OPINION: Setting the record straight on maternity care in Alaska

Advocacy for the challenges of effective health care delivery in Alaska is always good, but the recent commentary in the Anchorage Daily News about Alaska’s “maternity care deserts” missed the mark in many ways and Alaskans deserve clarification of the facts describing what currently exists in our state. Although some places in Alaska do meet the criteria for “maternity care deserts,” we are unique in that many of the issues with providing health care to women in rural areas have been met and overcome through the efforts of dedicated individuals and health care organizations.

First and foremost, most communities in rural Alaska are not on the road system. Thus, health care organizations across the state have developed infrastructure to deliver care to small communities. Some of the critical pieces include hospitals in hub communities, where emergency departments, inpatient, and maternity services are available to residents of surrounding villages. These are staffed by dedicated health care professionals with expertise in rural health care delivery, including physicians, nurse practitioners and certified nurse midwives, among many others.

For pregnant women in Alaska, prenatal care is provided in rural clinics by community health aide practitioners. The care in these clinics is structured to follow recommendations from national health care organizations such as the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives. Throughout prenatal care, individuals are monitored for any health conditions for the pregnant woman or their baby that would require more specialized care outside of the person’s home village. If the care is too complex for the hub community hospital to provide, patients can receive specialty prenatal care in Anchorage or have the baby in Anchorage if the delivery is anticipated to be difficult. In addition, Alaska is a leader in telehealth services. Care that used to be done only with in-person visits can now be done through high-speed internet connections to provide quality care as close to home as possible for women with complex pregnancies.

When it is medically necessary for women with complex pregnancies to travel to population centers, extensive work is being done in partnership with organizations such as Ronald McDonald House, the Alaska Native Birthworkers Community, behavioral health organizations and others to provide emotional support for pregnant women from outside of Anchorage, as they are spending one of the most stressful times away from their support networks and community.

To support this complex system of care for obstetric patients, the Alaska Medicaid system financially covers a majority of deliveries in Alaska. Equally important, Alaska Medicaid covers emergency transportation when this service is needed. This partnership between Alaska health care organizations and Alaska Medicaid has been invaluable in making sure that Alaska women have access to the obstetric care they need when they need it.

In addition, the Alaska Perinatal Quality Collaborative, which is coordinated by the Alaska Division of Public Health, is a multidisciplinary group of stakeholders who work on statewide initiatives that focus on improving quality health care delivery in all facilities that provide birthing services. AKPQC statewide educational opportunities are offered in-person and virtually to bring health care workers across the state together to share resources and experiences.

This high level of care is, in part, available because of the great partnerships between funders, health care organizations, nonprofits, local communities, and the state of Alaska that recognize the importance of delivering exceptional care to pregnant women and their families, regardless of ZIP code. There is always more work to be done to develop and expand existing programs and improve the quality of care for expecting mothers, and more resources are certainly needed. We must, however, recognize the hard work of dedicated health care professionals and organizations that have taken the challenge of providing the highest quality health care to pregnant women in rural Alaska. This uniquely Alaskan system of care could certainly be a model system to solve what has been called “maternity care deserts” that exist in the rural areas of the Lower 48.

Dr. Matt Hirschfeld is vice president of Specialty Services for Southcentral Foundation. Dr. Christina Rodriguez is a maternal fetal medicine physician at Southcentral Foundation. Dr. Leanne Komorowski is inpatient obstetrics and gynecology medical director at Southcentral Foundation. Whitney Summers, WHNP, serves as manager of maternal fetal medicine/gynecology-oncology at Southcentral Foundation. Dr. Melissa Tondre is outpatient obstetrics and gynecology medical director at Southcentral Foundation. Misty Nix, RN, is a clinical specialist RN for the OB-GYN clinic at Southcentral Foundation. Monica Lee, SHRM-CP, MBA, is director of operations for specialty services at Southcentral Foundation. Dr. Daniel Hartman, MPH, is service line medical director (Specialty Division) at Southcentral Foundation.

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