MercyOne takes to the skies to combat Iowa's lack of medical care for rural pregnant women

As Iowa continues to struggle with a lack of obstetric care in rural areas, MercyOne Des Moines Medical Center has unveiled an emergency response team to reach the far corners of the state to treat pregnant women struggling with labor and delivery.

MercyOne's Maternal Transport Team is a specialized service that deploys across Iowa to patients in rural areas with few obstetricians, or where obstetrics care is unavailable.

The hospital system created the new services, which have been in development for the past year, in light of Iowa's ongoing maternity care shortage, health system officials say.

Forty-one hospitals — or about a third of Iowa's hospitals — have shut down their labor and delivery units from 2000 to 2021, according to a state report. In many cases, these closures left a county without a birthing facility.

"We can take care of the most vulnerable regardless of where they live in the state," said Dr. Dennis Szurkus, chief medical officer for MercyOne Des Moines Medical Center.

So far, Maternal Transport Team has responded to three calls statewide

Since the service went online three weeks ago, the Maternal Transport Team has been deployed three times, said Ryan Gochoel, regional director of MercyOne Emergency Transport.

On Oct. 17, the team responded to a call involving an expectant mother in Waterloo, Jenna McCready, who was carrying twins.

She went into preterm labor at 26 weeks of pregnancy, and doctors knew they needed to get her to the Des Moines hospital's advance NICU, said Dr. Neil Mandsager, a maternal and fetal medicine specialist at the MercyOne Perinatal Center in Des Moines.

The team flew McCready to Des Moines, and her twin girls were born shortly afterward at just about 2 pounds each. McCready's daughters, Magnolia and Stevie, were admitted into the NICU and are making a good recovery.

“They have done well," Mandsager said. "They’re growing every day, and we’re optimistic that they will graduate in a few weeks and go back home.”

How the Maternal Transport Team works

The Maternal Transport Team responds to cases where a maternal patient needs care that isn't available locally, including patients who arrive at a facility without obstetrics services.

The team can also respond to any laboring patient with a critical need, such as preterm labor or serious complications such as pre-eclampsia.

The initiative takes specially trained nurses from the health system's maternal unit and neonatal intensive care unit (NICU) and pairs them with emergency crews from MercyOne Air Med, the air ambulance transport, and its emergency ground transportation.

The ground ambulances will respond to most calls, but the hospital's helicopter is available to respond to time-critical cases, Gochoel said.

So far, 12 maternal nurses and 12 NICU nurses have been trained to respond with the ambulance's emergency crew, Gochoel said.

In addition, the teams will travel with external fetal heart monitoring equipment to monitor a laboring patient's contractions and the baby's heart rate.

At the same time, physicians at MercyOne in Des Moines can provide virtual support to the health care facility that's caring for the patient until the emergency crew arrives, Szurkus said.

“I can't guarantee that we can get to the patient every single time, but we will make a concerted effort to do so based on the safety of the crew, the weather and what the aircraft can facilitate," he said. "So, it may require a fuel stop, but we're going to do our best effort to try and get to that patient. And in the event that we are not able to, we also have our ground partners available for a little bit longer of a transport but still provide the same level of care and expertise, just in a different mode.”

The federal No Surprises Act passed in 2022 protects patients with health insurance from any surprise bill from out-of-network services, including air ambulance transport. That means patients who need the Maternal Transport Team's services shouldn't be charged for it, Gochoel said.

A third of Iowa's hospitals have closed OB units in the past two decades

MercyOne officials said a similar program existed 20 years ago, but the service was underutilized. In recent years, with physician recruitment becoming an increasingly difficult challenge for health care systems and Iowa's obstetrician workforce declining, MercyOne officials said the need for this program became clear.

Szurkus said the new Maternal Transport Team is part of the health system's larger goal to deploy resources across the state to meet the needs of patients statewide, not just those in the Des Moines area.

“Labor and delivery, rural health and access to care continue to be priorities for MercyOne now and forever, and the service we are bringing attention to today is one more way we can fulfill our mission in the state of Iowa," he said.

The shortage of obstetricians and gynecologists is a major factor cited in many of these closures, the report says, and that workforce challenge has continued to plague Iowa.

MercyOne Newton Medical Center indefinitely paused birthing services last month following a decade of "significant" challenges in recruiting obstetric-gynecologists and other physicians trained to offer labor and delivery care. Specifically, officials said they struggled to recruit physicians trained to offer cesarean sections, or C-sections, to laboring patients.

Iowa State Medical Director Dr. Robert Kruse praised MercyOne during a press conference Tuesday, stating maternal health is a critical public health priority for many of Iowa's rural communities.

“Access to obstetric services can be a challenge," Kruse told reporters. "Programs like this fill an important gap, ensuring that every mother, no matter where she lives, has access to care she needs, especially in emergencies.”

“On behalf of Iowa HHS, I want to express our full support for this initiative," Kruse continued. "It's programs like these that move the needle on maternal and child health, and I'm confident that this will make a tremendous difference for families across the state.”

About 33% of Iowa counties are defined as "maternity care deserts" because of their lack of labor and delivery wards as well as availability of maternity care providers, according to a March of Dimes report.

The March of Dimes report states that reduced access to this care is tied to poor health outcomes for women. The farther a patient travels to access maternal care, "the greater the risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU admission," the report reads.

It's estimated 57% of rural hospitals nationwide don't offer labor and delivery services to patients. Nearly 40% of hospitals that did offer labor and delivery care lost money on those services in 2023, raising questions about how many more facilities could be at risk of closing their maternity wards in the coming years.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm.