Newman Memorial Hospital in the northwestern Oklahoma town of Shattuck was founded over a century ago by pioneer physician O.C. Newman. Dr. Newman came from Tennessee with a dream to serve Northwest Oklahoma. He delivered care on horseback, fostering“health equity” before it was a term.
Tom and Amy Vasko shared Dr. Newman's dream.
The couple moved to Shattuck from Virginia, leaving careers in urban facilities so Tom could become Newman Memorial's CEO and Amy a certified nurse midwife at its clinic. So far, their vision of improving health equity has included bringing back orthopedic surgery to the critical access hospital for the first time in 16 years.
Now they have a new project to tackle: reinstating the hospital’s labor and delivery unit.
Most counties in and near Oklahoma’s panhandle are maternity care deserts, which are predominantly rural areas without birthing facilities and providers. Oklahomans' median driving time in areas without delivery services is 38 minutes. Women in the panhandle are often driving hours to attend prenatal care appointments and deliver.
Tom and his team have worked on putting the puzzle pieces together to improve their community’s situation, and he said the only thing they’re missing is about $3-4 million in start-up funding for supplies, tech and labor. Once the hospital gets there, it can be profitable by delivering babies, and Tom hopes the model they’ve created could be replicated in other struggling rural counties.
How Oklahoma counties became maternity care deserts
Arnett resident Cheyenne Wear drove about 40 minutes to Woodward to attend prenatal care appointments and deliver her first two kids, who are now seven and five. But when her doctor moved to Enid, her drives for her third kid got a lot longer and more expensive.
She and her sister, who was also pregnant, planned their appointments together and carpooled to save gas money. The two women made the over-four-hour round trip to get care, often with kids in the backseat. Women typically visit their doctor 10-15 times while pregnant depending on when they begin prenatal care.
“Your spouse, he works in the other direction. So … you had no choice other than to take your kids two hours to go see a doctor for only five minutes, if it was just a normal doctor visit,” Wear said.
Wear and other women have to seek alternatives because rural hospitals don’t have labor and delivery units. Shattuck’s closer options are in Enid, Texas and Kansas. Although, a hospital in Woodward identified a temporary staffing solution in late July by contracting with two outside physicians after it lost two OB-GYNs in June.
Sixty-nine percent of Oklahoma’s rural hospitals don’t have obstetric services, and out of the 25 hospitals that do, 62% experienced financial loss overall on patient services. Over half of Oklahoma’s 77 counties are maternity care deserts.
Tom said rural hospitals started trending this way over time, beginning in the 80s, when they transitioned to a prospective payment system, which was a change in Medicare reimbursements meant to address increases in Medicare hospital spending. Many rural hospitals closed or faced significant financial strains under this system.
The designation of critical access hospitals saved facilities like Newman Memorial by reducing their financial vulnerability through enhanced reimbursements.
Now, rural areas are also struggling with recruiting and retaining staff. Oklahoma already faces a shortage of these providers, ranking second to last in a national study on women’s health in its number of providers who practice obstetrics and gynecology, with 55 per 100,000 women ages 15-44 in 2022.
Dr. Kinion Whittington, an OB-GYN in Durant, said rural areas are unappealing to newer physicians, who are looking for more work-life balance and urban amenities after school.
“You can actually turn your phone off and go to the ballgame. Take your kids out without being interrupted. And that's what we're seeing is that recruiting people into these smaller areas is very difficult, if not impossible,” Whittington said.
Other financial challenges are often fueled by public and private insurers not paying enough to cover maternity care costs. Also, no money is exchanged for maternity reimbursements, which include prenatal care, until the baby is born. Tom said Newman Memorial needs help with start-up costs because it can’t cover the unit until its patient volume is up to around 300 births.
The farther a woman has to travel to receive maternity care, the greater risk they have of maternal morbidity and adverse infant outcomes like stillbirth and costly NICU admissions. Oklahoma’s maternal mortality rate sits at 31 deaths per 100,000 live births from 2019-2021. Nationally, the rate was 22.3 deaths per 100,000 live births in 2022.
Oklahoma also received a D- in pre-term births in its latest March of Dimes Report Card.
“We're getting to a point now where we're really concerned about mothers just showing up in the emergency room department because they have no place to go, or they've gone into labor,” Tom said.
When Wear delivered in Enid, she was scheduled for an induction to have her first vaginal birth after two C-sections. She drove two hours and, after being induced, was in labor for seven hours before her delivery was switched to a C-section.
Amy said situations like this aren’t uncommon when care is far away.
“When women are having to travel this far, the most convenient thing for both the physician and the woman is to schedule an induction of labor. … We have to get to 39 weeks before we can schedule those for a normal, healthy pregnancy.” Amy said. “Well, their body might not be ready at 39 weeks, so then they're being induced for three days, and then they end up with a C-section. That all could have been avoided if they were able to go into labor on their own.”
A model to bring labor and delivery back
To recruit the staff necessary to bring back Newman Memorial’s labor and delivery unit, Tom and Amy returned to their urban roots and called on Dr. Zach Wohlgemuth. He’s an OB-GYN working in rural North Carolina and Amy’s former labor and delivery coworker in Virginia.

