Dr. Acosta’s story

Deep in the heart of Texas: One doctor’s fight against maternity care deserts

Terry County, Texas — In the remote expanses of West Texas, the journey to quality obstetric care can be a grueling ordeal. Between the lack of resources and long drive to a hospital offering quality obstetric care, too many women across the country struggle to get the care they need before, during, and after pregnancy. Dr. Kristy Acosta, a Family Medicine Obstetrics Provider at Brownfield Regional Medical Center, describes the harsh reality: “What ends up happening is people just don't get care. They just show up to the emergency department. And you have worse outcomes when you don't get any prenatal care.”

Dr. Acosta witnesses the consequences firsthand. Women who attempt the long drive to Lubbock, the nearest city with adequate facilities, sometimes don’t make it. “We’ve had several cases where women were en route to Lubbock but delivered here because they couldn’t get there in time,” she recounts. This underscores a critical issue revealed in the March of Dimes' 2024 report, Nowhere to Go: Maternity Care Deserts Across the US. The report highlights that a staggering 35.1% of counties in the US are maternity care deserts, lacking basic birthing facilities or obstetric clinicians.

Dr. Acosta’s dedication to her community is deeply personal. Raised in nearby La Mesa, she chose to stay close to home despite the daunting challenges. Her role is multifaceted, encompassing both family medicine and obstetric care. This broad scope of practice means that every day presents new challenges—some predictable, some not. “Our mission is to ensure safe deliveries, whether at home or in a hospital, but sometimes circumstances are beyond our control,” she says. Her commitment is evident in the numerous emergency calls she receives, like one about a delivery at a gas station.

As the sole family medicine obstetric provider at Brownfield Regional Medical Center, Dr. Acosta is on call around the clock. To take a day off, she needs to arrange coverage months in advance. But finding someone willing to step in is challenging. This relentless schedule highlights a broader issue: the declining number of family medicine doctors who specialize in obstetrics. “Family medicine doctors who do obstetrics are a dying breed. People want to have families and work a set number of hours.”

The shortage of obstetric care providers isn’t an abstract issue but a daily reality for many rural women. “There was another provider here when I started, and that provider left. Out of me caring for the community, really enjoying working with my patients, and enjoying the staff, I’ve chosen to stay,” Dr. Acosta explains. Many patients face financial barriers as well. “We have patients who drive from La Mesa but sometimes call saying they can’t afford the gas,” she adds. “If they can’t manage a 30-minute drive, how can they get to a farther facility?”

Financial strain further complicates access to care. Dr. Acosta recounts a recent example: “I saw a patient who couldn’t afford her $20 medication. So she didn’t take her medications all weekend. Thanks to our staff, one of our team members was able to find a coupon and get the medications for $3.72.”

Addressing the maternal and infant health crisis requires multifaceted solutions. Dr. Acosta advocates for expanding and supporting midwifery services as a viable option. “They provide great care if we set up more birthing centers in local areas,” she says. Midwifery care has been shown to improve outcomes and reduce the need for medical interventions, yet only 27 states and Washington, DC, allow Certified Nurse Midwives (CNMs) to practice to their full extent.

Dr. Acosta’s unwavering dedication embodies the broader need for systemic change. “It’s our duty to provide everyone with care,” she states. She’ll deliver a baby if she believes she can provide adequate care, and if not, she’ll ensure they get to a facility that can. Her commitment highlights the urgent need for expanded access to quality care.

As we confront the challenges posed by maternity care deserts, Dr. Acosta’s story serves as a powerful illustration of the critical need for systemic reforms. By supporting healthcare professionals, expanding services, and improving access, we can work toward a future where every pregnant person, no matter where they live, receives the care they deserve.

Dr. Acosta shared her story with March of Dimes in March 2023. The maternity care access designation may have changed in her county since then.