Four Wyoming birthing facilities have closed over the last dozen years — ending options for mothers to deliver babies in Riverton, Kemmerer, Rawlins and Evanston. With 11 of the state’s 23 counties lacking a practicing OB-GYN as of last year, even accessing prenatal care can be difficult.  The state’s maternal care gaps have grown impossible to ignore. Yet, a year after lawmakers identified the issue as a matter of top concern, little has been done to address policy or funding concerns. To be clear, experts say the challenges facing rural maternal care are numerous and complicated — and not something that can be solved with a single solution. Still, attempts to tackle the problem through raising Medicaid reimbursement rates or creating grants to support labor and delivery programs failed in the recent Wyoming Legislature.  Now, lawmakers appear likely to take the issue up anew. The Joint Labor, Health and Social Services Committee proposed as its top interim study topic “Maternal Medical Care in Wyoming and Maternity Care Deserts.”  Wyoming Women’s Action Network founder Jen Simon, an advocate for better maternal health services, hopes a second round of lawmaker study will yield action. Legislative debate on the topic, particularly in the Wyoming Senate, illustrated that lawmakers are concerned and thoughtful about the issue, she said.  “I’m hopeful that that is the tenor and the energy that comes into the interim around this topic, because it’s immensely important in every conceivable way for the future of our state,” Simon said.  The Legislature’s Management Council meets April 8 to finalize interim topics.  Where we are  WyoFile’s 2023 Delivery Desert series revealed significant gaps in maternal care, with families going to extraordinary lengths to deliver babies, doctors spread thin or on the brink of burnout and hospitals juggling the complicated cost formulas in thinking about maintaining labor wards.  Places like Fremont County have seen annual births plunge following facility closures, while anecdotes of families temporarily relocating to towns like Billings and Salt Lake City at great cost and inconvenience to deliver their babies have increased. A Wyoming Health Department assessment found that nearly half of the state’s counties lacked a practicing OB-GYN in 2024. The State Scorecard on Women’s Health and Reproductive Care ranked Wyoming 42nd that same year. The state placed behind all of its neighbors.  This map from the 2024 State Scorecard on Women’s Health and Reproductive Care shows overall scores by state. (Scorecard/Commonwealth Fund) Solutions have been elusive. Complicating the issue are provider challenges like low birth volume in rural areas, high costs of medical malpractice insurance, financial viability struggles for hospitals, abortion legislation’s impacts on doctors, liability concerns and barriers for midwives to deliver in hospitals.   However, health care advocates have called on the state to expand Medicaid, promote midwifery and build partnerships that could expand care.  The Joint Labor Committee made Wyoming’s maternity care shortage its No. 1 interim priority in 2024, along with childcare. However, no bill explicitly aimed at alleviating the care gaps emerged from the committee. The OB Subcommittee of Gov. Mark Gordon’s Health Task Force also worked to explore solutions. That group narrowed its focus last summer to three areas: how to better utilize midwives, doulas and family physicians alongside obstetricians in delivery care; the possibility of creating OB medical fellowships to bolster care in Wyoming and regionalizing the state’s maternity care. Meanwhile, care has eroded further. Evanston Regional Hospital discontinued labor and delivery services on Dec. 30, citing declining demand. Debates and attempts Maternity care did come up during this year’s legislative session budget talks.  Gordon included a raise to the Medicaid reimbursement rate for maternity care in his supplemental budget.  “This is a complicated issue that we continue to evaluate and develop recommendations to address,” Gordon wrote in his budget recommendation. “One thing that we can do today is increase Medicaid rates for our providers to ensure we can help retain the services in Wyoming, as Medicaid births account for approximately one-third of the deliveries in Wyoming.” As such, Gordon requested about $2.4 million to be added to the Department of Health’s budget — split evenly between state and federal dollars.  The House Appropriations Committee stripped those funds, the Senate Appropriations Committee restored them, but the supplemental budget wasn’t passed, rendering those actions moot.  The Senate also debated allocating $18 million to the Health Department to provide grants to support delivery and maternity care. The current gaps are “unacceptable,” Sen. Chris Rothfuss, D-Laramie, said when introducing his funding amendment. “We don’t have any solutions on the horizon. I was personally hoping there’d be some good opportunities and options through this legislative session, but we just haven’t seen it.” Given that, Rothfuss said, the grant program would be “effectively a stopgap measure” to prop up the fragile maternity care system until better solutions are reached.  Sen. Charlie Scott, R-Casper, said that while not in favor of large expenditures, he supported this one. “You want to destroy a community’s ability to attract new businesses and keep existing businesses that might be mobile?” Scott asked. “Take away their delivery care. Take away their obstetric care. It really puts them behind the eight ball.” Sen. Gary Crum, R-Laramie, also supported the amendment, pointing out that without a facility in Rawlins, many Carbon County women have to drive 100 miles to Laramie and over Elk Mountain, a notoriously dangerous stretch of Interstate 80.  “Let me remind you, some of us in this body have given birth,” Cheyenne Republican Sen. Evie Brennan said. “I can tell you 100 miles on one of those [deliveries], I may not have made it to the hospital.” Sen. Evie Brennan, R-Cheyenne, during the 2025 Wyoming Legislature. (Mike Vanata/WyoFile) Brennan noted that while $18 million is significant, “we’re talking about access for women who are carrying our most valuable resource: our children … Let’s not fight on this one. Let’s put our money where our mouth is and let’s say, ‘these are our most valuable resources.’” Critics, however, balked at the program’s expense and vagueness.  “It’s a real issue out there, but it takes a little more contemplation to stand up a program and just throw one-time money at it,” Sen Larry Hicks, R-Baggs, said. “I appreciate the sentiment … but without more details, I can’t support an $18 million appropriation when I don’t know what it does.” Evanston’s closure is a cautionary tale, Rothfuss said, of the dominoes that can continue to fall while Wyoming lawmakers continue to study the issue.  He failed to sway the body’s majority, however. The Senate voted it down 11-20. Political newcomers The Wyoming Legislature was filled with freshman lawmakers in 2025, noted Micah Richardson, associate director of policy at the Wyoming Women’s Foundation. Getting up to speed on the legislative process is difficult, she said, and could have created a drag on the conversation about maternal health care.  Wyoming midwife Heidi Stearns checks an infant after a home birth. (Courtesy Teal Barmore Photography) She lamented the failure of a couple of smaller bills that could have helped move the needle on the issue. House Bill 231, “Medical education funding,” for example, would have expanded medical training and education at the University of Wyoming through a partnership with the University of Utah — potentially boosting provider numbers.   Richardson also believes that to enact change, Wyoming will likely have to expend funds.  “There can be some creative solutions or pieces of the puzzle to kind of get us there, but it is also going to take an investment,” Richardson said. “Not just, you know, ‘we say this is important,’ but it’s going to take some money to make sure that these things are given the support they need to be successful.” Simon of Wyoming Women’s Action Network is encouraged by the Senate debate, hoping it will carry momentum into future lawmaker work. “At least the senators can say, ‘It’s a priority from our perspective, for our hospitals, our residents, our families, our economy and our future,’” she said. 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