When Mercy Hospital in Durango stopped providing tubal ligations, a form of female sterilization, at the time of cesarean section as of April 15, doctors at Southwest Memorial Hospital in Cortez undertook efforts to spread the word that contraception and birth control services remain available in the Four Corners.
Jessica Kaplan and Erin Schmitt, obstetricians and gynecologists at Southwest Memorial Hospital, said the hospital provides wide-ranging maternity services for low- and high-risk vaginal births and C-sections in addition to contraceptive care and birth control.
Contraceptive options include tubal ligation at the time of C-section, among other times, as well as other sterilization surgeries, Kaplan said.
General surgeons provide vasectomies through the hospital’s outpatient clinic, she said. Other methods of birth control such as intrauterine devices (IUD’s), subdermal implants, contraceptive patches, vaginal rings and depo shots are also available.
“Pretty much any other form of birth control. There's nothing that we don't provide,” she said.
Southwest Memorial Hospital in Cortez is 47 miles from Durango. The doctors said it can be challenging for people to access care for reproductive health issues, especially in a time way when family planning is under political and regulatory siege across the country. It is important to be aware of services that are available in the area so people aren’t unnecessarily traveling long distances to get desired contraceptive care.
Schmitt said she is still surprised by the number of people who don’t realize Southwest Memorial Hospital offers obstetric care. And getting through Wolf Creek Pass and other mountain passes from Cortez or Durango to Denver in the winter has delayed care for women before.
She said patients have had unintended pregnancies because they missed appointments to have their tubes tied in Denver due to pass closures and inclement weather.
“And two or three months goes by and all of a sudden they're pregnant again,” she said.
Sometimes, women have significant medical conditions such as cardiac disease or diabetes that put them at increased risk during pregnancy, making knowledge of and access to care all the more important, she said.
“We just wanted to make sure women of the community feel supported and make sure they know they have a lot of resources,” she said. “One, for tubals during C-section, but also like birth control and contraception and other things that they have access to here, so that they don't have to face the difficult decisions of an unintended pregnancy.”
Kaplan said the American College of Obstetricians and Gynecologists found about 50% of women who don’t get their tubes tied at the time of delivery will end up not getting the procedure at all, even if they have access to services in the future. There are many factors that could prohibit those women from getting care, but the data speaks to the importance of offering tubal ligation at the time of C-section.
Schmitt said Southwest Memorial Hospital delivers about 200 babies annually. She doesn't know how many new patients are seeking contraceptive care in Cortez after Mercy Hospital’s policy shift from providing tubal ligations, but it is occurring. She recently delivered a patient’s fourth baby by C-section and tied her tubes, which was not offered at Mercy Hospital.
“The numbers are kind of small right now. So we haven't really done any analysis,” she said. “But definitely, the talk is in the community about what women would do if we didn't have these services. So we're reaching out and trying to do as much education as we can.”
Outpatient vasectomies have also noticeably increased recently, Kaplan said.
Mercy Hospital stopped providing tubal ligations at the time of C-section in April after it quietly announced the “completion of re-education with our Community Board, clinical leaders, caregivers, and the Mercy Ethics Committee on the application of the Ethical and Religious Directives for Catholic Health Care Services.”
Brie Todd, a gynecologist at Four Corners OB/GYN, an independent clinic that provides labor and delivery services at Mercy, said in a previous interview she was informed of the planned policy shift in an Aug. 15 meeting with Patrick Sharp, former Mercy CEO, and Augustine Nellary, director of mission integration at Mercy.
Neither representatives from Mercy nor Centura Health, its parent organization, responded to requests for comment on Tuesday.
The Colorado Sun reported earlier this month the Colorado Senate passed a bill requiring hospitals to disclose to patients if they do not provide reproductive health care, including tubal ligation at the time of C-section, among other things.
Kaplan said limiting options to patients through hospital policies is not beneficial to patients, but if policies are restrictive, patients should be made aware in order to make informed choices.
“It's good to be transparent about what services you do provide so that patients can make an informed choice, especially if that's going to influence where they want to get care,” she said.
“It's important for providers to know, like, I would want to be part of a system that supports women rights and choices,” Schmitt said. “So I think it's good for everyone to be clear and on the same page, so you can kind of have a collective, you know, working environment, peace and education.”