Thirteen counties in Kansas ceased to offer obstetric care services from 2013 to 2023 — a statistic that points to a shrinking availability of maternal care in Kansas, the lack of which can cause poor outcomes in pregnancy and delivery, overburdened hospitals and long drives for women seeking adequate care.

Jennifer Cunningham drove more than six hours for care at the University of Kansas Health System for two of her four, high-risk pregnancies because she didn’t feel the limited obstetrics department in her home area of Garden City could take care of her.

Garden City, with a population of about 27,000, serves as a local hub for shopping and other services in southwest Kansas. But with a declining number of providers who can deliver, Cunningham said, many of the women she knows are driving to Wichita, or further, to seek adequate care during their pregnancies and for deliveries.

It makes her worry for the future growth and prosperity of the town.

“If we can’t provide those basic services, we can’t continue to survive in general,” Cunningham said Tuesday during a KU Health news briefing on rural maternity care. “Local professionals, who are lawyers or other doctors or other professionals, they aren’t going to choose to come and live here if they can’t even have a baby here.”

Obstetric and family medicine providers are searching for solutions to the maternal health care deserts in everything from telehealth to student loan repayment incentives.

Bob Moser, executive director at the Kansas Center for Rural Health, said it is difficult for a rural hospital to retain or attract an OB-GYN doctor or someone who can provide those services.

“It’s challenging if you go out there and you’re the only provider providing obstetrical services, because you’re basically on call 24/7,” Moser said.

Additionally, these hospitals often lack consistent anesthesia services and wraparound, pre- and postnatal care.

“As more (communities) are dropping (obstetrical services), it falls to those who are remaining to take on that added burden,” Moser said.

Patients are driving further, sometimes an hour or more, to seek care throughout their pregnancies, which means more time off, additional child care and increased expenses.

Moser said the travel distance also increases the risk of roadside birth or a person in labor walking into the nearest emergency room, to be met with a nurse who maybe hasn’t delivered in 10 or more years.

Marc Parrish, a maternal-fetal medicine specialist at KU Health, performs telemedicine services with patients across the state.

Parrish was Cunningham’s caregiver and performed some of her check-ups via telehealth and a partnership with an ultrasound clinic in Garden City.

Parrish said it’s like being “in a fight with one hand tied behind your back.” Telehealth can only be as good as what the local partner is able and willing to provide, he said.

Michael Kennedy, a family medicine physician and rural health expert with KU Health, said he also sees a lack of obstetric exposure during residency programs and not enough effort to get doctors in training to experience rural hospitals.

There are several loan repayment programs on a state and federal level that incentivize doctors who specialize in OB-GYN services or choose to serve in health professional shortage areas. Kennedy and others on the panel said these programs could be an effective way to alleviate some of the maternal care shortages.

Maternal care deserts exist throughout the country, including in urban areas.

Sandra Stites, an OB-GYN and chief medical officer at Vibrant Health in Kansas City, Kansas, said if care is not culturally accessible, even folks in an urban setting can be in a care desert that can endanger their pregnancies.

Medical professionals on the panel said solutions for all of these shortages will require collaboration across local, regional, state and national advocates.

Carrie Wieneke, OB-GYN clinical service chief for KU Health, said access to maternal care is on the 2024 list for the top 10 patient safety hazards.

“We’re going to have to work together with lots of people at lots of levels, not only in Kansas City but Topeka and D.C., to really be able to provide the care that people deserve,” Wieneke said.