Dr. Anaeme delivering “Sophie” assisted by Julia Chan DNP, CNM

By Elizabeth Kizer, DrPH

Earlier this year, the Arizona Rural Health Association (AzRHA), in collaboration with the Arizona State Office of Rural Health (AzSORH) and partners, announced the launch of a grant-funded initiative to strengthen obstetric (OB) care in communities with non-birthing Critical Access Hospitals (CAHs). Since then, the program has made significant progress.

To date, five of the seven targeted CAHs have hosted OB simulation training under this project: Douglas ER & Copper Queen Community Hospital, Hopi Health Care Center, La Paz Regional Hospital, Parker Indian Health Service, and Sage Memorial Hospital. In October, the team will train at Northern Cochise Community Hospital, with San Carlos Apache Healthcare Center scheduled before year’s end.  Also, White Mountain Regional Medical Center served as the pilot site. 

So far, 147 health professionals have attended these trainings. Over half were nurses, EMTs, and paramedics.  Additionally, many nurse practitioners, pharmacists, physicians, and other allied health professionals attended. Notably, about half of the attendees reported they had never worked in a facility with birthing services—yet more than two-thirds had previously assisted with a precipitous vaginal birth. This highlights the importance of preparing rural providers for the precipitous births they are likely to encounter, even though their facilities are “non-birthing” hospitals.

I was able to attend the training at Sage Memorial Hospital on September 16-17th.  Participants shared their experiences with a precipitous birth in an ambulance in a remote community, and I reflected on my own experience living over an hour from my OB/GYN and birthing hospital when I was pregnant with my first child in Apache County.  Listening to medical professionals discuss their experiences, ask questions, and engage in the simulated birth gave me a renewed appreciation for the skill and care they provide to rural residents.   

Early evaluation results are promising. Pre- and post-surveys show participants overwhelmingly gained confidence in their skills and knowledge. The program’s success was also highlighted nationally on September 24, 2025 when the AzRHA team presented outcomes at the Critical Access Hospital Conference in Kansas City, Missouri.

This work is a clear reflection of AzRHA’s mission: to lead in partnerships, education, and policy to improve the health status of rural communities in Arizona. By equipping rural healthcare teams with the skills to respond to precipitous births, AzRHA and its partners are advancing safer birthing experiences and better health outcomes for rural families across the state.