MISSION, S.D. (Dakota News Now) – In rural South Dakota, miles often separate expectant mothers from healthcare.

“A lot of women out here are left without any maternity care options,” said Rachel Kocak.

In Mission, moms mark their due dates and calculate miles to the nearest delivery location. Rachel Kocak, expecting her third child, said one option just closed.

“We used to have a birthing unit, I think up until a couple of months ago, and they lost their OB. So, Winner is no longer delivering babies,” Rachel said.

Some mothers remember when they could reach the hospital within a five-minute drive.

“IHS, for tribal members, they don’t deliver babies out here or provide prenatal care,” Rachel explained.

Families hope to reach the hospital before the baby arrives.

“So women either have to drive to Valentine, which is about 30 to 35 minutes from Mission, they can go to Wanblee, which is on the Pine Ridge Reservation, or they have to go to Pierre, Rapid City, or Sioux Falls,” Rachel said.

And if the roads are bad.

“I think there are a lot of babies who are unintentionally born at home. So it’s a tough place, I think, for mothers,” Rachel said.

The March of Dimes breaks down government data, showing a large portion of rural South Dakota as a maternity care desert, requiring travel of 38 or more minutes to reach an appointment or delivery room. The infant mortality rate is higher among native American babies born, compared to other races.

Health Department maps show counties in medium blue have 56 infant deaths per 100,000 births. Dark blue counties have three times as many. Grants aim to increase the number of healthcare workers, and funding supports a doula workforce program.

Kocak would like to see doulas and midwives available.

“Great opportunity for anyone who wants to become a home-birth midwife out here. The birth rate is still, I’m not sure what it is, but it’s high. There’s still a growing young population, and just not enough people to help deliver the babies,” Rachel said.

If care were closer, the outcomes could be brighter.

“You know, having the support network can make a huge change in the lives of these young, you know, these babies and young mothers who are building new families,” Rachel said.

The South Dakota Department of Health released a statement to Dakota News Now, which can be read in full below.

The South Dakota Maternal and Infant Health Task Force was created in 2025 to bring partners together to help improve the health and wellbeing of mothers and infants across the state. Their 5-year strategic plan was recently released, which has three priority areas: postpartum care to improve maternal health; safe sleep education and prevention strategies to protect infant health; and systems of care work that improves access, coordination, and quality of care statewide. One of the strategic plan activities that is supported by Rural Health Transformation is the creation of Regional Maternal and Infant Health Hubs, which will create a hub-and-spoke network connecting hospitals, clinics, tribal health services, and community organizations. These hubs will improve care coordination, strengthen referral pathways, and expand access to services for families in rural and tribal communities.