Investigations of maternity deserts may continue into 2025

CHEYENNE — Wyoming’s legislative and executive branches are investigating the growing issue of maternity health care deserts, and conversation on Friday indicated the situation may require another year of study.

Five Wyoming counties — Crook, Weston, Niobrara, Big Horn and Sublette — have been classified as maternity deserts by the March of Dimes, said Franz Fuchs, senior policy analyst for the Wyoming Department of Health, during the Legislature’s Joint Labor, Health and Social Services Committee meeting in April.

He added that seven more Wyoming counties — Carbon, Platte, Goshen, Johnson, Washakie, Uinta and Lincoln — are considered “low access to maternity care” places.

The Labor Committee continued its discussion of OBGYN shortages on Friday, which is listed as the committee’s top interim topic.

Committee co-Chair Rep. Dan Zwonitzer, R-Cheyenne, said members are considering how the state could attract more specialty physicians or, if not, the possibility of cross-training family physicians and other medical professionals in delivery services.

The Governor’s Office Health Task Force is also investigating the issue through an OBGYN subcommittee, which was recently combined with the task force’s primary care subcommittee. Health and Human Services policy adviser Jen Davis, who serves on the task force, said the issue is “a super complicated topic in Wyoming, as it is with all rural medicine.” 

“Is there anything coming from the executive branch to say, ‘Here’s what we would like the Legislature to look at?’” Zwonitzer said. “And if so, will that be in the next 60 days?”

Davis said she didn’t know if the governor’s task force would have anything concrete by the committee’s next meeting in August. This discussion would likely continue in the 2025 interim session, she said.

“It’s complicated, and we just simply don’t have the amount of practitioners in Wyoming that we need,” Davis said. “This is a big topic, but I also get your point. We don’t want this to linger on because it’s a real issue for women in our state.”

Tense relations between midwives, OB-GYNs

Rep. Jeanette Ward, R-Casper, said there is a current issue of obstetricians unwilling to work with midwives for liability reasons. She proposed reducing regulations in tort reform to empower midwives and create a better working relationship.

“It is difficult sometimes to make everyone play nice, unless you require it by statute, right?” Zwonitzer said.

In order to qualify as a midwife in Wyoming, an individual must either graduate “from a midwifery education program accredited by the midwifery education accreditation council” or a similar organization, or have five years’ experience practicing as a licensed or certified midwife in another state.

All midwives must also be certified by the North American Registry of Midwives, or a similar organization, according to the Legislative Service Office. The board, however, is not allowed to require a midwife to have a nursing degree or diploma to practice in Wyoming.

Davis said there is a place for midwives, doulas and family practitioners in this conversation, but not without some coordinated effort. One of the big issues is getting agreements for physician oversight of deliveries performed by a midwife.

Many physicians don’t want to take on the liability of the delivery because they were not involved in the prenatal care, she said.

“Midwives are not going to be able to practice at the top of their scope if there are no physicians who are willing to assist them at the hospital level if there is a problem with the birth,” Davis said.

Rep. Sarah Penn, R-Lander, suggested looking at other states to see where physician oversight of certified nurse midwives, or other midwives, may not be required. She acknowledged the removal of this requirement could create “a lot of turf wars,” but said it might be necessary, given Wyoming’s unique rural landscape.

“We have a situation where we just simply do not have the ability to provide for these women,” Penn said. “We’re talking about requiring women to drive hours in order to deliver, which, unfortunately, means we have babies in the car.”

Davis said the problem with this is it’s either hospital policy, which the state has no control over, or on the physician to decide whether they want to take on that liability. Ward asked if it would help to pass legislation that would require a hospital receiving taxpayer or state funding to give admitting privileges to midwives.

“You still have to have the physician buy-in to do it,” Davis said. “You could require the hospital, maybe, to give midwives privileges. But if it requires a surgical intervention, the surgeon still has to do that. If it requires a C-section, you still have to have the physician willing to do that.”

Uplifting rural residency programs

Wyoming Medical Society Executive Director Sheila Bush said lawmakers should shift their focus to uplifting rural residency programs, which the country is in desperate need of, and away from “buying more student medical seats.”

Medical residency students in densely populated cities, such as Chicago, rarely get the opportunity for hands-on training, Bush said. Residents may be guided in their training, but don’t get the chance to actually perform procedures themselves.

Residency programs best work when they’re affiliated with a university or medical school, Bush added.

“I think the residency deserves our focus,” Bush said.

In the 1970s, Wyoming declined to enter in a partnership that would receive federal graduate medical education funding, she said.

“As a result, we don’t have the opportunity to reenter that partnership,” Bush said. “We’re the only state in the country where there is no federal funding support for our residency programs.”

Residency programs are either fully sustained on generated revenue by the clinic itself, or through capture enhanced reimbursement as a Federally Qualified Health Center.

“In terms of ongoing, we know that number directly, it’s in our budget each year,” Bush said. “And that’s, you know, what it requires for the state to invest in those residency programs to provide for their sustainability.”