland an option. “It’s going to be a huge challenge and it’s an insane privilege that we can even consider it,” she said in a text.  

Stress of travel

Gordon’s health policy director Davis has heard many stories like Gunther’s. “But that’s not an option for everybody,” she said. 

Traveling is suboptimal for reasons beyond time and cost. The farther a woman travels for maternity care, the greater the risk of maternal morbidity and adverse infant outcomes. 

In rural areas of Wyoming, 22.4% of women live over 30 minutes from a birthing hospital compared to 5.2% of women living in urban areas, according to the March of Dimes. 

And yes, traveling for health care has always been a given for many of Wyoming’s rural residents. But Fremont County is home to the state’s 9th and 13th largest towns — these aren’t specks on the map. Riverton, the larger town, hasn’t had a labor and delivery unit since 2016. 

There were 608 births in Fremont County in 2010, a number that fell last year by 44%, to 339, according to Wyoming Department of Health data. (Wyoming’s birth rate has also fallen statewide in that time). 

Fremont County families had 442 babies last year, according to state records, meaning that 103 — almost one in four — babies were born out of county. 

Losing confidence  

Nature Conservancy restoration scientist Maggie Eshleman initially saw an obstetrician in Lander when she became pregnant in 2021, but the office, which was relatively new, never seemed to have her test results, she said. 

She found a provider in Casper instead. The decision to seek care elsewhere proved a blessing in disguise, she said, because a swarm of complications ensued. At one point, she was life-flighted to Denver to treat pregnancy-related kidney stones and an infection. 

She and her husband ended up driving to Casper roughly a dozen times through the now infamous winter conditions of 2022-23, she said. They ultimately stayed for the final month because the weather was so severe. His employer has a Casper office, and she could work remotely. 

The birth went smoothly; a favorite nurse ended up delivering her son.

Other mothers, like Riverton dispatcher Val Hinkle, have found themselves shuffled through doctors as provider turnover churns. Hinkle, whose first child was delivered 11 weeks early via C-section in 2017, has since established care with two midwives that left the county, including one she loved. “I just keep establishing a patient/doctor connection with these people, and they keep leaving.”

Even talking with other Riverton moms, she said, “it just seems like it's incredibly difficult to even find anybody.” 

Hinkle’s first pregnancy was a frightening ordeal; her son weighed only 2 pounds and spent 55 days in the NICU in Denver. At this point, she said, her desire to have another child has dampened. 

“I feel like it's pretty terrifying honestly,” she said. “Especially being high risk. It definitely changes the aspects of my life where I'm like, ‘oh, yeah, I want to have another baby,’ because it's just scary.”

Riverton mom Chelsee Kucera delivered her son in Thermopolis earlier this year. Most of the Fremont County moms she knows have done the same, she said. That’s despite Lander being closer, and the Hot Springs County facility being on the other side of the narrow, windy and often precarious Wind River Canyon.

In her case, she had plenty of time to get to the hospital. Just a few days after she delivered, however, a rock slide in the canyon caused hours-long traffic delays, she said. 

Unforeseen complications 

As a resident of Dubois — the small, isolated mountain community in Fremont County’s northwestern corner — Sara Domek understood from the outset that traveling to deliver a baby in a larger town was part of the deal. 

Her closest choices were Jackson, which lay over Togwotee Pass, and Lander, which lay on the other side of a stretch of a highway notoriously strewn with wildlife. Both are roughly 75 miles away. 

Friends and peers had more positive reviews for Jackson’s hospital than Lander’s, she said, and she already saw a Jackson OB-GYN, so that’s where she went when she became pregnant in late 2019. 

Her pregnancy entailed around 20 prenatal trips to Jackson, Domek said. She went into labor in the middle of the night in July 2020, triggering a late-night drive over the pass and south on a long, empty stretch of highway. 

“I remember this cow elk standing on the side of the road,” Domek said. “Luckily my husband was attentive and aware. I was not so much, because I was having contractions.”

Domek delivered her son at St. John’s Health, Jackson’s hospital. 

Unbeknownst to anyone, however, part of Domek’s placenta was retained in her uterus. That interfered with breastfeeding, which prompted many trips back and forth to Jackson to see a lactation consultant. All those hours in the vehicle likely contributed to a blood clot that developed in her leg about a week after giving birth — which doctors detected and treated with blood thinners.

On yet another trip to an OB appointment in Jackson soon after, however, she realized she was bleeding heavily. By the time they reached the doctor’s office, it turned alarming. 

Domek was rushed to emergency surgery — the retained placenta had caused a hemorrhage. She lost so much blood she almost required a transfusion. It happened so fast. 

“It was totally timely and so lucky that I was there,” she said. “Had I been here in Dubois and not happened to be over there, I don't know what my story would look like.”

When Domek thinks about having a second child, she worries about access to care, but also the sustainability of Jackson providers with the flood of patients from elsewhere. And the implications of a potential statewide abortion ban on reproductive health services. 

“Even though it was really scary having a baby during COVID, it is a different kind of scariness now,” she said. 

Medical moms 

Annalee Neary grew up in Crowheart — a tiny hamlet on the Wind River Indian Reservation southeast of Dubois. She went to nursing school at Central Wyoming College in Riverton, and did her clinicals at SageWest Lander before moving away to advance her education. When she began thinking about moving back and working near Lander earlier this year, her partner in Minnesota was scared. 

That’s because Neary is pregnant, and she has other health complications, including heart issues. The thought of moving to the middle of Wyoming far from specialists made him very uncomfortable, she said. 

The allure of family and community outweighed those fears, and they moved back. Neary is due in February, and their plan is to deliver the baby in Jackson. She is seeing a maternal health specialist there and plans to stay at a friend’s house.

Pregnancy in Fremont County is a blessing and a curse, Neary said.

“Pretty much everyone that I've talked to, it's like, there's this excitement: ‘I'm pregnant. This is great!’” But that soon gives way to, “‘Oh, shit. Now what?’” 

Lander pediatric nurse Aven Glazier also traveled for her second birth; she went to Jackson in October for a scheduled C-section. 

For her and other mothers, she said, it comes down to confidence. 

“There's one OB and one midwife right now that are serving non-reservation patients, and I just didn't feel comfortable with that option with no backup,” Glazier said. “It's something where you want to feel as completely comfortable as possible. Because it's just so important. 

“One choice isn't a choice,” she said. 

What’s next 

This provider paucity does not just touch mothers and newborns. It’s also a story shaped by doctors reluctant to join the rigorous world of rural health care. It’s about administrators balancing priorities to keep unprofitable labor and delivery wards open. About community leaders trying to ensure amenities to attract families. 

And it’s a story of overburdened physicians on the brink of burnout while others try to keep up with a wave of clients coming from outside their county borders. That’s coming up in part two. 

Correction: The name of Maggie Eshelman's employer was corrected. —Ed.