Not even a flood could stop them.

Come hell or high water, four physicians from UCHealth Yampa Valley Medical Center take turns making the drive to Craig, Colorado, a small mining community 50 miles to the west that, like many rural places, does not have a lot of doctors.

Drs. Laurie LeBleu Vaszily, Elaine Stickrath and Kate Feller make their way along U.S. Highway 40, a two-lane road that twists and turns along the Yampa River with a sheer rock wall along one side. In the Spring and Fall, the doctors keep a keen eye out for wildlife – especially deer, careful to give them the right-of-way they deserve.

When U.S. Highway 40 closed to flooding in spring 2023, Dr. Jeff Chamberlain spent 30-45 minutes on a detour of rugged dirt roads, determined and eager to see patients.

Like her colleagues, Dr. LeBleu makes the drive several times a month. On a recent fall day, with a canopy of colorful leaves shading part of the road, she went to see Breanna McAlexandar, among other patients. Breanna is a mother of two young children who came to the clinic for a checkup six weeks after delivering a healthy son, Oliver, who weighed in at 8 pounds.

“It’s much more convenient to have this appointment in Craig,” Breanna said.

Having doctors come to Craig saves Breanna from having to load up newborn Oliver and his sister, Estella, who is named after Breanna’s grandma and born on April 16, 2021, to travel to UCHealth Women’s Care Clinic in Steamboat Springs.

Having doctors at the Women’s Care Clinic in Craig has been “a huge help’’ to her, saving her time in the car, a drive down a winding road and giving her peace of mind that the doctors are only a few minutes from her home.

“We don’t have to plan our whole day around an hour drive to Steamboat, an hour for the appointment and an hour drive back,” she said.

Breanna is one of about a dozen or so women each day who come to the clinic for a variety of appointments, including annual checkups, Pap smears, general gynecology appointments, and post-partum and post-operative appointments.

Craig, with cold and snowy winters and temperatures near zero, has long been a coal mining town that draws elk hunters to the picturesque town created at the confluence of the Yampa River and Fortification Creek. Its hospital ended OB/GYN services in 2020.

Maternal deserts: Bringing health care to rural Craig, Colorado

According to the March of Dimes, more than one-third of U.S. counties are considered maternity care deserts, which are defined as counties without a hospital or birth center offering obstetric care and without any obstetric providers. That means more than 5.6 million women live in counties with no or limited access to maternity care services.

In Colorado, 37.5% of counties are defined as maternity care deserts compared to 32.6% of counties in the U.S. overall. Moffatt County, where Craig is located, is one of 24 counties that meets this definition.

“The number of patients impacted by maternal care deserts is increasing,” Stickrath said. “Rural hospitals are ending their maternity services, be it due to financial constraints or lack of providers willing to live in more rural areas.”

In rural areas across Colorado, 49.1% of women live more than 30 miles from a birthing hospital, with 6.4% of women in Colorado not having a birthing hospital within 30 minutes.

“Outreach to rural areas is so important,” said LeBleu. “Everyone should have access to health care, whether it’s in person or through video appointments. While we know patients seek care when they’re not feeling well, we also want them to engage in and seek routine health care services, be it annual appointments, yearly blood work or scheduling key health screenings like mammograms. We don’t want access to care to be an issue, which is why we’re so committed to our patients and traveling to them.”

Meeting patients where they are helps strengthen the provider-patient relationship. It’s a mission the physicians take seriously.

“I can’t remember the last time the physicians cancelled,” said Ted Morton, practice administrator in physician services at UCHealth Yampa Valley Medical Center (YVMC). “They’re committed to their patients.”

The appointments in Craig give doctors time to talk to pregnant moms about prenatal health, as well as what to expect when delivery draws nearer. Helping women who live in rural Colorado understand what to look for is important since the 30-minute mark is critical in an obstetric emergency.

“The standard is 30 minutes from decision to incision,” said LeBleu. “In a true emergency, such as a placental abruption or an umbilical cord prolapse, we want 30 minutes or less from recognition of the problem to delivery of the baby in order to try and eliminate detrimental effects to the newborn and mother.”

The placenta pumps 600-700 cubic centimeters (cc) per minute at term, and a woman holds approximately 5,000 cc of blood during pregnancy.

“In a hemorrhage situation, a woman can bleed out her entire volume of blood in about eight minutes,” said LeBleu. “If there is a large abruption or post-delivery hemorrhage between here and Craig, we have major patient safety concerns.”

