A legislative committee dedicated itself to the maternal healthcare desert in Wyoming this interim. During its last meeting before next year’s legislative session, it came up dry, with no specific solutions.
The Labor, Health and Social Services Committee’s top subject during this interim was how to increase the number of labor and delivery and maternity health care professionals in the state. This, after the state lost three labor and delivery units over the past six years.
Joint interim committee meetings
All 12 interim committees meet throughout the year, when the legislature is not in session, to dig into topics they decide are important. Those topics are usually assigned by the Management Council, a 10 member body of state representatives and senators. Interim committees travel the state to attend at least three meetings where they hear from experts and the public. Members of the committees task the Legislative Service Office (LSO) to research and write up draft legislation.
In 2023, the time and effort going into building, drafting and vetting draft legislation during the interim cost about $680,000.
Historically, legislation drafted during the interim does pretty well during the session. However, last year on the first day of the session, 13 committee bills were killed.
The problem
During its first meeting this year, members of the Labor, Health and Social Services interim committee heard from experts around the state about decreasing birthrates, difficulty recruiting and retaining OB-GYNs, and closures of labor and delivery units in the state.
Jenn Davis, Gov. Mark Gordon’s health and human services advisor, presented the results of a survey of Wyoming hospitals administered by the Governor’s Health Task Force OB Subcommittee. It was meant to get a better picture of what’s happening with maternal care across the state. Fifteen hospitals responded, including the single birthing center in the state.
When asked what the main obstacles are for providing labor and delivery services, the majority of hospitals said the inability to employ trained or skilled staff to offer the services. Other top reasons included the inability to hire OB-GYN physicians, affordability of service for the hospital, and insurance and liability of service.
Davis and the Wyoming Department of Health (WDH) remarked another huge obstacle to keeping this type of care in communities is how few babies are born in the state.
“Based on the low volume [of births], people can’t keep their skills up to be competent in doing deliveries,” said Davis. “We don’t have a high level NICU here, so high risk [births] already goes out of the state. So this is just looking at how we can do better for our low risk births in Wyoming.”
Since 2018, three labor and delivery units have closed across the state. Two cited financial costs of staffing the department after births continually decreased.
Davis ultimately compared the issue to one reason why the state is unable to keep younger people in the state.
“We’re not going to be keeping our young people here in the state or bringing young people in the state if they can’t have babies,” she said.
Committee members responded to the presentation by asking stakeholders and the LSO to research more and get back to them with ideas for solutions at the next meeting.
Potential solutions
At the next meetings, members heard from experts on potential solutions, as well as how other states have dealt with similar problems. Those included creating a midwife trajectory at a community college in the state, a rural family doctor residency and a regional OB-GYN hub. Plus, trying to get a clearer picture of midwives practicing in the state and their relationships with local hospitals and OB-GYNs.
This included the OB Subcommittee, which recently combined with the Primary Care Subcommittee. The group is made up of OB physicians, family nurse practitioners, midwives, University of Wyoming staff and Wyoming Medical Society, among other stakeholders.
They mentioned seeing if there’s an appetite for an OB fellowship through the WWAMI family practice program. WWAMI stands for the states served by the University of Washington School of Medicine: Washington, Wyoming, Alaska, Montana and Idaho.
Other solutions included trying to make it easier for midwives to work with hospitals and OB-GYNs throughout the state, plus increase education available in the state for both OB-GYNs and midwives.
During the second meeting, committee chair Rep. Dan Zwonitzer (R-Cheyenne) didn’t mince words about how difficult it’s been trying to find legal solutions to increase the number of practitioners who can deliver babies.
“We have struggled on some concrete definitive things that we believe we can put out for the 2025 session that'll make a dent and really increase care and help alleviate some of these issues,” he said.
That sentiment continued to the last meeting in August when solutions kept getting discussed by all stakeholders. But no solution was picked and committee members didn’t ask the LSO to draft any type of legislation that would address the maternal health care problem in the state.
What now?
At the end of the August meeting, one public commenter identified a specific statute that doesn’t list certified nurse midwives as being able to practice in a public hospital, suggesting that adding them could be an easy legal solution that the committee could address.
Rep. Jeanette Ward (R-Casper) grabbed at that and moved to amend the statute.
But Chairman Sen. Fred Baldwin (R-Kemmerer) said, “That would require a bill draft and it's a great idea, but we don’t have another meeting. So what I would suggest to you [is] that perhaps you consider that as an individual bill.”
However, Ward lost her seat in the primary and won’t be at the next session.
Baldwin, who is retiring, said work on this subject needs to continue.
“Those who are staying in the Legislature and those who are lucky enough to be on this committee again or those who are associated with the OB Subcommittee need to not let this go,” he said. “We need to explore this further.”
No interim committee bill was drafted. The general session will convene on Jan. 14, 2025.
