Colorado has 64 counties. Of those, 24 lack access to both maternity care providers and a hospital with labor and birth services – which are also known as maternity care deserts. The state has 43 hospitals in rural areas – and fewer than half (21) provide labor and birth services.
This data shows rural healthcare and maternity care are critical needs for Colorado’s rural population.
The University of Colorado College of Nursing at the Anschutz Medical Campus is changing that by expanding access to care through the college’s new Colorado Rural Midwifery Workforce Expansion Program. It will increase the number of certified nurse-midwives (CNMs) in rural Colorado over the next four years.
“People should be able to get healthcare in the community they live,” Jessica Anderson, DNP, CNM, WHNP, FACNM says. She is the director of midwifery and women’s health services and a professor at The University of Colorado College of Nursing at the Anschutz Medical Campus.
Anderson is one of three faculty members chosen to run the program. The program supports CU Nursing’s development of a Rural Midwifery Track through the college’s Nurse-Midwifery (NMW) Graduate Program.
“We will have additional conversations about practice development, leadership, collaboration, business aspects with a focus on rural communities. We want to give midwives extra tools to move midwifery along in those communities.”
Making Midwifery Education Accessible for Students
Three to five full-time students will be a part of the program every year. Their tuition and fees will be paid for, and they will get a stipend for living expenses.
“We’re hoping to eliminate some financial barriers for students,” Anderson says. “We’re taking nurses and providing them advance practice education with the hope they’ll go back to rural areas and practice as a midwife.”
For NMW student Miranda Salky, she knows the reality of the cost of graduate school and the limitations to care in a rural community. A Steamboat Springs native and resident, she currently splits her time between there and Denver and intends to continue to work there upon graduation.
She says if the new Rural Midwifery Track was available when she was considering going back to school, it would have been an easy decision. According to the National Center for Education Statistics, the average cost of graduate tuition and fees per year in the U.S. was just under $20,000 for the 2020-21 academic year.
“Graduate education is really expensive,” she says. “There’s a lot of people who would like to do this, but they can’t afford to go back to school. I think this will help incentivize people who want to go back to school but couldn’t because of the cost. The stipend for living expenses is also huge because in these rural areas it’s expensive to live, and this will make it easier to get access to amazing midwifery care.”
Healthcare Challenges in Rural Colorado
Salky knows how difficult it is for patients in rural Colorado to get care. The hospital in Steamboat Springs is hours away from other hospitals, meaning patients drive hours for an appointment.
"When you’re living in Colorado and you’re driving two to four hours to go to an appointment, it can be dangerous, especially if you have patients who are far along in their pregnancy and they go into labor,” she says.
Salky says one challenge with maternity care in rural Colorado is a lack of services, including things like fetal echoes. Patients who are high risk or need further care need to be sent somewhere else – most often, to Denver.
“With CU’s new program, it will make it easier for people to get care and not interrupt their daily lives by planning for transportation, so I think the program is going to be amazing,” she says.
“The barriers that exist are significant. We hear stories of people driving hours to get care and to receive tailored care for their needs,” Anderson says. She says other barriers include the costs of travel, missed work for appointments, and of course navigating the weather.
“We want to eliminate those barriers by providing care in rural areas and in people’s communities and most of all we want people to have access to high quality midwifery care. Rural healthcare providers know rural life, they know the resources in their community and are able to provide comprehensive care addressing the rural challenges,” she says.
Anderson started her nursing career working in a rural hospital, so she sees the need for expanding access to care.
"I worked in a 22-bed hospital as a labor and delivery nurse,” she says. “When I was there, that’s where my commitment to midwifery care started. I wanted people to have access to midwifery care, and I thought ‘Wouldn’t it be cool if they could access it here, and not have to drive to the city’?”
Continuing to Focus on Rural Areas
Anderson says reaction to the grant program has been positive, and it’s propelling more conversations about rural healthcare at the state level.
“People are excited about it,” she says. “These conversations (about rural healthcare) have come to the surface in many prenatal spaces. State healthcare leaders are having those conversations that are intentional – and they know we have to focus on rural aspects of care.”
CU Nursing is currently recruiting nurses to enroll in the Colorado Rural Midwifery Workforce Expansion Program. The college has already partnered with several organizations for the program, including six rural midwifery practice sites.