The state of Montana said Thursday it was awarded $10 million in federal funding to help women living in rural areas get better health care when they're pregnant and after giving birth.
The money will go toward a variety of programs all meant to connect rural providers and their patients with experts in specialized pregnancy and postpartum care in other parts of the state.
"It's proximity. Big Horn County is over 5,000 square miles and doesn't have a hospital or delivery program in that county. The nearest birthing hospital is more than 50 miles away from Hardin. Remote areas bring problems," said Sheila Hogan, director of the Department of Public Health and Human Services, on Thursday. "The individual in the community and the provider will work together to address the needs of the woman."
Data collected by the Centers for Disease Control and Prevention show that Montana has the sixth-highest mortality ratio to births in the nation. The women who live in rural areas and on reservations have even higher risks than the rest of the state.
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Kristen Rogers, head of the health department's Family and Community Health Bureau, said pregnant women in rural areas face the same risks as those anywhere else in the state, but lack the proper access to care to treat any problems that may come up in a pregnancy.
"There are not enough experts, there's not enough clinics. If you're in rural Montana and you have not only mental health issues, but you're pregnant and you're starting to have mental health issues around your pregnancy or postpartum, all of these things can go together," Rogers said.
The $10 million will fund projects under the umbrella of Montana Obstetric and Maternal Support program, called MOMS. Roll-out will begin in the early part of 2020 and rely heavily on an existing telehealth network operated by Billings Clinic.
"The reason telemedicine is so important in a state like this is (rural providers and their patients) gain immediate access to expertise, experts that can help with all these different not only medical disorders but also psychiatric disorders," Rogers said. "It's perfect for women and their families, but it also supports our providers in rural Montana so they have the access they need. ... I'm sure it can be scary out there when something happens that you really are not equipped to deal with."
Montana has long struggled to recruit and retain health care providers in rural areas, and while a focus on telemedicine does not mean the state is backing away from working on that issue, it does provide an immediate answer for providers and patients, Hogan said.
Rogers said though telemedicine was born out of a need to provide services in rural frontier areas, it has become a respected way to treat patients around the country and even in large urban areas.
"People don't have to get into a helicopter or airplane to get to a center that has expertise because a woman is in an emergency station," Rogers said.
Doctors, behavioral health care providers, peer teams and Billings Clinics' OB/GYN experts will be connected to rural providers around the state using the existing Billings Clinic Eastern Montana Telemedicine Network. That network connects with 30 hospitals and clinics around the state, including in some of Montana's larger cities like Helena that aren't thought of as frontier communities but still look to experts in other cities for specialized prenatal and postpartum care.
Under the framework of Project ECHO, which stands for Extension for Community Healthcare Outcome, OB/GYN experts from Billings have scheduled grand rounds for providers at rural clinics.
There will also be a provider consultation access toll-free hotline where OB/GYN experts have dedicated time for consultation with rural providers on cases.
The money will additionally pay for Simulation in Motion trucks that travel to rural hospitals and clinics with training opportunities for providers, so they can better learn how to handle various situations that could arise in a woman's pregnancy or postpartum.
Finally, a new Maternal Mortality and Morbidity Task Force that Rogers says will initially meet twice a year, to start, will review selected maternal mortality cases and develop recommendations for how to avoid maternal deaths going forward.
Hogan said the new MOMS program is also meant to work alongside the existing Meadowlark Initiative that helps hospitals provide treatment to pregnant and postpartum women with substance use disorder or mental illness.