Pregnancy Care Desert: Mariposa County mothers travel out-of-county for health care


Finding quality health care in the foothill communities is hard enough, but when you’re pregnant it can be nearly impossible. In Mariposa County, there aren’t only OB/GYNs, but there isn’t even a birthing hospital.

Despite the lack of those resources, two programs are trying to help women make sure they’re getting the care they need.

The John C. Fremont Healthcare District stands as Mariposa County’s only hospital. In the last couple of years, it has bolstered its imaging services. The newest addition to their lineup of machines is a Hologic Discovery Bone Densitometry machine. The top of the line machine helps detect bone diseases.

However, something you won’t find inside the hospital is a labor and delivery department. The hospital stopped offering those services 30 years ago, according to CEO Matthew Matthiessen, he couldn’t say why that decision was made.

While the hospital can provide some prenatal care for mothers-to-be in the county, they still have to head outside of the county to be able to get specialty care from an OB/GYN or to deliver at a hospital. This causes many to go back-and-forth between Merced and Fresno.

Katie Rule was one of those mothers. Her first child, Gracie, was born in 2007, and her second child, Evan, was born in 2010.

“I got a midwife in Oakhurst and then I delivered in Clovis [for Gracie],” Rule said. “But then for my second child, I had to go all the way to Fresno for every single appointment. Everything.”

One free county program that has been helping mothers since 2006 in the county is the Smart Start program out of the Mariposa County Department of Health and Human Services. First funded through a grand, the Maternal, Child and Adolescent Health Division at the California Department of Public Health started funding it in 2009.

“If I didn’t have the program, I wouldn’t have gotten the prenatal or postnatal care that I have. I wouldn’t have had somebody come in and check on my kid,” Rule said.

The program brings public health nurses right to patients’ homes — supporting moms from pregnancy, up to when their child turns five. During the visits, the nurses go over everything to make sure the mother and child have a healthy life.

“The visiting nurse does not take the place of the actual visit to the doctor, or a prenatal care provider,” said Margarita King, public health nurse manager at the Mariposa County Department of Health and Human Services. “But, having this service and being a support to the moms is very critical.”

The nurses encourage mothers to keep up with their appointments with their doctors.

Dr. Subhashini Ladella, a perinatologist at UCSF-Fresno, said expectant moms need to see the doctor an average of eight-to-12 times before and after their pregnancy.

Missing this care is dangerous for the mother and child.

“They could have miscarriages first and second trimester. Also…surveillance for preterm delivery would reduce [that risk],” Ladella said.

The distance, according to King, is the biggest obstacle for Mariposa County mothers. From the town of Mariposa, the closes OB/GYN is 45 minutes away in Merced. To get to the closest one in Fresno, it can take anywhere from 70-to-90 minutes.

Those times are similar for those living in the northern part of the county, too, as most travel to Sonora in Tuolumne County.

“Most of our moms are limited in their resources, either financially, or they just don’t have a car,” King said.

Another program helping mothers in the county is Helping Hands. First founded in Oakhurst in 1998, it expanded into Mariposa in 2014. The program offers free parenting classes to new and expectant moms. They’re also given new clothes, diapers and other essentials when they attend enough classes.

“The classes are designed to help people connect with their kids,” said Lindee Blew, a client care professional with Helping Hands.

Just like Smart Start, the program acts to complement doctor’s visits to make sure their clients are on the same page as their health care providers.

All with a personal touch. Blew said she approaches each of her classes as if she’s talking with friends or family. Some things she’ll say, “I’ve noticed some things, have you talked to your doctor about it? Would you like me to go to the doctor’s with you?”

Helping Hands continues to grow each year. Last year, it hosted 415 classes. This year, it’s already held nearly half of that.

The increasing needs for care for pregnant women in the county isn’t lost on King. She said a concern for her is the health care worker shortage, which affects the entire Central Valley. Right now, a majority of the workforce in the county is getting ready to retire.

For King, the way to fix that is mentor the future.

“[We are] reaching out to our nursing schools and other community partners to explain what other nursing fields are out there, such as public health nursing,” she said.

King’s department is currently short two public health nurses, which is about 55% of the nursing workforce.

As noted, both the Smart Start and Helping Hands programs are free for families to participate. More details on each program below:

Smart Start

  • Any Mariposa County resident is eligible to enroll in this program.
  • Topics covered in visits include reducing risk of illness and injury and parent-child relationships.
  • Click here for the program’s website.
  • Feel free to call 209-966-3689 or 800-459-4466 with questions and more information.

Helping Hands

  • Besides offering pregnancy tests and parenting classes, the program hosts birthing classes.
  • There are also support services for men and miscarriage/pregnancy loss support.
  • Click here for the program’s website.
  • Feel free to call Helping Hands’ Mariposa office at 209-742-5500.

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