BETHEL, Alaska — The contractions were coming eight minutes apart, and Billie Jo Yupanik was breathing into them, her gaze down, hands cradling her abdomen.
Around her, other pregnant women padded around the open, airy rooms of the Yukon-Kuskokwim prematernal home, chatting on phones or grabbing coffee from the pot. They mostly smiled and nodded at Ms. Yupanik as they passed, but otherwise seemed to pay her little mind. Going into labor, after all, is hardly remarkable in this place.
Childbirth has become more dangerous for women across much of the United States over the last two decades; maternal death rates have doubled since the late 1980s, according to federal figures. Rural places — here in Alaska and across the lower 48 states — are among the hardest hit as vast distances, widespread poverty and fewer doctors make it harder to obtain access to health care. And Native populations are often on the very edge of that disparity: A baby born to an Alaska Native mother is four times as likely to die in the first year of life as a white baby.
But here on the far western end of the nation’s biggest and most rural state, where roads are nearly nonexistent and populations are scattered across tiny villages, caregivers are trying to change the equation not by sending more doctors out, but by bringing more women in. At their first prenatal visits to the hospital, doctors assign a due date for the baby and a “be in Bethel” date 30 days earlier, for a stay at the prematernal home, which the hospital operates nearby. An added stern warning makes most women comply: If they don’t come, they might give birth without a doctor’s care at all.
Bethel, population 6,400, is the biggest town for more than 350 miles in any direction, and the Yukon-Kuskokwim Health Corporation, the one hospital in the region, serves an area the size of Oregon.
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