My name is Jenni Van Otterloo. I've been
married to my husband for about what will be four years this summer. We've lived
here in Sanborn, Iowa for the whole four years of our marriage. We have two kids.
We just had one about two and a half weeks ago. Being in Sanborn, Iowa there's
not a lot of close hospitals. The nearest hospital is in Sheldon Iowa which is 10
miles west of us, and they're pretty small. The only pregnancies they take in
Sheldon are what's considered a normal pregnancy.

Before I got married, I found
out I had a pulmonary embolism; blood clots in my lungs that later on were
going to play a factor into pregnancies with being on blood thinners,
and things like that. I've been with McKay now for, oh
probably five, six years so she's been aware of my history for a while. My name is Kimberly McKay. I'm an obstetrician- gynecologist in Sioux Falls, South Dakota
and I am the Clinical Vice President of the ob/gyn service line for Avera

Avera Health is a health system that covers 72,000 square miles of South
Dakota, Minnesota, and Iowa, down into Nebraska
and we have about 16 facilities that deliver babies. We deliver 6,000 or so,
6,500 babies a year, so we know a lot about rural. We know a lot about what
goes on in rural medicine. 15% of our patients are American Indian, about 10%
are other nationalities. Half of our patients are covered by Medicaid,
either as a primary or secondary insurance. And so, you know, large
geography, very diverse patient population. Care planning for rural
patients is difficult sometimes. Ideally they're low-risk, they have no
medical issues, they are normal weight, they have every resource available to
them, but as it turns out not very many pregnancies in the United States of
America are low-risk. So when I looked for different providers near me, both
places told me that with a condition like mine, with a blood disorder that I
have, they don't have the resources, like the blood bank on hand, at their
hospitals to handle anything that would happen, if something were to happen
during delivery or during pregnancy, so I was referred to Sioux Falls, therefore
back to Dr.

McKay in Sioux Falls at Avera. Prenatal care, in general, for a
low-risk pregnancy is 13 visits. 13 days out of that where you take time out of
work. 13 days where you need to travel for things like ultrasound and lab work.
Add 90 miles, a 90 mile drive, to that and it makes things extremely complicated.
geography doesn't pick and choose the low risk and high risk patients. The distance is huge. I have to travel an hour and a half to an hour and 40
minutes for every doctor appointment, and that's just one way, so I'm on the road
for over three hours for a 30-minute appointment every time that I need
go to a doctor's appointment. we have Avera eCARE which is one of the largest
telemedicine networks in the United States. We're looking to add more
technology to figure out how to keep patients as close to home as possible
until they actually need to come into their maternity center to deliver. I had really good care. The only thing that Dr. McKay and I talked about, just
trying to cut back on some of the distance, and the traveling, and things
like that through video conference calls, or whatever, just to do some of those
would be really helpful.

I think that would be something that would be great
to see happen in the future. And the other piece is that Family Practice
physicians, and nurse practitioners, and PAs are extremely important part
about how we provide care. They aren't always as comfortable with obstetrics
unless they, themselves, are personally providing that care in their community. And so much of what we do, in particular through our eCARE services, is helped
them feel comfortable with what they're seeing. So when I went into labor with my
second child, I went to work that morning. I had contractions. They usually tell
you to go in when they're 5 to 7 minutes apart. They tell me to come in when
they're 10 to 12 minutes apart. So I actually went to work that morning
because they weren't that close yet, but by the time I made it to the hospital I
had my daughter within an hour of getting checked into the hospital, so it
was cutting it really close.

I'm glad we made it, and everything worked out ok, but
yeah, there's just a lot of extra things that we have to plan with..