Two Mothers, Two Distinct Pregnancy Journeys
A closer look at how location shapes motherhood in Texas.
by Emma Powell, CHW, Save Texas Moms Maternal Health Intern
Defined by a ZIP Code: Where a mother lives can shape the support she is able to reach before, during, and after pregnancy.
Why Access to Pregnancy Care Can Change from County to County
For Texas mothers, living in different counties can mean completely different pregnancy experiences. Almost half of Texas counties are maternity care deserts, meaning they have little or no access to maternity care services, such as hospitals offering obstetric care, birth centers, OB-GYNs, or certified nurse-midwives. This can leave mothers with long distances to travel to access critical services such as prenatal care, emergency services, labor & delivery, and postpartum support.
The stories of Ashley and Olivia show how striking the disparities can be when comparing full-access counties to maternity care deserts side by side. While Ashley and Olivia are hypothetical, their experiences reflect reality for many Texas mothers.
“Almost half of Texas counties are maternity care deserts, meaning they have little or no access to maternity care services, such as hospitals offering obstetric care, birth centers, OB-GYNs, or certified nurse-midwives.”
Full Access: Plano, in Collin County, represents a full-access county where mothers have more nearby options for prenatal care, hospitals with obstetric services, and postpartum support.
Ashley
Ashley lives in urban Collin County, which has full access to maternal care.
Ashley suspects she may be pregnant. She has private insurance and has scheduled an appointment with her Primary Care Provider to confirm.
After confirming her pregnancy, Ashley is referred to an OB-GYN and schedules her first prenatal appointment. Her OB-GYN is in-network with her insurance, and their office is in her county, near her house.
Ashley works near her OB-GYN’s office. She is able to attend all of her prenatal appointments during her lunch hour and never has to take time off.
Ashley has an abundance of OB-GYNs, midwives, and hospitals nearby. She can compare her options and choose what works best for her pregnancy and birth journey.
If Ashley requires any specialty care or mental health support, there are multiple providers available in and around her county.
Ashley lives near multiple hospitals and ERs that provide obstetric care. If she experiences any complications or emergencies, there are multiple options that can accommodate her needs.
“Ashley has an abundance of OB-GYNs, midwives, and hospitals nearby. She can compare her options and choose what works best for her pregnancy and birth journey.”
Ashley has multiple fully equipped hospitals and midwives in her county. She can choose how she wants to give birth without considering travel time.
After birth, Ashley attends her postpartum checkup with her OB-GYN close to home. She has nearby access to providers and mental health resources, should she experience high blood pressure, depression, anxiety, breastfeeding difficulties, or complications from delivery.
What Are the Levels of Maternity Care Access?
Full access: Counties with broader access to maternity care, including hospitals or birth centers offering obstetric care and available obstetric providers.
Moderate access: Counties with some maternity care services, but fewer options than full-access counties.
Low access: Counties with limited maternity care options. March of Dimes defines low-access counties as those with one or fewer hospitals or birth centers offering obstetric care, fewer than 60 obstetric clinicians per 10,000 births, or a high share of reproductive-age women without health insurance.
Maternity care desert / no access: Counties with no hospitals or birth centers offering obstetric care and no obstetric providers.
Source: March of Dimes PeriStats
Long Distances: Extended travel for care can become part of the pregnancy journey for mothers living in maternity care deserts.
Olivia
Olivia lives in Madison County, a maternity care desert in rural East Texas.
Olivia suspects she may be pregnant. Like ¼ of adults in her county, she is uninsured. She visits a local non-profit organization for a free pregnancy test to confirm.
Because Olivia is pregnant and uninsured, she may now qualify for Medicaid for pregnancy, but it can still take time to apply, be approved, and be connected to care. The closest OB-GYN to Olivia is in another county, so she will have to drive a considerable distance to get there.
Each time Olivia wants to attend a prenatal appointment, she has to decide if she can afford to take time off from work. If she has other children, she may need to arrange childcare. If Olivia doesn’t have reliable transportation, she may not be able to attend appointments even if she wants to.
There are no OB-GYNs in Madison County, so Olivia has far fewer options. There is one hospital in Madisonville in case of emergency, but it does not offer labor & delivery services.
If Olivia requires specialty care, she will have to travel outside of her county. Access to mental health support is also limited near her, so she would likely need to travel or use telehealth.
“There are no OB-GYNs in Madison County, so Olivia has far fewer options. There is one hospital in Madisonville in case of emergency, but it does not offer labor & delivery services.”
There is one hospital/ER in Madison County for emergencies, but it does not have an OB-GYN or a Labor & Delivery department. Olivia would likely need to be transferred to a larger hospital capable of meeting her needs. In obstetric emergencies, every minute counts. Delayed access to obstetric care could be dangerous for both Olivia and her baby.
If Olivia wants to give birth in a hospital or with a midwife, she will have to travel to another county.
Olivia will have to travel outside of her county for postpartum care. This may be difficult for her as she recovers from delivery, cares for her newborn, and returns to work. These factors, along with transportation challenges, could make her less likely to seek postpartum care.
You’re Not Alone No Matter Where You Live.
National Maternal Mental Health Hotline
• 1-833-TLC-MAMA
• Text/Call/Chat
• Free, 24/7, Confidential
• English or Spanish
• Staffed by Trained Counselors
When Barriers Build on One Another
These are just hypothetical scenarios, but they highlight how different life can be for women living in the 46.5% of Texas counties that are maternity care deserts.1 The availability of maternal health services isn’t the only barrier Texas women face, either. Factors like broadband access, limited transportation, childcare, insurance status, and language can also play a role. All of these challenges compound one another and impact the entire pregnancy journey. Inadequate prenatal care, labor and delivery services, and postpartum care can result in worse health outcomes for mothers and their babies.
How Texas Can Close the Gap
Strategies to minimize these disparities and improve maternal health care access in Texas fall into four main categories:
Bringing Care Closer: As highlighted in Olivia’s story, the distance to care can be a significant barrier for many Texas women. Mobile clinics, community health events, and local health partnerships can reduce the burden of travel time by meeting mothers where they are.
Making Care Easier to Reach: Another way to connect Texas mothers to care is by making it easier for them to reach. Transportation support can help mothers physically access care, while telehealth and improved broadband access can help them access it digitally.
Expanding the Workforce: The maternal health workforce can be expanded to include midwives, doulas, and community health workers. Reimbursement for services offered by midwives and doulas would make these options more accessible to mothers.
Reducing Financial Barriers: Cost remains a significant barrier for many mothers seeking care. Expanding Medicaid coverage and reimbursement for maternal health services from prenatal care to postpartum support, and everything in between, could help ease these financial burdens.
Need Help Finding Care or Support?
Save Texas Moms works to reduce maternal health access gaps by connecting pregnant and postpartum mothers with resources, supporting community-based health partnerships, and raising awareness about the realities of maternity care deserts across Texas.
If you are pregnant or postpartum and live far from care, Save Texas Moms can help connect you to:
• Local maternal health resources
• Diaper and food bank options
• Education tools
• Community-based support hubs
• Mental health support resources
Your ZIP code should not determine the care, information, or support you can reach.
Emma Powell, CHW
Emma is a Maternal Health Intern with Save Texas Moms. She is currently pursuing a Master of Public Health with a concentration in Health Policy & Management at Texas A&M University. Her family’s experiences with health care in rural areas have informed her interest in increasing access to health care and vital resources for rural Americans.
