(upbeat inspirational music) - Hello, and welcome to "Prairie Pulse."

Coming up a little bit later in the show, we'll learn about painter Bailey White.

But first, joining me now is our guest, Dr.

Andrew Williams, an associate professor at the University of North Dakota Public Health Program.

Dr.

Williams, thanks for joining us today.

- Well, thank you for having me.

- Well, as we get started, tell the folks a little bit about yourself and your background.

- Yeah.

So I'm originally from Watertown, South Dakota.

And I finished my undergrad degree at Minnesota State in Moorhead.

And immediately after that, went out to New York and did my master's degree in public health.

And then ended up in Grand Forks for a couple years working at the med school.

I did some work on fetal alcohol syndrome, where I was driving around North Dakota talking with providers about how to ask women about their substance use and what they should follow up with.

And then after a few years there, decided to, decided I wanted to go back to school again.

And so went out east and did my degree at the University of Maryland.

And then was at the National Institutes of Health for a couple years.

And then we found our way back in Grand Forks at the med school again.

So I've been there for seven years.

And a lot of my work focuses on pregnancy and access to obstetrics care and prenatal care.

- Well, and you are here today to talk about the current state- - Yeah.

- Of obstetric service in rural healthcare.

But before we get into all that, you know, how did you become interested in the field or that field of study?

- Yeah, so I was always interested in, you know, kind of health and medicine as I was kind of going through my academic career, especially early on.

And then when I had my first real job, I like to say, at the medical school working on fetal alcohol syndrome, that just got me more interested in that specific aspect of health, of, you know, what's going on during pregnancy.

'Cause it's a short confined time, but so much interesting stuff happens both physiologically and socially.

And so that spurred me to go get my PhD in maternal and child health and focus more on the research side of things there.

And when we ended up moving back to Grand Forks and at the School of Medicine, just kind of wanting to make sure that my, the work that I was doing was responsive to, you know, the state of North Dakota and our region, especially 'cause we're a public university.

So I wanted to make sure that that service aspect was tied into at least some of the work I was doing.

And then once I started it, this really became apparent of, you know, really need to focus more on rural communities and what's going on there.

So it was just sort of kind of a natural evolution of interested in some pregnancy work.

Kind of focused on things like adversity and stress.

And, you know, when you can't access healthcare, that's some adversity, that's some stress that has negative impacts on families.

So that's kind of where I ended up focusing a bit more on the, what's going on with obstetric care.

- Yeah.

You know, your research, I guess, how has your research changed over the years with the challenges facing rural healthcare providers?

- Yeah, I mean, I think, you know, some of the first work I was doing when I started at UND was really just looking at kind of basic access to care.

And some of the data that we had was allowing us to look at what barriers to care moms have, especially in rural areas.

And pretty consistently came up with things like don't have transportation to always get to an appointment or trouble finding appointments.

And then you talk about a family that doesn't live nearby a facility.

You also have childcare and work and all those other duties.

And then that just kind of opened up the door for me to start digging more into some of those questions and some of those realities of trying to access care when it's not nearby and what happens with that.

- Yeah.

And of course, we are here to focus on the state of obstetric services in rural areas.

But based on your knowledge, can you give us an overview, really, of what the state of care looks like?

- Yeah, so over the last, especially last 20 years or so, rural communities have lost a lot of the hospitals and facilities that do specifically labor and delivery.

There's still, you know, a lot of early prenatal care that occurs, so in early weeks of pregnancy.

People will, you know, get care in their rural communities, but then they're oftentimes transferred out to a larger hospital, larger system to do maybe the end of their prenatal care and obviously the labor and delivery aspect of that as well.

And with the declines that we've seen in especially the hospitals in rural areas stopping obstetric care, that just adds a lot of stress and time anxiety onto families that are trying to get to care.

So it's not just the labor and delivery side of things, but, you know, getting to your prenatal care appointments.

You might have to drive an hour or two.

