(NEW YORK) — Early on in her pregnancy, Tori Wapsheli made plans to deliver her second child in the same hospital where she had her first — Astria Toppenish Hospital on the Yakama Indian Reservation in Washington State.

But with just three months left in her pregnancy, the hospital suddenly shut down its Family Maternity Center, leaving Wapsheli and others in the community scrambling. In a news release, the hospital cited higher costs, reduction of Medicaid reimbursement from 150% to 100%, inability to recruit enough staff and a 50% decrease in deliveries as the reason for the closure.

“Just being so far out here, Toppenish was the place that would have worked easier,” Ciera Wheeler, who was more than 7 ½ months along when the pregnancy ward closed, told ABC News.

Patients in active labor who come to Astria Toppenish when there’s no time to stabilize and transfer them before delivery will now have their babies delivered in the emergency room and then, after being stabilized, transferred by ambulance to another hospital, the release said.

For Wheeler, the closest hospital with a maternity ward was now 45 minutes away, she said.

Options for maternity care on the reservation, which spans more than a million acres, have gone from bad to worse. Pregnant women looking for care are often forced to travel roads that can become dangerous in poor weather, according to the women ABC News spoke to on the reservation.

“This area is very rural. It is isolated. So the traveling distance plus the resources that are needed to get quality care not there,” said Jessica Whitehawk, who founded the Ttáwaxt Birth Justice Center with the help of fellow advocates Leslie Swan and Semone Dittentholer.

The Yakama Indian Reservation is just one of many U.S. communities dealing with a shortage of obstetric care.

Over a third of all U.S. counties are what’s known as maternity care deserts, which translates to more than 2.2 million women of childbearing age and 146,000 babies born in areas without obstetric providers, hospitals or birth centers offering obstetric care, according to a recent March of Dimes report.

It’s an issue that’s contributing to the high U.S. maternal death rate, said March of Dimes chief medical officer Dr. Elizabeth Cherot.

In 2021, there was a 40% increase in the death rate from maternal causes compared to the year before, according to the Centers for Disease Control and Prevention. After a spike during the pandemic, preliminary data suggests the number of maternal deaths began dropping in 2022, but numbers are still higher than experts would advise.

One of the states with the highest number of maternal deaths, according to the CDC, is Mississippi, where Byron Stribling lost his pregnant wife, Harmony, and their unborn child while on the way to the hospital in July 2021.

“We don’t have a hospital. We don’t have an emergency room. The nearest hospital was about 15, 20 miles away, give or take,” Stribling told ABC News.

Harmony was five days away from delivering her baby when she developed complications from preeclampsia. On the drive to the hospital, Stribling pulled over to perform CPR as directed by a 911 dispatcher. By the time first responders arrived around 15 minutes later, she and their unborn child were dead. They were about three minutes from the hospital, according to Stribling. Stribling believes that if there had been an emergency room or hospital in closer proximity to their home, his wife or child might have been saved.

There are no obstetric providers in more than 50 counties in Mississippi, according to Rachael Morris, a maternal fetal medicine specialist at the University of Mississippi Medical Center. She and her team have been trying to fill the gap by training hundreds of first responders in parts of the state that lack maternal care on what to do if there’s an emergency.

“We teach you how to intubate a baby. We teach you how to deliver a baby,” Morris said.

Morris said that almost 90% of the mortalities they’ve had over a 2-year period were deemed preventable.

“It’s frightening. Something’s got to change,” Morris said.

According to the CDC, the maternal mortality rate for Black women is three times higher than non-Hispanic white women, although all ethnicities saw an increase in 2021. For women over the age of 40, the mortality rate is seven times higher than for women under the age of 25.

At 38 years old, Dominique Armour is considered to be of advanced maternal age. She’s 8 months pregnant with her tenth child, putting her in a high-risk category. She told ABC News this will be her fourth time driving across state lines, from Arkansas to Mississippi, to give birth because of limited options.

“My last baby, I almost had on the side of the road,” Armour said.

The only hospital in Armour’s county hasn’t had a delivering physician in more than five years, according to Armour. Access to prenatal care is also limited, she said, and the last time she was able to see a doctor was months ago.

“It was hard. I had to go by myself. I don’t want to talk about it. I don’t,” Armour said in tears.

Alice Rogers Johnson of the Arkansas Birthing Project says she is exploring options like the March of Dimes mobile clinic to get women in the area access to more care.

“A lot of women do miss appointments because they don’t have transportation,” Johnson said.

Back at the Ttáwaxt Birth Justice Center, the founders are working to expand their services, hoping that one day they can build a new birthing facility on the Yakama Nation grounds.

“We’re trying to rebuild our kinship, our nationhood, our family strength, providing a safe place for our families and women and children to come to have more options, to be cared for and to heal,” Whitehawk said.

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