{"id":67989,"date":"2023-01-25T13:53:52","date_gmt":"2023-01-25T20:53:52","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=67989"},"modified":"2025-03-17T13:17:57","modified_gmt":"2025-03-17T19:17:57","slug":"nurse-midwives-improve-access-to-maternal-health-care-in-rural-areas-colorado","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/nurse-midwives-improve-access-to-maternal-health-care-in-rural-areas-colorado\/","title":{"rendered":"Nurse midwives needed to bridge rural-urban reproductive health care divide"},"content":{"rendered":"
<\/div>
\"mother
Nurse midwives are helping to provide better access to maternal health care in underserved rural areas in Colorado. Photo: Getty Images.<\/figcaption><\/figure>\n

Throughout the United States, rural communities suffer from a lack of a precious resource: access to maternal health care for women before, during and after they give birth. The problem springs from one of the country\u2019s great divides.<\/p>\n

Simply put, people who live in rural areas of the United States have dramatically poorer access to reproductive care than those who live in urban areas. For example, only about one-quarter of rural counties in the country has an obstetric hospital<\/a>, while all urban areas do. That disparity has sobering consequences. In rural communities, rates of maternal and infant mortality, maternal complications<\/a>, and teen births are significantly higher than in urban areas. The challenges are even more pronounced for people of color who live in rural areas<\/a>.<\/p>\n

The lack of perinatal care \u2013 and more broadly, inpatient care \u2013 in rural communities can lead to compounding problems. For example, substance use disorders, mental and behavioral health challenges and medical problems like diabetes and hypertension may go unaddressed and lead to poor outcomes, not only for pregnant and postpartum people but also for their children.<\/p>\n

Colorado faces these challenges. In 2022, 13 counties in the state had no hospital<\/a>, and two had neither a hospital nor a clinic. The unsurprising result is a lack of providers, including physicians, registered nurses, and advanced practice providers, such as physician assistants, certified nurse-midwives and clinical nurse specialists, said Dr. Amy Barton<\/a>, professor and Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing with the University of Colorado College of Nursing.<\/p>\n

\u201cEven though we may experience a nursing shortage in the Denver metro area from time to time, it\u2019s nothing like the shortage of providers in rural communities,\u201d Barton said.<\/p>\n

\"Jessica
Jessica Anderson<\/figcaption><\/figure>\n

Barton is working with colleagues, including Jessica Anderson<\/a>, director of Midwifery Services and associate professor of Clinical Practice at CU Nursing, to close the maternal health care chasm by implementing telehealth services, bolstering educational opportunities in local communities and strengthening the diversity of the nursing workforce.<\/p>\n

Confronting a rural care crisis in obstetric services<\/strong><\/h2>\n

These and other efforts are critical in a country where health care crises like the COVID-19 pandemic and opioid scourge are \u201cactually amplified in rural areas\u201d and worsened by provider scarcity, Barton said. That\u2019s due to economic pressures that today threaten hundreds of rural hospitals with closure<\/a>.<\/p>\n

Barton and Anderson have been at the forefront of finding ways to stave off that devastation with practical measures. They collaborated on a 2021 paper<\/a> that addressed the challenges of providing perinatal care in rural areas. The paper suggested opportunities to improve care, including \u2013 among others \u2013 providing telehealth services; increasing the numbers of certified nurse-midwives, physician assistants and other advanced care providers; and bolstering statewide networks<\/a> that develop evidence-based initiatives to improve pregnancy outcomes.<\/p>\n

Anderson is also a member of an American College of Nurse Midwives task force<\/a> that focuses on meeting the needs of midwives who serve rural areas.<\/p>\n

COVID opens the door to remote health care<\/strong><\/h2>\n

An inspiration for bridging care gaps for people in rural and other underserved communities \u2013 including those facing transportation issues, economic challenges and language barriers \u2013 came from an unlikely source: the COVID-19 pandemic.<\/p>\n

\u201cOne positive effect of the pandemic is we began focusing on providing virtual health care for our patients,\u201d Anderson said.<\/p>\n

