Leading Lactation Insights - November 2022

Maternity Care Deserts in the US

Maria Lennon, MSN, CNM, IBCLC

The United States is suffering a crisis in caring for women of childbearing age. Maternal mortality rates are much higher in the US than in other industrialized countries. The evidence is clear that regular prenatal care results in improved outcomes for both mothers and babies. Nearly 7 million women live in counties where there is low or no access to OB care.

The March of Dimes (MOD) has just published the 2022 Maternity Care Deserts Report which explores different aspects of healthcare that affect how and where maternity care is provided in the US. It also confirms that access to maternity care is worsening throughout the country.

What is a Maternity Care Desert? 

Counties in the US which have no hospitals or birth centers offering obstetric care and no OB/GYN physicians or certified nurse midwives to provide OB care are called maternity care deserts.

What does it mean to live in a maternity care desert?

Women may have little access to appropriate preventative, prenatal and postpartum care if they live in counties with few hospitals or birth centers (one or fewer) providing obstetric care, few obstetric providers (fewer than 60 per 10,000 births) or a high proportion of women 18-64 without health insurance (10% or more).

“In the U.S., significant racial and ethnic disparities exist in maternal and infant perinatal outcomes. Disparities are also evident in access to care. Although the majority of women living in maternity care deserts are non-Hispanic White, 12.8 percent of Native American women who gave birth in 2020 lived in maternity care deserts. In 2020, one in 4 Native American babies (26.7%) were born in areas of limited or no access to maternity care services. Additionally, 1 in 6 Black babies (16.3%) were born in areas of limited or no access to maternity care services.”

There is a lack of equity in quality maternal care. Prior to childbirth, racial and ethnic disparities in maternity care exist. One in four Native American women (24.2%) and 1 in 5 Black women (20.1%) did not receive adequate prenatal care in 2020, compared to only 1 in 10 White women (9.9%).

A few of the findings in the MOD report:

• In just 2 years, there has been a five percent increase in counties that have less maternity access. 
• In maternity care deserts alone, there are approximately 2.2 million women of childbearing age and almost 150,000 babies affected.
• In those 2 years, there has been a two percent increase in counties that are maternity care deserts since the 2020 report. That’s an additional 1,119 counties and 15,933 women with no available maternity care.

Do you live in a Maternity Care Desert?

To find out whether you live in a maternity care desert, the March of Dimes has an interactive map that can be accessed by clicking here.

Another very helpful tool provides a more comprehensive picture of the maternity care desert locations, as well the relationship between maternity care deserts and issues of race/ethnicity, income status, and health outcome disparities among women of childbearing age. “This map can be used by federal, state, local, academic, and other stakeholders to aid in the identification, education, and resource allocation necessary to combat the maternal health crisis affecting women and children in the United States.”

https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/march-of-dimes-maternity-care-deserts-dashboard.html.

For more information and to read the full report click here.

This month we are spotlighting Heather Shelley, BSN, RN, LDEM, IBCLC

Megan Quinn

Heather Shelley is a nurse and IBCLC who originally hails from Canada, but now practices out of Lehi, Utah. She became interested in healthcare as a profession in part due to her father, who was a paramedic and often shared various stories from his work. Heather also notes that her interest in healthcare was already brewing when she was just ten years old as her parents were preparing her for the birth of a younger sibling. She says, “They asked me what I wanted brought home from the hospital after the birth. I asked for the placenta, but they didn’t actually bring it home and I was very disappointed!” Heather also mentions that she became committed to improving the birth experience for parents after the birth of her own son. This led to her attending the Midwives College of Utah and graduating as a midwife in 2009. Her career as a midwife has taken her across the globe, from Indonesia and Ecuador to Haiti, the Dominican Republic and back to Utah, where she currently practices. 

Heather shares that she struggled to breastfeed her own children and, years later while helping with lactation at a hospital, opted to get her lactation consultant certification. She then went on to become an IBCLC in 2021 as a way to most optimally help families wanting to breastfeed. Currently, Heather owns the Birthing Your Way birth center. Here, she helps parents deliver their babies, completes postpartum visits and lactation consultations, and teaches nursing and midwifery students “as a way to create more people in the healthcare field that are passionate about improving the journey of parents.” Heather shares that Birthing Your Way is extremely Baby-Friendly and follows the guidelines of the Baby-Friendly USA initiative, including supporting immediate skin-to-skin contact, honoring the golden hour, establishing breastfeeding, and refraining from offering formula, pacifiers, or bottles to clients. 

Heather says that current professional challenges she regularly encounters include working with insurances for families who are resistant or unable to pay out of pocket. She also notes an overall lack of awareness surrounding available resources to the public and the importance of better promoting these resources for families in need. 

Outside of work, Heather shares that traveling is her passion. She also enjoys crystal hunting in the Andes Mountains and says, “we drive up, pull to the side of the road, and just dig. The crystals are right there.” She notes that, in the last year, she has visited Ecuador several times with the goal of eventually creating a birth center there.

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