Let alone if you have a complication.

You may be doing that a lot, those drives to go see specialists or something like that.

And so with that access to care, that's really the big issue a lot of rural communities are facing.

Is how do we still make sure we're getting high quality and safe care when we may not have all of that available, you know, in the closest town or at the health center that were typically go-to for other reasons?

- Take a step back here for a moment and let's define it.

What is obstetrics care?

- So obstetric care is the care surrounding pregnancy, labor and delivery, and that early postpartum period.

- You know, what's the reason why hospitals would close OB services in an area?

- So a lot of it has to do with resources and financing.

We've seen over the past few decades, especially, it's been much harder to always have full staff available in some of these hospitals.

We also know that the reimbursement rates from, you know, insurance and Medicaid don't necessarily always cover everything that goes on for pregnancy care and labor and delivery.

It's really expensive.

And so when hospitals are looking at how can we stay viable for a rural community, well, they oftentimes start looking at the, "What's costing us the most money?"

And oftentimes it's labor and delivery.

And so that's a big reason that we're seeing that happen.

And another reason is we know that, you know, there's been a population shift towards more urban centers.

And you got to have patients if you want to stay open.

So if there's fewer births, fewer pregnant people showing up to those facilities, then it becomes less viable to offer those services.

- Well, so I mean, I've got here, according to a study from the University of Minnesota Rural Health Research Center, in 2024, roughly 300 counties have lost hospital-based OB care, with rural areas being hit the hardest.

You're defining that.

So I mean, is it a trend or is it just a reality of, as you said, resources and financing?

- I think the reality right now is a lot of that resources and financing.

And it's both the human, you know, kind of the human resources.

'Cause you need to make sure you've got providers in those areas that are trained to provide care.

And one of the big things, you know, I work at the medical school, and one of the big things that we're trying to do at the medical school is get more North Dakota providers to serve in North Dakota and hopefully go into those rural areas as well.

But that's a challenge for the vast majority of states of trying to get those providers.

Whether it's medical, like, MDs, physicians, nurses, or some of those advanced practice professionals too.

There's really that need for just more of that workforce to be able to offer services in the rural communities.

- You know, are there certain demographics of people that are affected by the closure than others?

- Yeah.

You know, in our region, it's definitely the rural communities in large part, but especially with our... You know, we have five tribal nations that have land in North Dakota.

And it really affects, you know, those populations as well.

The Indian Health Service facility at Belcourt on Turtle Mountain Reservation is the only IHS facility, or tribal facility, that does labor and delivery.

But they still end up sending some patients out to other healthcare facilities, especially if there's, you know, more advanced complications or things like that.

So there's a number of different groups that are impacted when a rural facility stops offering obstetrics care.

- Well, can you expand on that a little bit?

I mean, your research works to understand the health disparities of indigenous and rural communities.

- Yep.

- So with all these disparities, how often do you see the impact on these communities?

I mean, what all is the work you're doing on that?

- Yeah, so when it comes to those disparities, especially if we're looking at sort of access to care, we know in North Dakota that, especially the American Indian populations have, they start prenatal care later than other populations in the state.

And it's about two times higher risk of starting late prenatal care compared to white Americans and other populations in the state is really what we're looking at.

But then we have, you know, if you're not gonna look at it by race, if you're gonna look at it by geography, we still see those higher rates of late prenatal care in our rural communities too.

And it's important to get that early prenatal care because we can make sure, you know, the mom's getting all the screenings, the education, just the regular checkups.

And if you miss that during pregnancy, we might miss complications when they start.

So then they're not managed well during pregnancy.

And then that can lead to complications with birth and complications after pregnancy for the mom too.

And for some of these, it's not just that, you know, postpartum period.

If you have something like poorly controlled gestational diabetes, that increases your risk for developing type two diabetes and other health conditions much later in life as well.

So it's a really important period to try to get that care started and maintain that care throughout pregnancy.

