CLINTON COUNTY, Ind. — In a town with nearly 17,000 people, there isn't a maternity ward in Frankfort.
A third of Indiana counties have the same problem.
"I was so worried," said new mom, Madison Balero. "I searched for an OB (Obstetrician) here in town and there was one, but he was not delivering in this town."
Balero, like most expectant mothers had concerns, but the lack of healthcare access in her community makes her worry especially unique to Indiana rural communities.
"That's the big thing! Moms come to me nowadays and say, 'Where am I going to deliver? How am I going to do this?" explained Libbi Smith, RN, a Clinton County prenatal care coordinator. "I mean, when you say, 'I live in a town, but I can't have a baby there', many people are just baffled. What do you do?"
Frankfort Hospital shut down its maternity ward in 2017, a year after IU Health purchased the small, rural facility.
Moms who could once deliver at Frankfort Hospital now come to Smith, a former ER nurse who works with Healthy Communities of Clinton County Coalition.
During their pregnancy, Smith connects the local women to the closest doctor and facility for checkups and delivery.
"We've had a client that had trouble going back and forth. Husband worked in the daytime. She didn't drive. One of our staff members was pregnant and they would schedule their appointments the same day and our staff member would even help her get to the appointments. So it's a real problem," the health advocate described.
89 out of more than 160 Indiana hospitals have maternity wards, according to the Indiana State Department of Health.
For rural communities without that facility, the mother's doctor could be anywhere from 30 minutes to 2 hours away in rural communities.
Balero had three options: Witham Hospital is about 20 minutes away in Lebanon; IU Health Arnett is about 25 minutes away in Lafayette, or Franciscan Health Lafayette East is about 30 minutes away.
During her first pregnancy, Balero's daughter came quickly, so the second time around she knew a long drive left room for major complications.
"I actually got to the hospital and had him in less than an hour, so it's kind of nerve-wracking," the new mom described.
Aside from the emotional toll Balero describes, Smith told FOX59 there can be a physical consequence too.
"Those can be life or death things sometimes," Smith explained. "If you're commuting too far and you go into labor in the car or have complications, we can talk about maternal death and fetal death happening."
According to the Indiana State Department of Health & CDC, the Hoosier State ranks third in the nation for maternal mortality, mothers who died from pregnancy or childbirth complications; the state is seventh for infant mortality.
Maternity deserts in rural communities play a role in the alarming statistics.
When FOX59 asked how the state plans to address this issue, Dr. Kristina Box answered, "What I would say to you is that we are working closely with our rural counties to establish community health workers or potentially even hire nurse midwives or advanced practice nurses that can work in a county where there aren't OB services, and go out into counties surrounding them."
In 2019, Indiana Governor Eric Holcomb put Dr. Box in charge of fixing this statewide issue. The State Department of Health Commissioner knows this field well, having worked 30 years as an Obstetrician & Gynecologist (OB/GYN).
"In order for me to be an effective and a functioning and a compassionate doctor, and be the best that I can be for the patients when I'm there, I need to have time off at some point and time as do all OB/GYNs or family doctors that are providing this care," the physician detailed.
State officials say if rural towns have an OB/GYN, they can't get time off.
"Often times, they're the only person that is there, so they don`t have anybody to give them relief, so that means 24/7, they`re on call and covering for that population," Box said.
The American College of Obstetricians and Gynecologists (ACOG) found that less than 10 percent of OB/GYNs work in rural communities.
"So physicians don’t want to move to our community," said Smith. "I think it's a great place to live. I've lived here a long time, but not everybody sees it the same. So yeah, to get somebody to move this area is a lot of ask."
She says in big cities, the physicians often find larger, more experienced staffing, better resources, plus more options for school, sports, and activities.
But state health experts say even if OB/GYNs move and practice in rural Indiana counties, money for maternity wards is "really the issue."
"It involves not only an OB provider, but a neonatal provider, so usually pediatrics, neonatal nurses," the Indiana health commissioner explained. "It usually involves anesthesia of some type, and that's 24/7 to be ready for any woman that comes in at any point and time or child that needs that care, and that's an expensive thing to deliver."
Adding to this issue, ACOG expects there will be 8,000 fewer OB/GYNs than necessary for the U.S. by 2020, and 22,000 fewer by 2050. This is a critical physician shortage that Dr. Box says the state must also plan for to combat maternal and infant mortality.
Dr. Box says most struggling rural hospitals, already strapped for cash, can't pay the price to operate; and soon staffing any hospital with OB/GYNs could be problematic.
Despite the numbers and reasons for these rural maternity deserts, Balero says talking about it isn't good enough because her son, Samuel, Indiana moms and their babies can’t afford anymore losses either.