“She and I being up at three o'clock in the morning on calls, there (were) times where we were just waiting for deliveries, and so we ended up talking and kind of always talked about rural health,” Wohlgemuth said.
Those conversations turned into action. Wohlgemuth proposed a traveling OB-GYN group for Shattuck with four core doctors who would each work one week on a four-week shift. The group, as it stands, would include Wohlgemuth, one of his partners and two people he’s trained in residency.
“It allows the current workforce to be able to provide services in an underserved area that is incredibly rewarding and fulfilling personally, and it also allows for the newer generation of the workforce to be able to balance work and home,” Wohlgemuth said.
Wohlgemuth said he has seen the model succeed where he works in rural North Carolina. Their obstetric care is fully staffed for the first time in six to seven years.
He said the work he’s accomplished in the community has reminded him why he is passionate about being a physician. He hopes the model can do the same for other providers involved in Oklahoma’s plan.
“The three or four people that I've talked to that are interested in it, what they are looking forward to, if and when this comes to fruition, is being part of a community that really appreciates having physicians,” Wohlgemuth said.

Tom said the hospital has also been working on updating its old labor and delivery unit. The goal is to have four postpartum rooms, a triage room and two labor rooms.
"I have all the pieces. I figured that out. I just need some funding. Not a ton of funding. And I can create this model and journey and work with some of the OB-GYNs, even outside the state of Oklahoma, that want to help and answer that call,” Tom said.
Policy solutions
Sen. Casey Murdock (R-Felt) said he’s willing to support that fight through an interim study and legislation. Murdock visited the hospital in June and said he’s especially concerned about his district, which is a maternal care desert.
“For a state that is pro-life and brags on being pro-life, and a quarter of it doesn't even provide labor and delivery, is astonishing,” Murdock said.
He said an immediate solution for areas like Shattuck comes down to money. He wants to work with the Oklahoma Health Care Authority to fund maternity wards.
“With the budget surpluses that we’ve had the last few years, it should not be a heavy lift,” Murdock said.

He also wants to see more emphasis on prenatal care, which is something Amy is building on in Shattuck. As a certified nurse midwife, she can see patients for up to 26 weeks.
Dr. Whittington, a member of the Oklahoma State Board of Health Maternal Health and Obstetrician Desert subcommittee, said the group is looking at NICU admissions from rural areas to determine how much the state is spending and see what can be done to prevent unnecessary costs through preventative care.
“You have to quantify what the real problem is and put a dollar amount on it before you can get people to pay for it, which is reasonable,” Whittington said.
He said it's a slow process.
"There will be several closures of labor and deliveries in Oklahoma this year. And there's several at risk right now,” Whittington said. “And it is not because of the lack of number of deliveries. It's a lack of providers. It's a lack of training of ancillary people.”
Tom said he hopes funding will be found soon to bring back a simple service to the community he and his family have grown to love.
“It's not like we're trying to get neurosurgery out here or some cutting-edge cancer treatment center out here,” Tom said. “We're just trying to give somebody, a human, the right and basic access to what is just a natural aspect of life. We all come into the world that way.”
Joey Burgtorf, the hospital’s COO, said she worries about emergencies happening in the meantime.
“We've had a baby born here in the hospital in the ER, luckily … our nurses that were on that night had labor and delivery experience, thank goodness. So it all went very smoothly,” Burgtorf said. “But it could have gone very differently.”
StateImpact Oklahoma is a partnership of Oklahoma’s public radio stations which relies on contributions from readers and listeners to fulfill its mission of public service to Oklahoma and beyond. Donate online.
Copyright 2024 KGOU