- Well, I think you're just defining, you know, what challenges patients face, you know, if their local care unit closes.

So I mean, are there other challenges they face with that?

- Yeah, so when the care unit closes, you obviously lose that direct access to the healthcare that you're looking at.

And so when it comes to things like a complicated pregnancy, let's say if someone has high blood pressure during pregnancy.

Which is a big contributor to maternal mortality and also infant mortality, neonatal mortality.

And so when you have something like high blood pressure, you oftentimes need to go into the doctor many times, especially towards the end of your pregnancy.

So one of the things that we're going to start doing soon is looking at remote blood pressure monitoring for moms.

So that way they can do just their basic blood pressure checks at home, they can report it.

And we'll hopefully be able to see that they're managing their care better without having to take all that time to, you know, drive in just to do a blood pressure check.

If you can do it at home, you'll save that time and, you know, save the gas money, which is especially important right now, and those types of things.

So that's what we'll be looking at in terms of how well that works.

- Yeah, and it's got to affect other departments.

County EMTs, emergency departments.

Maybe they take- do they take on some of that care for labor and delivery?

- Absolutely.

- Can you talk about that some?

- So yeah, so it's really, you know, if you're having an emergency, you're gonna go to the closest healthcare facility regardless of if you know they're gonna have obstetrics care or not.

And so we do know that these, you know, rural hospitals that have emergency departments and rural, you know, EMS services are seeing, you know, pregnant women.

They're seeing, you know, people that are maybe in labor or maybe have some complications that need to be cared for.

And so what we've started doing is working with some of the smaller rural hospitals and community clinics in the state.

And we've provided them with... Well, we've asked them, like, "What do you guys need in terms of obstetrics care?"

And so they told us that, you know, they want some more training.

They want more education on, you know, emergency birth services.

And so we've been able to provide some of that.

And we're also going to be starting a project soon where we're working specifically with emergency services and emergency departments on things like maternal hemorrhage to make sure that if they see that, they can respond to that appropriately, stabilize that mom, and then transfer them onto a facility with more capability of taking care of that.

Yeah.

- Yeah, but, so what's the emotional impact on patients, I guess, when their local OB unit closes?

And what about the community itself?

- Yeah, I mean, first sort of for the families, it's just an additional stressor during a somewhat kind of stressful time anyway.

There's lots of changes that happen, you know, especially if you're a new parent.

This is your first kid.

You got all sorts of other things going on in your life about getting ready for the baby.

And then throw in, "Oh, now I have to drive two hours away just to see my doctor."

It's just that additional stress, additional financial pressure on the families that if we could avoid, it'd be great.

But that's just sort of the reality for that.

And then for the community, it's just sort of a loss of sense of... For some people, they talk about it as sort of a loss of a part of their community 'cause babies aren't being born in that community anymore.

I grew up in a, you know, town of about 20,000 people.

And, you know, the local newspaper would, you know, they don't do it anymore, but, you know, they'd always post like, "Oh, here's all the births," and that type of thing.

And if you don't have sort of that sense of who's welcoming new babies and these new families, there's just sort of that social aspect that you lose with those communities.

- You know, would you say there are maternal care deserts out there?

- Yeah.

Yeah, and so the March of Dimes is the organization that kind of started this aspect of maternal care deserts.

And they really view this as, they look at it at county level.

And if there's no obstetric providers in the county, that's one of the big indicators of a maternal care desert.

And for those communities, or excuse me, for those counties, North Dakota actually has the highest percentage of our counties are rural, or are maternal care deserts compared to anyone else in the country.

So we have, it's like 74-75% of our counties are considered care deserts.

So there's no obstetric-based services within those counties.

And that's why we're trying to look at things like remote blood pressure monitoring or what's the impact of telehealth and other types of healthcare for these areas.

Just as a way to try to figure out what's a way that we could alleviate some of those lack of access to care issues.

Because, you know, we don't have the resources to go and build a new hospital somewhere or something like that.