\"Dr.
Dr. Amy Barton<\/figcaption><\/figure>\n

The new emphasis led to an initiative to help women get vital prenatal care through virtual appointments and equipment to monitor their health at home, as well as clinic visits. Certified nurse-midwives \u2013 registered nurses who complete master\u2019s-level midwife education programs approved by the national Accreditation Commission for Midwifery Education \u2013 lead the effort, which is slated to begin this spring. Participants will be recruited from the University Nurse-Midwives \u2013<\/a> Center for Midwifery-Anschutz Medical campus practices and from the CU Center for Midwifery \u2013 Longmont <\/a>clinic.<\/p>\n

A rural-urban divide for maternity care<\/strong><\/h2>\n

Too often, access to maternal and perinatal care is determined by where a person lives. Anderson noted that women have access to services from certified nurse-midwives at a variety of sites along the Front Range. The options have grown. For example, the UCHealth Center for Midwifery Lone Tree \u00a0\u2013 Highlands Ranch Hospital<\/a>, which opened in 2020, has grown impressively, with birth volume increasing, the number of clinic days doubling and the hiring of a fourth midwife now underway.<\/p>\n

But that success only highlights the shortfall of birth services in rural areas and the need for more options like the telehealth pilot, Anderson said.<\/p>\n

\u201cWe know that patients will still have to drive to some appointments,\u201d Anderson said, \u201cbut having to make only a few is more palatable than 13 trips. Hopefully, this program will help reduce the barriers that people face accessing perinatal care.\u201d<\/p>\n

Improving health care in rural areas starts with its residents<\/strong><\/h2>\n

CU Nursing also aims to help communities lacking health care options cultivate their own resources. The overarching goal: build a workforce that not only provides women\u2019s health services but also reflects the communities they serve. Barton called it a \u201cgrow your own approach\u201d to removing barriers to care.<\/p>\n

\u201cIt\u2019s easier to develop providers locally as opposed to convincing someone from an urban area to move to a rural one,\u201d she said. \u201cYou really want people who are engaged in and committed to their communities.\u201d<\/p>\n

Among the seeds of that strategy is a satellite pre-nursing program set to launch this fall at Fort Lewis College in Durango, with the first nursing class planned for 2025, Barton said. The southwestern Colorado town of roughly 20,000 people sits in the middle of sprawling La Plata County, which covers nearly 1,700 square miles.<\/p>\n

\"Carole
Carole Nighswander<\/figcaption><\/figure>\n

In addition, CU Nursing is working toward building a more diverse workforce. According to the American College of Nurse Midwives<\/a>, Blacks make up just 7% of all nurse midwives in the United States. In response, CU Nursing created the Nursing Midwifery Diversity Scholarship to attract more students from various underrepresented communities. Anderson said the Nurse Midwifery program has thus far awarded two scholarships.<\/p>\n

The scholarships attempt to change the face of health care in towns and neighborhoods where resources are few and careers in medicine a remote goal at best, Barton said.<\/p>\n

\u201cStudents from marginalized and underserved populations often don\u2019t see themselves in the role of health care provider,\u201d she said. \u201cPatients are more comfortable with providers who look like them and speak their language. That can help to overcome an inherent lack of trust.\u201d<\/p>\n

Anderson added that, more broadly, the mission of CU Nursing is to educate nurses who will \u201cinfiltrate all areas that have access needs. We are training students who want to go back to their communities and serve.\u201d<\/p>\n

From rural America to the urban classroom<\/strong><\/h2>\n

One of those was Carole Nighswander, who earned a master\u2019s degree in nurse-midwifery in 2021 from CU Nursing. The degree capped a long quest that deepened the roots she long ago sank in the soil of southwestern Colorado.<\/p>\n

Originally from suburban Chicago, Nighswander left home at 17 to attend Fort Lewis College in Durango. She studied French and anthropology but maintained \u201ca longstanding desire to be in reproductive health. I wanted to be a midwife when I was 16 years old.\u201d<\/p>\n

