The Biglefthand’s story

‘You're probably just going to end up having a baby on the side of the road’: The reality of being pregnant in rural America

Rosebud County, Montana — In the vast expanse of Rosebud County lies the small town of Colstrip. It's a community with tight bonds, where neighbors support each other through thick and thin. But for parents like Vania and Ray Biglefthand, accessing maternal care is full of challenges, made worse by the stark reality of living in a maternity care desert—meaning there’s no access to birthing hospitals, birth centers offering obstetric care, or obstetric providers.

Their story began with unexpected news: A third child on the way, bringing with it a mix of excitement and trepidation. "I was scared,” Vania recalls. “I started crying because we were just getting back on our feet." But soon excitement took over, and, initially, the pregnancy was healthy. However, Vania and Ray faced the daunting prospect of navigating a healthcare system with limited access to care. With the nearest birthing hospital two hours away in the city of Billings, routine prenatal visits turned into long, stressful journeys. "We had to get our kids ready, take time off of work, make sure we had everything, and then travel two hours,” Vania says.

Going into labor and being far away from adequate maternity care is a scary thought for any pregnant person, but it’s a reality for 5.6 million women in the US. “Out this way, there’s nothing,” Vania says. “There are no rest areas, no stores, no gas stations, nothing. You're probably just going to end up having a baby on the side of the road and hope someone stops for you or try to drive to the nearest clinic.”

Vania experienced this fear when, at 29 weeks, her water broke. Some more unexpected news: Low amniotic fluid, and hospital bed rest for the rest of her pregnancy. This affected the entire family. “After my boys got out of school, we loaded up and it’d take almost two hours to get to the hospital in Billings to visit my wife,” Ray recalls. “Then we’d hang out for a little bit. By then it’d be like 10 at night, or almost midnight sometimes, and then we’d make our way back.”

After a month on bed rest, Vania gave birth to their son, Valen. He was born six weeks early, weighing just 4 pounds, 10 ounces. He was put on a feeding tube, and quickly grew stronger in the neonatal intensive care unit (NICU). In the face of adversity, Vania and Ray found comfort and support in March of Dimes. Through our NICU Family Support® program, families receive culturally appropriate care and access to vital resources, bridging gaps in traditional healthcare services. "It was like a safe haven,” Vania says. “You get to relax and just be yourself and be at ease and know that there's other people there to support you when your family is not there.”

After 16 days in the NICU, Valen was able to go home. Today, he serves as a reminder of the strength found in community, heritage, and organizations like ours fighting for the health of all moms and babies.

For American Indian families like the Biglefthands, access to adequate maternal care is a persistent issue. In Montana, where approximately 7% of the population is American Indian, the lack of proximate birthing facilities compounds existing healthcare disparities. In the NICU Vania and Ray found themselves in, 25% of extremely low-birthweight babies are American Indian—an alarming statistic reflective of broader systemic challenges.

As Vania reflects on her journey, she echoes the sentiments of countless American Indian families: "We're strong, our DNA is strong. We're resilient people." But should people have to be “resilient” when it comes to their healthcare? As a country, we must do more to ensure that families have access to the care they need—because every mom and baby deserves to be healthy regardless of wealth, race, gender, or geography.

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