So trying to work with how the system is now while recognizing that there's much bigger issues that need to be addressed as well.

- Yeah, before we came on the air though, you were talking about your work and what your team's doing.

- Yeah.

- Can you expand on that a little bit?

- Yeah, so I'm also executive director of the North Dakota Perinatal Quality Collaborative.

It's a mouthful.

And we kind of have two different projects going on right now.

The first project that we have is we work with our larger hospitals that do most of the deliveries and most of the prenatal care in the state.

And for the last few years, we've been focused on screening and treating and referring out for care for mental health disorders during pregnancy and postpartum.

And that includes substance use because those are some of the big drivers of maternal mortality in the state, but also the country.

And then, but we also said, you know, we have all these maternal care deserts, but there's clinics, there's providers out there that are working and seeing pregnant people and families.

So we have a second project in which we're specifically focusing on rural hospitals and community health centers, those types of organizations.

And, you know, we went to them and said, "What are the types of things that we can help you out with?"

So that's where we've done some in-person simulation training, some specific events for them so they can... We want to make sure they stay on top of their care.

'Cause one of the biggest things in obstetric care is the more you provide obstetric care, the higher quality you can provide 'cause you're used to doing it.

And when you don't have any or really low volume of that care, that's where that practice really comes in.

- So what steps are being taken to help with this strain?

I mean, wouldn't training more doctors and nurses help with the problem?

- Yeah, and that's one issue that is sort of kind of pervasive around, throughout rural communities.

You know, with the medical school, they are making the big push to have more North Dakotans in the medical school and hopefully get more of those North Dakotans to stay in the state and provide care.

One aspect of that though is we don't have an obstetrics residency program.

So that training that doctors do after medical school, we don't have one of those programs in the state.

So all of our obstetricians in the state have received that additional training elsewhere.

But we do have a good number of them that have come back to provide care.

But having more people trained up in obstetrics and gynecology and hopefully wanting to practice in North Dakota rural areas would be a great thing.

- Well, we're about out of time- - Yeah.

- But is there any legislation, state or federal level, addressing this at all?

- That's a good question.

It's really hard to stay on top of everything going on right now in the legislature.

So we'll see.

Nothing that I know of off the top of my head for the upcoming legislative session from North Dakota.

But I will say that, you know, there's a variety of things that have happened at the federal level.

They've called things like a Momnibus bill that focuses on maternal mortality.

But one of the things about politics right now is that as fractured as we are, there's a lot of bipartisan support for addressing things like maternal mortality and rural healthcare.

And so whatever is maybe in the works that we don't quite know about yet, I think there is that push to do something.

- Okay.

Well, we're out of time.

But if people want more information, where can they go?

- Well, they can always look me up on UND's website and shoot me an email.

But there's other organizations, like the March of Dimes is a good spot.

The Center for Rural Health at the UND Med School as well.

And then the organization that I'm directing, North Dakota Perinatal Quality Collaborative, as well.

We've got some information about what we're working on too.

- Okay.

Well, thank you so much for joining us today.

- Yeah, absolutely, thank you.

- Stay tuned for more.

(upbeat inspirational music) Ever since she was little, Bailey White was surrounded by art.

Through the never-ending support of her family and community, Bailey continues to grow her craft with each stroke of her paintbrush.

She finds the beauty in both the landscape of the Midwest and the cities she has lived in.

Bailey finds inspiration through Moorhead's landmarks and the people that love them.

(light upbeat music) - I would say that one of my gifts in this world is being able to pick up on something artistic very easily.

And my greatest weakness is boredom and moving on to the next thing very quickly.

So I've got a little bit under my belt of what I'm capable of.

When I start a piece, it is always a little bit daunting.

I can really drag my feet and say, "Oh, I don't want to do this.

It's so much work.

It's gonna take hours."

And then those hours are gone in what feels like minutes.

I'll come back afterwards and say to my husband, "Did I just forget that I love painting?"

