Since the 2022 ban on abortion in Texas, much of the coverage on reproductive care in the state has focused on the harm that lack of access to abortion has caused pregnant people and their families. Yet in addition to the suffering, medical complications, and even death that the ban has brought, another crisis in care affects much of Texas, including Caldwell County.

Not only are 25.4% of Caldwell County residents under age 65 uninsured, but the county is one of 118 so-called maternity deserts in Texas (defined as “areas without access to birthing facilities or maternity care providers”), according to a 2023 March of Dimes report. Pregnant people in Caldwell must travel an average of 19.1 miles to a birthing hospital, compared to the state average of 8.2 miles.

While Caldwell does have one hospital – Ascension Seton Edgar B. Davis, in Luling – it’s not a maternity care facility. In January of this year, New Yorker reporter Stephania Taladrid detailed the heartbreaking 2021 death of Luling resident Yeniifer Alvarez-Estrada Glick, along with her unborn child. Glick, whose pregnancy was deemed high-risk by doctors, repeatedly traveled to hospitals in Kyle and Austin to receive care. While she was harmed by her lack of access to abortion – the complications that led to her death would not have occurred had she not been pregnant – Glick, like many people in Texas with less than perfect health, wanted to have her baby. Surely she and her daughter deserved the opportunity for that to happen as safely as possible.

Doulas and midwives report that many pregnant Caldwell County residents currently wind up traveling to the Austin area for care. The Texas Department of State Health Services classifies the hospitals in Kyle and San Marcos as “Level II” maternity centers, which “provide care for conditions that present a low to moderate risk of maternal morbidity or mortality.” In contrast, San Antonio and Austin have several Level IV Specialty Care Centers, which “provide comprehensive care for pregnant and postpartum patients with low risk conditions to the most complex medical, surgical or obstetrical conditions and their fetuses, that present a high risk of maternal morbidity or mortality.”

If the lack of care is deeply felt now, rapid growth in the county (Caldwell experienced an 8.7% population increase from 2020 to 2023) and a rising pregnancy rate throughout the state will only continue to increase the pressure. 

Caldwell County Judge Hoppy Haden says the lack of maternity care in the county is due to the fact that “such services are often tethered to well-appointed hospitals. Caldwell County has been trying for years to attract another hospital to meet the needs of a growing community. However, hospitals are privately owned businesses and typically gravitate toward areas that are more affluent and/or densely populated. From a county and local government level, it’s like bringing any other business to our area. There isn’t much we can do beyond telling our story, offering economic development incentives and waiting for someone with financial resources, a plan and an interest in being here to commit and follow through.”

Haden adds, “Beyond that, it’s worth mentioning that while there may not be a birthing hospital in Caldwell County, Caldwell County residents are a short drive from birthing hospitals in Kyle (16 miles from Lockhart), San Marcos (17 miles from Lockhart) and New Braunfels (29 miles from Lockhart). Because of the traffic in places like Austin and San Antonio, having access to a hospital doesn’t necessarily equate to less time in the car for people living in those municipalities.”

Lockhart Mayor Lew White tells the Examiner that, although the city doesn’t currently have a hospital, “we have several independent family practices here and several that are managed by Ascension … Recently, our first urgent care center opened and the City is in discussions with a major hospital group to build and manage a 24/7 free-standing emergency room, which we hope will grow to be a hospital in our growing community.”

Ashley DiStefano, a certified postpartum doula and, with Britt Herzog, the co-owner of Simple Guidance, offers both pre- and postpartum services to parents in Lockhart. She knows that there’s not much access to maternity care in the area, but she and Herzog are doing what they can to improve the situation. DiStefano says that in addition to maternity care, there needs to be “more support for new parents in general. Childcare is difficult to access and daycare options are limited.”

Expectant parents can also find assistance through GALS (Giving Austin Labor Support) and Mama Sana Vibrant Woman. While both organizations are based in Travis County, they work with lower-income and BIPOC residents in the area to provide assistance in the form of volunteer doulas as well as classes and support circles. Virtual options allow for participation without traveling to Austin.

Taylor Burge has lived in Lockhart for nine years.  As a mother and a candidate for county commissioner, Burge is well aware of the challenges the county faces. She says one problem is that information about available services is sometimes lacking: “Communication is first and foremost.” 

Burge believes that a good first step would be bringing all of the community stakeholders to the table and figuring out what solutions are doable, including perhaps partnering with neighboring hospitals and clinics. Burge points to the example of the Seton Children’s Care-a-Van, a mobile clinic providing low-cost care for children in Prairie Lea, Lockhart, Dale, and Luling, as a model that could be replicable for maternity care services. As she puts it, “Birthing isn’t as much the crisis as the care leading up to it,” which means that ensuring people have access to reliable and affordable care throughout their pregnancies is key.

BY AMY KAMP