Nursing ETDs

Publication Date

Fall 11-15-2018


Access to maternity care is disappearing for women across rural America. In the state of New Mexico, women often travel long distances to access hospitals and providers that offer childbirth services, as these resources are concentrated primarily in metropolitan areas. Although data on provider distribution is available, very few studies have explored the maternity care access crisis from the perspectives of the midwives and physicians who work in rural areas. The purpose of this critical ethnographic study was to explore barriers and facilitators to the provision of childbirth services from providers’ perspectives with the intent of informing policy debates around the preservation and maintenance of safe, local birthing options. A further aim was to explore the significance childbearing women and other community stakeholders placed on the availability of local birthing and support services. Over a one-year period, in-depth interviews and fieldwork were conducted in three rural northern New Mexico counties: Rio Arriba, Taos, and San Miguel. Thematic content analysis was used to analyze interview data, field notes, and supporting documents. This study had three overarching findings: (a) Structural barriers to rural practice are persistent across disciplines and contribute to the maldistribution of maternity care providers; (b) Midwifery care is culturally appropriate and appealing to women, but accessibility is limited due to the marginalization of midwives within rural health systems; (c) Perinatal support services such as home-visiting, doula services, and breastfeeding support are a critical complement to clinical care and help to counteract the fragmentation of rural services.

The dissertation concludes with a discussion of implications for policy reform, clinical training, and suggestions for further research. In order to assure the sustainability of rural maternity care resources, it is imperative that the insights and expertise of providers, community members, and other stakeholders be included in present and future policy directives.

Degree Name


Level of Degree


Department Name

College of Nursing

First Committee Member (Chair)

Kim J. Cox, PhD, CNM, FACNM

Second Committee Member

Jennifer Averill, PhD, RN

Third Committee Member

Lawrence M. Leeman, MD, MPH

Fourth Committee Member

Van Roper, PhD, FNP-C


maternity care, rural health, rural health policy, rural childbirth, critical ethnography, rural New Mexico



Document Type