Women in rural Missouri face obstacles to prenatal care

Apr 26, 2012

There is a shortage of primary care physicians in rural areas and more than half of Missouri counties have no OB-GYN specialists, according to the Missouri Department of Health and Senior Services. KBIA’s Marie French takes us to Macon, where many pregnant women often drive 30 minutes or more to get care. 

One-year-old Bryce Grawe takes his afternoon nap at home in Macon. His crib is in a toy-cluttered room that he shares with his older sister Veronica. 

Chandra Grawe delivered both of them by cesarean section at Moberly Regional Medical Center. Two days after Bryce was born, he was taken by ambulance to Columbia. Doctors said his heart was abnormally large.  After seven hours at the Women’s and Children’s Hospital, she eventually received some good news: His heart was larger than most babies, but so was the rest of him.

"Moberly’s not used to dealing with babies that aren’t perfectly normal. Bryce was born nine pounds three ounces, so luckily we got to bring him home that night. But that’s Moberly," said Grawe.

There are no board-certified OB-GYN specialists in Macon. Grawe believes it’s an accepted fact of life there: To get specialized care and to deliver, women often drive to Kirksville, Moberly or even Columbia. And now women in Fulton face the same issue. The Callaway Community Hospital shut down its obstetrics unit last month. While ultrasounds and emergency deliveries can still be done at Callaway Community Hospital, routine deliveries will have to be done in Columbia.

Marjorie Sable is the director of the school of social work at MU. She believes that some hospitals may lack some specialized services.

“Sometimes the providers might not be specialists," Sable said. "So they may be fine for providing low risk care, but if they’re not a specialist, if there are complications, those women would need to be referred."

Macon resident Kayde Myers has been to Moberly for checkups eight times since finding out she was pregnant. One month away from her due date, she said the lack of access to care has hidden costs, such as losing three hours of work every time she goes to the doctor's office. And she doesn’t know if she will need to go to Moberly more often as her due date approaches.

According to Marjorie Sable, access to good care before the baby is born can indirectly influence infant mortality rates.

"One of the reasons that prenatal care is important is because its a time when you can identify potential problems or complications in pregnancy,” Sable said.

Complications such as pre-term birth and low birth weight are leading causes of infant mortality. The number of pre-term births in Macon County is not significantly different from the state average, according to the Missouri Department of Health and Senior Services. But, the percentage of women receiving inadequate prenatal care is higher  – nearly 18 percent in Macon as opposed to 11.5 across Missouri.

Despite the obstacles, Meyers and Grawe are determined to get the best possible care for their children.

"I’d rather drive so that they can have the more advanced equipment to make sure everything’s progressing fine," Grawe said.

Although basic prenatal care is available in Macon, both women prefer to go to Moberly and see the doctor who will deliver their children.  


Charles Minshew helped produce this story.