According to a recent study, the maternal death rate for Indigenous women in Iowa rose from 26 in 1999 to 139 in 2019. In roughly that same 20-year period, the state has closed the doors on more than 40 of its birthing hospitals. Those closures largely affect expectant parents living in rural Iowa.In 2019, the Unity Point Marshalltown Hospital said it would no longer deliver babies.Dr. Elizabeth Tigges is an OBGYN practicing in Grinnell. She is one of the health care providers working to bridge the gap to improve birth and maternal outcomes."I think the closure for Marshalltown was the worst thing that could have happened," Tigges said.Tigges said the majority of pregnant women from the Meskwaki Settlement in Tama County made the 20-minute drive to Marshalltown for their care. With that no longer an option, the commute nearly doubles, with the closest options for care being in Ames, Des Moines or Grinnell."But even just routine prenatal care, you know, they are seeing us 13 to 18 times a pregnancy," Tigges said. Tigges has absorbed dozens of patients who identify as American Indian or Alaska Native . It's through these patients she's learned the importance of tribal traditions surrounding pregnancy and birth. "It's on us as medical providers and on us as a community to give them a sense of community here and a sense that they can be vulnerable and they can say the things they need to say and get real with us, and we can then work with that," Tigges said.Indigenous women are twice as likely to die from pregnancy-related causes, experience poor birth outcomes, and postpartum depression.The Centers for Disease Control and Prevention launched the Hear Her Campaign. It shows what's putting AIAN pregnant and postpartum women at risk and what providers can do to improve outcomes.Megan Sloat is a certified nurse midwife at Primary Health Care in Ames. She's trained to provide obstetric and gynecological services."A community is only as healthy as its women," Sloat said. Thanks to a $2 million federal grant Primary Health Care received this fall, a midwife has been hired and has begun working in Marshalltown to help fill a gap there."If we can focus in on those things that prevent our patients from getting to the clinic and sort of help remedy them and provide resources to empower them, we also improve outcomes because we're getting patients into the clinic more often to receive the care they need," Sloat said. The grant money will also be used to increase telehealth services, offer in-house ultrasounds and hire community health workers who will provide education and resources to patients by visiting them at their homes."Even though we're dealing in sort of sparse options for care, the options that do exist need to be strong," Sloat said.The Meskwaki Nation did not comment on this report. However, they do have a home visiting program in Tama County. It provides services to pregnant women and families with Native American children who are under the age of three.