Near an I-80 off-ramp in Evanston, Wyo., across from a Chevrolet dealership, there’s an old, white house. Upstairs, it has a tattoo shop.
“So we'll have screaming down here and screaming up there,” midwife Jana Hartzell said laughing.
That’s because “down here,” Hartzell delivers babies.
“This is the birth room,” she said, entering a vibrant space.
Aside from the inflatable tub for water births, it looks like a bedroom with a queen-size bed, purple walls and yellow curtains.
“The goal is to make it feel like you're at home when you're having your baby versus, like, cold, sterile hospital feeling,” Hartzell said, wearing rhinestoned flip-flops and glasses.
Midwives specialize in natural births and using fewer drugs. They don’t have as many years of education as OB/GYNs but are trained to handle low-risk clients and transfer them to a hospital if things don’t go according to plan.
“We take on women who are experiencing normal physiological pregnancy,” Hartzell explained.
The idea for the birth center first came about last year when the local hospital delivery unit shut down, saying it didn’t have enough patients.
The Evanston delivery unit was one of 100 rural units to shut down since 2020 amid rising costs, according to an August report from the Center for Healthcare Quality & Payment Reform, a national policy center.
The study says, throughout the Mountain West, the median drive time to a hospital with labor and delivery services is around an hour.
That became true in Evanston, where the closure left many pregnant people risking having their babies en route to the closest delivery unit in Ogden, Utah.
“I never anticipated what happened,” Hartzell said. “We were like, ‘What are people gonna do now? I mean, I guess we have Utah close, and that's fine and dandy, but some people don't have a way of getting down there.’”
A new midwife, Hartzell had planned to start small with homebirths, but that would have required her traveling far distances and not being able to serve as many clients. Opening a birth center would allow her to see clients in one central location.
So Hartzell and another midwife pooled their money and opened the center, Mountain Heart Midwifery, which serves as a middle ground between hospitals and home births.
Others like Sarah Morey are doing the same. She co-founded Earthside Birth and Wellness Center in Cheyenne a couple years ago.
The center is now nationally accredited, but Morey said there’s still some challenges around insurance.
“We're basically eating $4,000 to $5,000 per client,” she said, referring specifically to those on Medicaid.
In Wyoming, Medicaid doesn’t cover fees for birth center facilities and administration. Morey is lobbying to fix this with state lawmakers — many who already see midwifery as a way to fill care gaps.
But there are other hurdles.
“It’s, then, the hands-on training,” Morey said.
To get a certification or degree, midwives need to attend a certain number of births in person and get experience dealing with emergencies. And in sparsely populated states like Wyoming, there's just not enough midwives to teach them.
“It's hard to feel confident,” Morey said, “without finding high volume centers to apprentice at, or having to leave your family for a month or two.”
Many people go to states such as Utah, which has larger birth centers. Others go to New Mexico, where there’s state-sponsored apprenticeship and a longstanding nurse-midwife university program.
“Community traditions were preserved,” said Abby Reese, who leads that program.
She said midwives were marginalized decades ago by mainstream medicine but in New Mexico, Indigenous and Hispanic communities helped keep the practice alive.
Many state lawmakers are also on board.
“They’ll say something along the lines of, ‘My grandmother was a midwife,’ or ‘I was born at home,’ and people actually have some connection to that,” Reese said.
In New Mexico, midwives attended more than a quarter of the births in 2021, according to the U.S. Government Accountability Office. That’s twice the average of other states in the region.
Reese wants midwives to provide the majority of birth care, like in some European countries, “with physicians in consultative roles so that we can leverage that precious workforce to use their unique skillset.”
Many states have a shortage of OB/GYNs, including Idaho and Wyoming, where lawmakers have passed abortion bans. Idaho has 35% fewer OB/GYNs than before its ban went into effect, according to one study. Providers say Wyoming is also losing OB/GYNs, even though its abortion bans have been blocked in the courts.
Those states are also training family care doctors to fill the void and take on more complicated pregnancies that require C-sections. Wyoming has considered creating a community college midwife track, but that has yet to happen.
States with larger populations like Arizona, Montana and Nevada, have launched nurse-midwife university programs in the past two years.
For 19-year-old Rustin Mitchell, midwives are part of the solution. She had her first baby in that Evanston birth room.
“There was a point where I was like, ‘Oh my God, I can't do this. Somebody give me some drugs,’” Mitchell recalled.
But she pushed through and afterwards got a home-cooked meal from midwife Jana Hartzell.
“Jana cooked me a pulled pork sandwich, gave me a nice glass of orange juice, a slice of cheesecake,” she said. “I was on top of the world.”
And she felt at home with her healthy baby boy.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Nevada Public Radio, Boise State Public Radio in Idaho, KUNR in Nevada, KUNC in Colorado and KANW in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.