Nighswander met that aspiration in the late 1990s after she gave birth to her first child. She earned a degree from the National College of Midwifery<\/a> and worked in Durango as a community midwife for 18 years. At that point, with her third child grown and about to leave home, Nighswander decided to \u201cstart over\u201d \u2013 not by abandoning midwifery but by extending her commitment to it with additional education at CU.<\/p>\n

It was not an easy path. Nighswander\u2019s nearly two decades of experience as a community midwife didn\u2019t translate to any credits in the university system. She earned her associate\u2019s and bachelor\u2019s degrees in nursing while continuing to work delivering babies. She finally put that part of her life on temporary hold with her decision to pursue her graduate degree at CU.<\/p>\n

\u201cI had to be available to come to Denver for my clinical rotations,\u201d Nighswander said. \u201cAnd I wanted to give it my all.\u201d<\/p>\n

Rural residents return with new skills for improving care<\/strong><\/h2>\n

She took advantage of opportunities for remote learning that the program offered but said she found the greatest satisfaction in working clinical rotations in an urban environment and an academic setting.<\/p>\n

\u201cIt was incredible working with the Center for Midwifery and University Nurse-Midwives,\u201d Nighswander said. \u201cIt gave me a stellar example of collaboration to care for women.\u201d<\/p>\n

Nighswander earned her master\u2019s degree two-and-a-half years after she started. Valuable as her experience in the Denver metro area had been, there was no question that she would resume her career as a newly certified nurse-midwife in Durango. She currently works with Southwest Midwives<\/a>, providing care for people through pregnancy, childbirth and after delivery, as well as an array of women\u2019s health services.<\/p>\n

\u201cDurango is the community that raised me,\u201d Nighswander said. \u201cBabies that I delivered are now having their own babies. It\u2019s a gift for me personally to work here, but also for my families.\u201d<\/p>\n

Nighswander said nurse-midwifery offers communities \u201ca lifetime of benefits\u201d that include care that is \u201caccessible, relatable and affordable,\u201d producing strong outcomes. And is integrated into the lives of women and families.<\/p>\n

\u201cOur goal is to be there for them during pregnancy, birth, puberty and menopause,\u201d she said. \u201cWe recognize that these are impactful times that are also incredibly vulnerable. We want to partner with women and when needed, collaborate with our physician colleagues to achieve the optimal health outcomes all women deserve.\u201d<\/p>\n

A wider range of services than just maternal and obstetric care<\/strong><\/h2>\n

As a certified nurse-midwife, Nighswander also has a much wider scope of practice<\/a> and thus can attend even more closely to her patients\u2019 physical, social and emotional needs. That\u2019s critical in Durango, with its large geographic area served by an 82-bed hospital that has a birth center and handles a host of specialty care services. Nighswander and her colleagues play an essential role in working with obstetricians while also helping to address the needs of a community confronting teen pregnancies, substance use disorders, mental health issues and chronic disease.<\/p>\n

\u201cWe can serve some individuals with long-term conditions,\u201d Nighswander said. \u201cOur accessibility is critical in order to care for women while recognizing their needs and potential barriers to health.\u201d She added that she wants to help \u201clevel disparities\u201d of care among American Indian and Alaska Native women, who make up about 7% of Durango\u2019s population<\/a>.<\/p>\n

\u201cIt\u2019s important for me to bridge those worlds and represent where I came from in community midwifery and nurse-midwifery,\u201d Nighswander said. The chance to split her time between Durango and the Denver metro area while pursuing her graduate degree was essential to her continuing evolution, she added.<\/p>\n

\u201cThe program at CU was priceless,\u201d Nighswander said. \u201cWith three kids, it [wouldn\u2019t have worked] to go away from Durango for two-and-a-half years. It would have been an opportunity lost.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Throughout the United States, rural communities suffer from a lack of a precious resource: access to maternal health care for women before, during and after they give birth. The problem springs from one of the country\u2019s great divides. Simply put, people who live in rural areas of the United States have dramatically poorer access to […]<\/p>\n","protected":false},"author":2143,"featured_media":67994,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[4750,25,3413,212],"class_list":["post-67989","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-access-to-care","tag-labor-delivery","tag-midwifery-services","tag-womens-care"],"acf":[],"yoast_head":"\nNurse 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