My name is Jenni Van Otterloo. I've been married to my husband for about what will be
four years this summer. We've lived here in Sanborn, Iowa for the whole four
years of our marriage. We have two kids. We just had one about two and a half
weeks ago. Being in Sanborn, Iowa there's not a lot of close hospitals. The nearest
hospital is in Sheldon Iowa which is 10 miles west of us, and they're pretty
small. The only pregnancies they take in Sheldon are what's considered a normal
pregnancy. Before I got married, I found out I had a pulmonary embolism; blood
clots in my lungs that later on were going to play a factor into
pregnancies with being on blood thinners, and things like that.
I've been with McKay now for, oh probably five, six years so she's been
aware of my history for a while.
My name is Kimberly McKay. I'm an obstetrician-
gynecologist in Sioux Falls, South Dakota and I am the Clinical Vice President of
the ob/gyn service line for Avera Health. Avera Health is a health system
that covers 72,000 square miles of South Dakota, Minnesota, and Iowa, down into
Nebraska and we have about 16 facilities that
deliver babies. We deliver 6,000 or so, 6,500 babies a year, so we know a lot
about rural. We know a lot about what goes on in rural medicine. 15% of our
patients are American Indian, about 10% are other nationalities. Half of our
patients are covered by Medicaid, either as a primary or secondary
insurance. And so, you know, large geography, very diverse patient
population. Care planning for rural patients is difficult sometimes.
Ideally they're low-risk, they have no medical issues, they are normal weight,
they have every resource available to them, but as it turns out not very many
pregnancies in the United States of America are low-risk.
So when I looked
for different providers near me, both places told me that with a condition
like mine, with a blood disorder that I have, they don't have the resources, like
the blood bank on hand, at their hospitals to handle anything that would
happen, if something were to happen during delivery or during pregnancy, so I
was referred to Sioux Falls, therefore back to Dr. McKay in Sioux Falls at Avera.
Prenatal care, in general, for a low-risk pregnancy is 13 visits. 13 days
out of that where you take time out of work. 13 days where you need to travel
for things like ultrasound and lab work. Add 90 miles, a 90 mile drive, to that and
it makes things extremely complicated. geography doesn't pick and choose the
low risk and high risk patients.
The distance is huge. I have to travel an
hour and a half to an hour and 40 minutes for every doctor appointment, and
that's just one way, so I'm on the road for over three hours for a 30-minute
appointment every time that I need go to a doctor's appointment.
we have Avera eCARE
which is one of the largest telemedicine networks in the United
States. We're looking to add more technology to figure out how to keep
patients as close to home as possible until they actually need to come into
their maternity center to deliver.
I had really good care. The only thing that
Dr. McKay and I talked about, just trying to cut back on some of the
distance, and the traveling, and things like that through video conference calls,
or whatever, just to do some of those would be really helpful. I think that
would be something that would be great to see happen in the future.
And the other piece is that Family Practice physicians, and nurse practitioners,
and PAs are extremely important part about how we provide care. They aren't
always as comfortable with obstetrics unless they, themselves, are personally
providing that care in their community. And so much of what we do, in particular
through our eCARE services, is helped them feel comfortable with what they're seeing.
So when I went into labor with my second child, I went to work that morning.
I had contractions. They usually tell you to go in when they're 5 to 7 minutes
apart. They tell me to come in when they're 10 to 12 minutes apart. So I
actually went to work that morning because they weren't that close yet, but
by the time I made it to the hospital I had my daughter within an hour of
getting checked into the hospital, so it was cutting it really close. I'm glad we
made it, and everything worked out ok, but yeah, there's just a lot of extra things
that we have to plan with.