This story mentions miscarriage.  PRESTONSBURG — Brooke Thacker tried for years to have a baby, having miscarriage after miscarriage along the way.  Finally, her dream came true and she gave birth to a baby boy this fall. She believes her smoothe birth wouldn’t have been possible without the prenatal care she was able to access near her home thanks to a grant-funded mobile clinic.  The Women’s Health Mobile Clinic is just over a year old, but the staff who run it say it’s already making a difference in the lives of Eastern Kentucky women who can’t — because of transportation issues, poor roads or other barriers — get to a doctor’s office.  The clinic, which is a van equipped with Starlink, operates through Big Sandy Health Care. Based in Floyd County, the clinic also travels to Johnson, Martin, Magoffin and Pike Counties. Sometimes the clinic goes to patients’ houses; other times it parks at local businesses.  The clinic fits in well with the mission of Big Sandy Healthcare, which was founded to reach underserved communities.  Brooke Thacker and baby Jimmy leave the Big Sandy Medical Center Women’s Health Mobile Clinic after her appointment on Dec. 10. (Kentucky Lantern photo by Arden Barnes) Reaching more women  Kentucky has dismal maternal mortality rates — and outcomes are typically worse for women of color than white women.  The 2024 March of Dimes report showed the state once again had high maternal mortality and preterm birth, both of which were worse for Black Kentuckians. The state has a maternal mortality rate of 38.4 deaths per 100,000 live births, much higher than the national rate of 23.5 deaths per 100,000 live births. A 2023 state report on maternal mortality also showed substance use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky — 88% — are preventable, that report from the Cabinet for Health and Family Services said. In Eastern Kentucky, many counties rank “high” or “very high” on March of Dimes’ vulnerability scale, meaning people in those counties are at an increased risk of maternal complications.  Most of Kentucky is at risk for poor maternal outcomes. (March of Dimes photo) Research shows accessing prenatal care can help lower the chance of complications for mom and baby. “We know that women who have access to early and consistent prenatal care, the mothers do better, and the babies do better,” said Dr. Lesley Dotson, the chief medical officer at Big Sandy Health Care. “You’re able to detect potential problems with the pregnancy, or even anomalies in the fetus. You’re able to detect that early so that the mom receives proper care, and then also appropriate planning for the delivery. That’s very important.” Being able to monitor the baby’s size throughout pregnancy can also lower a person’s risk of needing a cesarean section, she said.  The importance of the care is established, but access to it is more complicated.  Big Sandy Health Care Director of Nursing Laken Meade in Prestonsburg, Dec. 5, 2024. (Kentucky Lantern photo by Arden Barnes) “There’s not a lot of mobile units related to maternal health,” said Laken Meade, the director of nursing at Big Sandy. “March of Dimes does some work with the mobile unit, but nothing really in Kentucky or even in Eastern Kentucky, did anybody have anything like this.”  Gathered  around a boardroom table in June 2023, she and others came up with the idea of a medical van that could travel around the five-county service area and care for women otherwise not getting proper OB-GYN care.  They applied for a $2 million, 2-year maternal health grant from the federal Health Resources and Services Administration (HRSA) — and got it.  That grant will carry the clinic until late 2025. By then, staff hope it will be financially self-sustaining.  While there is a shortage of OB-GYN staff in the area, there’s no shortage of women who need that care.  Some Eastern Kentucky patients have to travel an hour or more to reach an obstetrician, Perry said. Others lack transportation altogether, or live near poorly-maintained roads, making travel tedious.  “We focus on those patients,” she said. Sometimes, the clinic parks at a local health department or, if possible, goes to a patient’s home.  A year into its operations, it’s seeing about eight  patients a day, twice a week and getting patients who often missed appointments in the past the routine care they require.  “We receive multiple comments from patients stating that they’ve been putting off seeing women’s health care providers because the nearest clinic is almost an hour away,” said Haley Mullins, the nurse case manager of the clinic. “And then with their work or child care schedule, it’s just too hard for them to make it happen. So, after they find out we have our mobile unit that can come to their community or even to their house, it makes it much easier for them to schedule and keep their appointments.”  A lot of patients can now come while their child is at school or they are on lunch break, she said, which would be more difficult or impossible if they also had to travel.  Inside the Big Sandy Medical Center Women’s Health Mobile Clinic on Dec. 5, 2024, in Prestonsburg. (Kentucky Lantern photo by Arden Barnes) Cari Perry, the assistant director of nursing at Big Sandy, said barriers to care also include food insecurity, lack of child care and more.  “A lot of our patients are just really stretched, financially,” she said. “When you’re stretched financially, you’re having to choose. A lot of these patients may have multiple children, and they’re having to choose, ‘what do I do? I don’t have child care.’ There’s not a lot of child care in the area too, which leads to not being able to work.”  