Frontiers: The People Powering Rural Maternal Care

00:00:00:18 - 00:00:10:16
Ashley Blake, D.O.
You have to love it. You have to love your job. You have to love your community. And really, it helps if you just think your feet in and embrace it.

00:00:10:19 - 00:00:32:28
Julia Resnick
Welcome back to Frontiers, a rural maternal health podcast series from the American Hospital Association. I'm your host, Julia Resnick. Voice you just heard was Dr. Ashley Blake, an OBGYN in Cynthiana, Kentucky. In our first episode, we heard from rural hospital leaders who made the choice to invest in maternal care and keep it close to home. But leadership alone isn't enough.

00:00:33:01 - 00:00:49:15
Julia Resnick
Even the most committed leaders can't sustain maternal care without the people to provide it. Today, we'll hear how rural hospitals are rethinking the maternal care workforce so that they are prepared to care for the next generation of rural families.

00:00:49:18 - 00:01:18:00
Julia Resnick
In rural communities, maternal care is deeply personal. Providers care for neighbors, coworkers, and oftentimes generations of the same families. Those relationships create a sense of purpose and connection. Many of the rural clinicians we spoke with chose rural medicine because of those relationships. At the top of this episode, you briefly heard from Dr. Ashley Blake, an OBGYN at Harrison Memorial, her hometown hospital.

00:01:18:02 - 00:01:20:09
Julia Resnick
Here's Dr. Blake.

00:01:20:12 - 00:01:43:02
Ashley Blake, D.O.
One of our labor nurses - I now see her sister, I see her mother in law, I see her cousins. They send pictures of me delivering her babies. They're three year-olds now that I delivered. Or color me pictures and bring me in gifts. You know, it's just like that is a reward and a benefit that no one like prepares you for how much of an impact it has.

00:01:43:07 - 00:01:54:21
Julia Resnick
In our first episode, you also heard from Jill White, chief nursing officer at Hutchinson Regional Medical Center in Kansas. She returned to her hometown to continue caring for the community that helped shape her.

00:01:54:24 - 00:02:19:13
Jill White
So I grew up here in Hutchinson, moved here at a very young age and spent my growing up years here through high school. I did move away, but quickly found that I missed it and wanted to move home and be back close to family. And as I've spent my adult years here, there's so much value in the size of the community that we are in raising a family here.

00:02:19:14 - 00:02:29:26
Jill White
I'm friends with people I work with, and we see each other, you know, outside of work, and there's so much to be said for that. It really is a big family.

00:02:29:28 - 00:02:40:13
Julia Resnick
If big families and relationships are what make rural medicine so rewarding, how do you help clinicians and training see the value of practicing in rural communities? Here's Dr. Blake again.

00:02:40:18 - 00:03:04:23
Ashley Blake, D.O.
I think that that is probably our biggest struggle, because all of the training takes place in these large cities that have targets, and they have Starbucks and they have malls and all the things that you need. And then you get your med school occurred there, your residency occurs there. And then the thought of going to somewhere without those things, I think, is sometimes hard for some physicians.

00:03:04:24 - 00:03:10:27
Ashley Blake, D.O.
The thing that makes it work the best is if you just plant your roots and, you know, embrace it and enjoy it.

00:03:11:00 - 00:03:26:10
Julia Resnick
But for rural hospitals to build a sustainable maternal health workforce, they have to create opportunities for students and trainees to experience rural practice firsthand. At Western Wisconsin Health, CEO Eilidh Peterson has made building that pipeline a strategic priority.

00:03:26:13 - 00:03:28:15
Eilidh Pederson
That pipeline starts at

00:03:28:15 - 00:03:57:27
Eilidh Pederson
different levels of training, so we do host rural residents. That's a wonderful opportunity to expose new physicians to rural medicine. We partner with all of our local colleges and universities to host midwifery students, to host medical students. And then recently, we've actually expanded the way in which we've hosted students to create that passion for rural medicine, namely obstetrical care.

00:03:57:27 - 00:04:22:10
Eilidh Pederson
So we do host high school students through our local scrub pumps. And then we started mentoring middle school students. We call it Mentored in Medicine. They are exposed to various careers in healthcare. And of course, we're going to talk to them about obstetrical care and the joys of entering into that practice. So we're starting early, but really through many channels and pipelines.

00:04:22:13 - 00:04:44:21
Julia Resnick
The future of rural maternal care is multidisciplinary teams where patients receive the right care from the right provider at the right time. For many rural hospitals, building that kind of team may be one of the most important strategies for sustaining maternal care into the future. Eilidh Peterson believes that diversity within the workforce has been one of the keys to strengthening maternal care at Western Wisconsin Health.

00:04:44:28 - 00:05:12:06
Eilidh Pederson
A diverse workforce has really been the number one solution for us. Not putting all of our eggs in one basket, but making sure that we have a number of different professionals for patients to choose from. To extend and expand our pipeline from where we can get qualified obstetrical providers has really been key. And a diverse workforce is really critical. For us

00:05:12:06 - 00:05:23:13
Eilidh Pederson
that looks like certified nurse midwives, obstetricians, family medicine with OB, and we'd love to hire our family medicine with OB and C-section.