The making of a beautiful family

Shortly after their wedding five years ago, Breanna and her husband, Christopher, started trying to have a family. They eventually worked with a fertility clinic in Denver to conceive their first child.

“Minus a more in-depth ultrasound at the clinic in Steamboat, we were able to do our other appointments at the UCHealth clinic in Craig, which was a huge help and only two blocks from my work at the time,” said Breanna. “Otherwise, I would have had to take a half day off work to drive to Steamboat, have the appointment and then drive back, on top of trying to get appointments to align with Christopher’s work schedule.”

“We know if we offer care locally, patients are more likely to seek care. If we don’t offer the service, patients may forgo or delay care,” said Ryan Larson, director of clinic operations at YVMC. “In the case of women’s care, we know if the physicians don’t go to Craig, there could be patients who get behind on their OB visits, ultrasounds, annuals, etc. Providing care in Craig keeps our patients and the surrounding communities healthy.”

Certified nurse midwife Jennifer Allen delivered Estella in the birth center at UCHealth Yampa Valley Medical Center in Steamboat Springs.

“My labor experience was amazing,” said Breanna. “The nurses were fantastic, and randomly, Christopher had gone to school with one of them. It was comforting for him to know someone in the room because it gave us that small community feeling.”

After they celebrated Estella’s first birthday, Breanna and Christopher began trying for a second child. Thinking they would need to go down the fertility treatment path again, they were shocked when Breanna became pregnant naturally.

They found out she was carrying a boy – “I’m a planner and wanted to know” – and at 39 weeks and six days, her water broke at home around midnight on Sept. 9, 2023.

“We had been timing contractions prior to that, but they weren’t within the 5-1-1 rule of them happening every five minutes, lasting one minute each, for an hour,” said Breanna. “Christopher’s mom arrived to stay with Stella, and about 12:15 a.m., I called the birth center in Steamboat to let them know we were on our way.”

Baby Oliver makes his debut

By the time they were approaching Hayden, still some 40 miles from the hospital, Breanna’s contractions were increasing in strength.

“By the time I got the words, ‘He’s coming,” out of my mouth, the next contraction happened, and Oliver was in my arms. He was born at 12:53 a.m.,” said Breanna. “Christopher called 911, and we pulled over to wait for the ambulance.”

While they’d packed hospital bags, they didn’t think they needed to bring potential delivery supplies with them.

“I found a kitchen towel in the back seat and wrapped Oliver in it,” said Breanna. “The officer who met and waited with us gave us a blanket to help keep him warm. Christopher and I were in shock at what had just happened, but hearing Oliver cry was such a relief.”

“When a baby is delivered outside the hospital, we worry that the baby may need stimulation or suction if they don’t transition quickly after birth,” said LeBleu. “I also worry about maternal hemorrhage after delivery as medications, a blood transfusion or even surgery can be needed to stop the bleeding. Breanna and Christopher did everything right in this situation. They called 911, and she put the baby against her body to keep him warm, which was great thinking. Luckily, Oliver started feeding right away. And Christopher remained calm and ensured the safety of everyone.”

Back at home, Estella has embraced her role as big sister.

“She doesn’t always understand how fragile Oliver is being this little, but she’s doing well with him,” said Breanna. “We’ve been fortunate to have a lot of family time as we adjust to being a family of four.”

While it wasn’t how they wanted to welcome their son into the world, Breanna and Christopher feel blessed and grateful that Oliver was born without any complications.

“Shock, trauma, awe, amazement – we experienced all of those emotions,” said Breanna. “It would have been great to have an uneventful birth story to tell and to have delivered closer to home, but it didn’t work out that way. At least we’re able to receive the care we can in Craig, thanks to UCHealth.”

Medical care close to home: Offering health care in rural Colorado

In addition to obstetrical and gynecological care, UCHealth also offers heart and vascular, pain management, primary care with integrated behavioral health, and lab services in Craig.

“We offer these services in Craig and to the surrounding communities because it matters to our patients,” said Larson. “Access to health care is important to one’s overall physical, social and mental status. It helps with disease prevention, detection, diagnosis and timely treatment. And it contributes to a better quality of life and longer life expectancy.”

Outreach in rural communities is made possible not only through investments by UCHealth, but by physicians who are eager to support rural Coloradans.

“Outreach is part of the job, and that’s part of what attracts us to these roles,” said Stickrath. “It is financially difficult for many patients to travel for a routine appointment. It is often not possible to miss that much work for most patients either. If we want patients to have care, it needs to be accessible.”