Kentucky remains one of the eight poorest states, and the  places served by the clinic are among Kentucky’s poorest, according to the National Institute on Minority Health and Health Disparities. From 2018 to 2022, more than a third of people living in the five counties got by on incomes below 150% of the poverty level —  in 2024, that was $38,730 a year for a family of three.  Residents living on less than that amount ranged from 36.4% in Pike County to 51.2% in Magoffin County — well above the Kentucky rate of 25.6% and national rate of 20.5%. What care does the clinic provide?  Big Sandy Medical Center Women’s Health Mobile Clinic on Dec. 5, 2024, in Prestonsburg. (Kentucky Lantern photo by Arden Barnes) The clinic provides a “range of essential reproductive and maternal health services and prenatal care,” according to Mullins.  That includes 4D ultrasounds, fetal testing, laboratory services, postnatal care, cervical and breast cancer screenings, contraceptive services, sexually transmitted disease (STD) testing, family planning, menopause support and more.  Nicholas Kellough, who manages the clinic’s technology and drives it, said keeping a strong satellite connection wherever the van travels is his main concern.  “What the Starlink has given us is that, as long as we don’t have any mountains or trees blocking the view of the sky from the satellite dish, if they can make contact with one of the Starlink satellites, we’ve got a connection,” he said. “And we’ve got a good, clean connection at that.”  He also has to keep weather in mind, as well as road conditions if he’s expecting to drive to a patient’s house.  “The clinical staff and myself, we … decide … can we make it to this patient’s house?” he said. They coordinate with the patient to find out the state of the driveway, whether or not it’s up a mountain and more.  Nick Kellough, outreach logistical support manager, on Dec. 5, 2024, in Prestonsburg, Kentucky. (Kentucky Lantern photo by Arden Barnes) “Geography matters,” Kellough said. “We try not to go out in too bad of weather with it either. But … we’ve got heat, we’ve got air conditioners. So, we do have creature comforts to make it comfortable for the patients too. That’s a very expensive unit and lives are priceless, so we don’t want to risk anybody’s life just trying to get out there. So, we will cancel if it’s inclement weather.”  Kellough doesn’t interact with patients, but gets a sense of purpose from bringing the clinic to them anyway.   “I think I care more than I should as just a driver and an IT guy,” he said.  Pushing for more full term deliveries  In addition to being able to sustain itself after the grant runs out, clinic staff say they want to serve more people.  “Our first and foremost goal over the next year is to be able to increase our access to more patients in surrounding counties,” said Dotson. “That’s probably our biggest goal — and to focus more on patients that have chronic health conditions during pregnancy like gestational diabetes and hypertension, getting them linked to services and educational courses to help hopefully improve outcomes with delivery.” Addressing those chronic health conditions can ultimately address the larger picture of maternal health, Perry said.  “Being in Eastern Kentucky, unfortunately, we do have a high number of women that have gestational diabetes, gestational hypertension, preeclampsia, those types of things,” she said. “And by improving access, I would hope for better outcomes. Instead of having prior-36-week deliveries, having 37, 38 -week deliveries; 40 week deliveries.”  Babies born too early can have health complications including breathing and eating problems, according to the Mayo Clinic.  Clinic made care “really convenient’ for Thacker  Haley Mullins, registered nurse manager, takes Brooke Thacker’s blood pressure during an appointment in the Big Sandy Medical Center Women’s Health Mobile Clinic, Dec. 10, 2024, in Pikeville. (Kentucky Lantern photo by Arden Barnes) Because of Thacker’s history with miscarriages and desire for a child, she knew how important it was to get prenatal care. Finding a good obstetrician she could trust close to home, though, was challenging. Thacker lives in Raccoon, a rural unincorporated community in Pike County, and her OB-GYN’s office was about an hour away in Prestonsburg. Getting there regularly, important for a healthy pregnancy and birth, was a burden.  Then she learned about Big Sandy’s mobile clinic, which traveled to Pike County, near her home.  “It would just be closer to our home, which was really convenient,” said Thacker, who also had gestational diabetes. She ended up going twice a week to monitor her and her son’s health — once to the mobile unit near home and once to the brick and mortar office.   “It was convenient not to have to drive all the way” to Prestonsburg each time she needed medical check-ups, she said.   She also found a familial-like support system with the “girls” running the clinic, she said.  “They’ve just been like family more than … people trying to help,” she said.  Thacker loved becoming a mother — and she’d like to do it again, she said.  “I might have two more,” she said. “If God lets it happen, then I’m here for it.”  When that time comes, she said, she will “absolutely” seek out the mobile clinic for her care.  Kirsten Crisp, an ultrasound technician for Big Sandy Health Care, holds patient Brooke Thacker’s son, Jimmy, 6 weeks, during Thacker’s appointment on Dec. 10, 2024, in Pikeville. (Kentucky Lantern photo by Arden Barnes) The post Not all expectant moms can reach a doctor’s office. This Kentucky clinic travels to them. appeared first on The Lexington Times.