00:05:23:15 - 00:05:51:07
Julia Resnick
One important member of that multidisciplinary team is the family physician with obstetrical training, often called an FMOB. In many rural communities, these physicians provide prenatal care, deliver babies including C-sections, and care for entire families, making them an important part of a sustainable workforce. Benjamin Anderson, CEO of Hutchinson Regional Medical Center, has become a strong advocate for expanding high quality training opportunities for FMOBs.

00:05:51:09 - 00:06:19:22
Benjamin Anderson
This is a passion point for me and I've seen the very best of full scope family medicine. There are a handful of residencies, maybe a dozen or two dozen residences in the United States that are consistently graduating board certified family physicians that are ready to do surgical OB. it's important to know the difference, and a lot of them are in training in what are called unopposed family medicine programs, where they're not competing against any other specialty for their numbers.

00:06:19:22 - 00:06:42:27
Benjamin Anderson
They're graduating with 200 deliveries and 101 hundred plus primary C-sections, where they are the surgeon, the primary surgeon on that. And so those are programs where there's a strong relationship between the OBGYN department and the family medicine residency. So they're getting that kind of exposure and that kind of direct, hands on experience. And so those are the ones from which we recruit.

00:06:42:27 - 00:07:02:21
Benjamin Anderson
And so there is a need to grow the number of unopposed family medicine slots in the United States. And there's some rural hospital transformation funds that are focusing on that to, to the program's credit. But those are the ones that it's really important to, to, to look at. We're looking for the Peyton Manning and Serena Williams of that. In Hutchinson

00:07:02:21 - 00:07:14:07
Benjamin Anderson
we're a larger community to accommodate full scope family medicine. But right on the right, right on the brink, we believe we have the capacity for and the volume to accommodate both.

00:07:14:09 - 00:07:38:25
Julia Resnick
Certified nurse midwives are another example of how rural hospitals are expanding the maternal care workforce. Working alongside physicians and nurses, certified nurse midwives provide prenatal, labor and delivery, post partum, and well woman care. Let's meet Samantha Crouch, a certified nurse midwife and director of the nurse midwifery program at University of Arkansas for Medical Sciences, also known as UAMS

00:07:38:27 - 00:07:40:16
Samantha Crouch, DNP
Midwifery care

00:07:40:19 - 00:07:42:01
Samantha Crouch, DNP
is, I mean, the

00:07:42:01 - 00:07:43:10
Samantha Crouch, DNP
reason that people are drawn

00:07:43:10 - 00:07:44:15
Samantha Crouch, DNP
To it,

00:07:44:15 - 00:08:14:26
Samantha Crouch, DNP
for a few different reasons. Really, the art of midwifery and the midwifery model of care, which places a really big emphasis on building trusting relationships within the health care provider and patient relationship. We spend a lot of time focusing on social determinants of health. And what's the holistic picture here for this patient? Not just checking in on mom and baby and what are the vital signs and what do the heart tones sound like.

00:08:14:27 - 00:08:51:26
Samantha Crouch, DNP
But really, how are you feeling about, you know, how is your partner feeling? What does your support system look like? What things are you nervous about? And really diving into some of the more emotional and psychological components of pregnancy. That really comes through for a lot of people and translates really well to rural health, because we do have a lot of specialized training in providing community based health care and providing continuity of care, which builds trust and builds partnerships and improves outcomes as well.

00:08:51:28 - 00:09:14:16
Julia Resnick
Recognizing the important role midwives can play, UAMS is investing in the next generation of the profession. This fall, they are launching the state's first publicly funded nurse midwifery education program to help address the growing need for maternal care providers and expand access to midwifery services across rural Arkansas, including many communities where midwifery services are not currently available.

00:09:14:19 - 00:09:57:27
Samantha Crouch, DNP
I have spent a lot of time looking into and kind of reflecting on as we've built is how to create better recruitment and better awareness about nurse midwifery as a career path in our areas across the state that don't currently have exposure to midwifery within the workforce. Trying to find ways where we can get certified nurse midwives practicing in some capacity, even just a day or two a week, so we can create exposure for the nurses and for the families of these rural communities, so that we can then recruit them into our program and send them back to their communities to practice.

00:09:58:00 - 00:10:11:22
Julia Resnick
The greatest impact comes when these professionals work together as a team. For Hutchinson Regional, building those connections across disciplines has transformed the way they deliver maternal care. Chief Nursing Officer Jill White shares more.

00:10:11:25 - 00:10:36:16
Jill White
OB itself can't sustain the health system. So how do we layer that to where you know someone who has that family med background, they can care for that entire life continuum, starting with OB and newborns, building that practice, building that relationship with their with their patients and families. And that really has had a huge impact in our delivery numbers as well.