(light upbeat music) I have been an artist my entire life.

It feels like I came out painting and drawing and just doing something.

And my mom, who is actually a really prolific stained glass artist, she always pushed my artistic ability.

She always encouraged me to go farther with it, to take classes and to just constantly be creating.

My mom had our home absolutely stocked with anything I might want to explore.

And so my whole life I have been painting.

(light upbeat music) The majority of my work is acrylic painting.

What I aim to do is to continue to push it and actually make it something that when you look at that, you say, "That is something Bailey White did."

Every single painting starts with the background.

I really, really love a baby sky blue.

The majority of my paintings have that as just a solid one color background.

Then I come in, I draw out the buildings.

And then it's just color blocking for me.

I really, really like to explore buildings around the Fargo-Moorhead area.

I like to paint our architecture and especially brick buildings.

And I love to share that with other people, especially people who have connections to those buildings.

It can be so easy to be lost in a building, when you're looking at architecture and you go, "I don't know what's next.

Everything's run together."

Especially when you're painting it, all of the lines, you lose them.

So it's just really important to color block and then just start blending.

And before I know it, the painting is done.

Every time I make a painting, I set out to do realism, but it always just ends up getting pulled back into illustration because I like to have my bold and thick lines.

I like to use paint pens.

And so it always just ends up somewhere between realism and illustration.

It's interesting because I don't want to fall into abstract or even like slightly abstract.

But I also want that to be such a recognizable part of my work.

It's just constantly pushing in different directions and just trying not to get stagnant in whatever I'm doing.

I've been calling it just like a patchwork style.

Drawing from the farmland, I want people to see all of that together.

I hope that people see the sense of community that I am trying to pull in.

I like to take the places around me and just show the beauty that's here, what the people here have made.

And then I just get to replicate that a little bit.

(light inspirational music) When it comes to the architecture stuff, I know what that's gonna look like 'cause I know exactly what it needs to look like to be recognizable.

But when I do some more creative stuff and I'm trying to expand my artwork, I try to not be so rigid about how I'm thinking.

I try to really let what wants to be be.

If I want it to be this and it's just not working, I say, "It's just not what the canvas wants to be."

And I have to let it go this direction.

I've been honored with some different things, like being the Giving Hearts Day 2023 Artist of the Year.

I've also gotten to work with Medora on a few different projects that just celebrates their region.

The one I did for the 2023 Giving Hearts Day Artist of the Year was called, "Flood Plains," and that was abstract.

It still was just imagery in a different form of our area.

(light uplifting music) I love the Midwest.

I love North Dakota.

I love Minnesota.

I love where I am from.

I have a hard time looking at a mountainscape and wanting to paint it.

And I think a lot of that comes from painting and creating what you know.

I've stared at wheat fields.

I see it every single day.

I know what she looks like.

I know what it's supposed to feel like when you see that painting.

I want to create things that the people around me will appreciate.

If we lived in a world where arts weren't supported by the communities around you, you would live in such a gray and stagnant world.

To think about the pieces that we would lose if that wasn't part of our lives.

My biggest goal is to just start getting to be in shows.

But I need to build my collection first.

And so just focusing on building up an actual portfolio of either the architecture of the patchwork designs that I want to do.

Just solid portfolios and pieces that all fit together.

Maybe some other people, if they were to tell their parents that they are going to go to art school, their parents might say that is a waste of money.

And though right now I'm not saying that it was the smartest decision I ever made, my mom knew that that's what I was gonna do.

She never questioned it.

She supported it the whole way.

And when I called her to tell her that this was happening for me, all she said was, "I am so proud of you."

(light uplifting music) - Well, that's all we have on "Prairie Post" for this week.

And as always, thanks for watching.

(upbeat inspirational music) - [Announcer] Funded by the Minnesota Arts and Cultural Heritage Fund with money from the vote of the people of Minnesota on November 4th, 2008.

And by the members of Prairie Public.