About two years ago, Mariposa Community Health Center faced a bleak possibility: Its labor and delivery department was close to shutting down.
“We saw this shift to our OB-GYN labor and delivery department just not being sustainable financially,” said Dan Prevost, the health center’s chief executive officer. Around the same time, Mariposa applied for a major federal grant known as the Rural Maternity and Obstetrics Management Strategies, or RMOMS Program.
“We were in a crisis,” Prevost told the NI earlier this month. “And we were reaching out to the state and to our federal representatives saying, ‘Hey, we need help.’”
Earlier this spring, Prevost received a call from the U.S. Health and Resource Administration: help was coming.
Over the next four years, Mariposa Community Health Center will receive $4 million from the federal government through an initiative meant to strengthen maternal health care options in Santa Cruz County and other pockets of rural Arizona. Mariposa was one of two healthcare providers in the United States to receive RMOMS funding for the 2024 grant cycle.
The funding comes at a critical time for rural healthcare providers, Prevost pointed out. Between 2011 and 2021, approximately 267 rural hospitals across the nation shuttered their maternal health programs, according to a study from health consulting firm Chartis.
And currently, Prevost said, Mariposa is the only clinic in Santa Cruz County providing OB-GYN resources – which include prenatal, labor, and postnatal services, along with female reproductive health services.
In recent years, “we had one of our local OB-GYN providers retire. We have another one … who just closed his practice,” Prevost said. “So now, 100 percent of both the office work for OB-GYN services, so prenatal and postpartum care, and hospital care is essentially on Mariposa.”
When it comes to pregnancy, the first three months are particularly precarious, according to Patty Molina, Mariposa’s Senior Director of Community Health Services.
“You’re so vulnerable to anything, to losing the baby, and miscarriages, and things like that,” she said.
To help ward off potential complications, she said, a key priority for Mariposa is to make sure patients begin prenatal care “on time.”
“That’s the main one … especially because we’re so close to the border,” Molina said, noting that some mothers don’t show up at Mariposa until they’re already past the first trimester in their pregnancy.
Receiving services earlier, she said, also allows patients to have helpful information more readily available: “What to eat, what not to eat, what to do, what not to do. Can you exercise? Can you take Tylenol if you have a headache?”
Those questions, Molina noted, can be daunting – particularly for pregnant teenagers.
“Most of them are really scared,” she added.
Aside from prenatal care and labor and delivery, Mariposa focuses on postpartum treatment, Molina noted – for instance, screening patients on the Edinburgh Postnatal Depression Scale and, based on the results, referring those patients for further mental health services.
Dan Prevost, Chief Executive Office, and Patty Molina, Senior Director of Community Health Services at Mariposa Community Health Center.
Photo by Angela Gervasi
But speaking in an interview earlier this month, Molina said, maternal healthcare stretched far beyond the examination table, encompassing Mariposa’s WIC (Women, Infants and Children) program, which focuses on nutritional assistance and breastfeeding support for low-income mothers, babies and young children. In addition, Molina noted, Mariposa hosts a Maternal Child Health Program, which provides services via home visitation.
Those visits, Molina said, can reveal – and have revealed – an array of risk factors for families, particularly poor housing conditions in Santa Cruz County.
“You might see, maybe, a four or five-member family in a one-bedroom house,” Molina said.
Or, she added, no electricity in the family’s home.
“We’ve even come across (homes) with asbestos and things like that,” she noted.
As a result, Molina said, Mariposa staff work as advocates for the family – attempting to connect patients with additional resources, like housing alternatives. Now, Mariposa is working with another partner group, the Santa Cruz County Housing Coalition, to address that need.
“That’s the important thing about inclusivity … that there’s health equity,” Molina said. “Not necessarily just for making sure that everyone has access to a provider, but access to resources that they might need as a family.”
Creating a ‘network’ for maternal healthcare
The grant money will help fund the salary of an additional women’s health nurse practitioner. Including the new nurse practitioner position, Mariposa is slated to have four OB-GYN providers come July, Prevost said.
Aside from that, Prevost said, a large swath of the federal funding will allow Mariposa to develop a more financially sustainable model for maternal healthcare in rural counties. Through the grant, Mariposa is required to collaborate with other hospitals and healthcare providers within the state; while Mariposa is the grant recipient, service areas involved with the funding will also include Graham and Gila counties, according to the HRSA.
“This program is going to utilize a network approach to develop a rural continuum of maternal and obstetric care,” said Julio Marenco, a public affairs strategist with the HRSA. “From pre-conception, through prenatal … labor and delivery, and postpartum services.”
Already, Prevost said, Mariposa is partnering with Southern Arizona Laborist – a network of OB-GYN physicians who specialize in on-call coverage for hospitals.
The world of maternal healthcare, Prevost said, has shifted in recent years – for instance, the emergence of laborists.
“‘Laborist’ is a relatively new term in the world of medicine. That means they have been trained to do labor and delivery in hospital settings,” Prevost said.
In other ways, he said, maternal healthcare has become more complex: more medications, more skills for OB-GYN providers to learn, more specializations, and more awareness of postpartum needs.
“There’s been this focus in med school where new providers either focus on being really good at the hospital work … or being really good at the prenatal care,” Prevost said.
And due to that new pattern of specialization, Prevost said, it now takes more staff to perform OB-GYN services.
“During this transition, which is ultimately a result of better quality of life for physicians, and more extensive treatment available to patients, the cost of delivering that care essentially doubled,” he said.
Using the grant funding, Prevost added, Mariposa will also look at new reimbursement models and even consider advocating for legislation that could ease financial burdens for rural healthcare providers.
Pointing to Mariposa’s labor and delivery department, Prevost said the program is in a better place than it was two years ago – but it still needs work to become sustainable.
“Now, it’s surviving, but at a huge operating loss financially,” he added. “But our goal is to make (it) thrive.”