00:10:36:19 - 00:10:41:02
(Dr. and Baby Background)
Okay. Next contraction. I think you're going to have a baby.

00:10:41:04 - 00:11:01:01
Jill White
We are on pace for over 100 more deliveries this year than we did even just last year, with onboarding of some new providers and working closely with the nurse midwives and getting them actual privileges to bring their patients on site. If they have that patient who, you know, can't deliver at the birth center, but they want their nurse midwife to follow them, great.

00:11:01:01 - 00:11:21:28
Jill White
We can do that here. The people that we serve are better the more that we serve. And so it's so important that we really maintain frequent touchpoints with patients like this, keeping those skills up, keeping our presence up. You know, it's so much about trust and relationship building in that patient population.

00:11:22:01 - 00:11:48:18
Julia Resnick
In low birth volume hospitals, providers may encounter obstetric emergencies less often than their colleagues in larger hospitals. That makes ongoing training, simulation, and peer learning especially important because every team needs opportunities to practice for the moments that matter most. Dartmouth Health partners with rural hospitals in northern New England to facilitate simulation drills. Emily Brayton, a perinatal outreach nurse, shares how that works.

00:11:48:20 - 00:11:52:15
Julia Resnick
You'll hear more about Dartmouth Health's work in the next episode.

00:11:52:18 - 00:12:28:27
Emily Brayton
Simulation and skills has been really beneficial to teams. We have one hospital in the North Country that has done a lot of work with a group at DHMC. We are teams that are kind of existing together, but we're not necessarily the same exact team. They are well supported, and so being able to go into that hospital and provide those teams with dedicated time with a neonatologist, and it really said it all with the people that showed up.

00:12:29:00 - 00:12:43:06
Emily Brayton
We didn't just have people who were there from their inpatient unit. We had all of the people who come and help when there's an emergency happening, regardless of whether it's happening on the OB side or with the baby.

00:12:43:08 - 00:13:09:21
Julia Resnick
Simulation is one way to maintain clinical skills. Another is creating opportunities for rural clinicians to spend time in higher volume settings, and then bring that experience back to their communities. At Banner Health that idea has become the rural OB pathways program. Here's Dr. Blake McLaughlin, an OBGYN and senior medical director of women's services at Banner Health. You'll also hear more from Dr. McLaughlin in the next episode.

00:13:09:24 - 00:13:36:27
Blake McLaughlin, D.O.
So something that we have done within Banner, we've created what's called the rural OB pathways program. And so what we do is we offer this program that folks can opt into where they will come from a rural facility like Paige, Arizona, or from Washakie, Wyoming, and they will come to one of our large volume facilities in Phoenix, and they'll spend seven, ten, 14 days embedded with that obstetrics team on labor and delivery.

00:13:36:27 - 00:14:06:06
Blake McLaughlin, D.O.
So they'll get high volume, high complexity of all of the things. But particularly they're focusing in on their optimization of their surgical skills and their obstetric skills. So we have had tremendous positive feedback from everyone involved in those experiences. Both for the physicians that are going and being embedded in that team, they're able to go back to their facilities and their communities that they came from, and they just have maintained that skill set and optimization.

00:14:06:08 - 00:14:17:14
Julia Resnick
Dr. McLaughlin believes that the same philosophy should begin during residency. Rather than asking clinicians to choose between urban and rural training, Banner is intentionally connecting the two.

00:14:17:16 - 00:14:38:12
Blake McLaughlin, D.O.
Those interns will spend their first year at the mothership there at the North Colorado Medical Center in Greeley, and they really get that foundational direction and education and training that they need. And then they'll go out to rural communities like our hospital in Sterling. So Sterling Regional Med Center, and they'll spend their last two years of their residency program embedded in that role community.

00:14:38:12 - 00:14:57:01
Blake McLaughlin, D.O.
And so they're really anchoring their heart, their mind, their attitude, their perspectives to rural medicine, but they're staying directly connected to that source program where they're getting that premier residency and fellowship equivalency training. Really ingrained them then, this connectedness.

00:14:57:03 - 00:15:27:08
Julia Resnick
Building a strong workforce is about creating a continuum of learning from early exposure and multidisciplinary teams to ongoing training and mentorship throughout a clinicians career. Together, these investments are helping ensure that role providers have the knowledge, skills and support they need to care for mothers and babies close to home. But no rural hospital can do it alone. Even the strongest workforce benefits from connection to colleagues to specialists, and to partners who can help expand what's possible.

00:15:27:10 - 00:15:52:03
Julia Resnick
That's where we'll go next. Join us for the final episode of Frontiers, as we explore how regional collaboration, digital tools, and new models of care are helping role communities strengthen maternal care for the future. This series is supported by the Commonwealth Fund, a national private foundation based in New York City that supports independent research on healthcare issues and makes grants to improve healthcare practice and policy.

00:15:52:10 - 00:15:59:10
Julia Resnick
The views presented here are those of the author and not necessarily those of the Commonwealth Fund, its directors, officers or staff.