My name is Jenni Van Otterloo. I’ve beenmarried to my husband for about what will be four years this summer. We’ve livedhere in Sanborn, Iowa for the whole four years of our wedlock. We have two kids.We only had one about two and a half days ago. Being in Sanborn, Iowa there’snot a lot of close infirmaries. The nearest hospital is in Sheldon Iowa which is 10 miles west of us, and they’re pretty big. The only maternities they take inSheldon are what’s considered a regular gestation. Before I enter into marriage, I foundout I had a pulmonary embolism; blood clots in my lungs that later on weregoing to play a factor into pregnancies with being on blood thinners, and things like that. I’ve been with McKay now for, ohprobably five, six years old so she’s been aware of my history for a while. My name is Kimberly McKay. I’m an obstetrician- gynecologist in Sioux Falls, South Dakotaand I am the Clinical Vice President of the ob/ gyn work wire for AveraHealth. Avera Health is a health system that covers 72,000 square miles of SouthDakota, Minnesota, and Iowa, down into Nebraskaand we have about 16 equipment that deliver babies.We deliver 6,000 or so, 6,500 newborns a year, so we know a lot about agricultural. We know a great deal about whatgoes on in rural medicine. 15% of our patients are Red indian, about 10% are other clans. Half of our patients are covered by Medicaid, either as a primary or secondary coverage. And so, you know, largegeography, very diverse patient population. Care planning for ruralpatients is difficult sometimes. Ideally they’re low-risk, they have nomedical publications, they are normal weight, they have every resource available tothem, but as it turns out not very many gestations in the United Mood ofAmerica are low-risk. So when I looked for different providers near me, bothplaces told him that with a condition like pit, with a blood disorder that Ihave, they don’t have the resources, like the blood bank on hand, at theirhospitals to handle anything that would happen, if something were to happenduring delivery or during pregnancy, so I was referred to Sioux Falls, thereforeback to Dr. McKay in Sioux Falls at Avera.Prenatal attend, in general, for alow-risk pregnancy is 13 stays. 13 daytimes out of that where you take time out ofwork. 13 daytimes where you need to travel for things like ultrasound and lab work.Add 90 miles, a 90 mile drive, to that and it realise things extremely complicated.geography doesn’t pick and choose the low-grade likelihood and increased risk cases. The interval is huge. I have to travel an hour and a half to an hour and 40 instants for every doctor appointment, and that’s just one route, so I’m on the roadfor over 3 hour for a 30 -minute appointment every time that I needgo to a doctor’s appointment. we have Avera eCARE which is one of the largesttelemedicine networks in the United States.We’re looking to add moretechnology to figure out how to keep patients as close to home as possibleuntil they actually need to come into their maternity center to deliver. I had really good care. The only thing that Dr. McKay and I talked about, justtrying to cut back on some of the interval, and the traveling, and thingslike that through video conference call, or whatever, exactly to do some of thosewould be really helpful. I think that would be something that would be greatto see happen in the future.And the other fragment is that Family Practicephysicians, and nurse practitioner, and PAs are extremely important partabout how we provide care. They aren’t always as comfortable with obstetricsunless they, themselves, are personally providing that care in their community. And so much of “what were doing”, including through our eCARE works, is helpedthem feel cozy with what they’re seeing.So when I went into labor with mysecond child, I used to work that morning. I had reductions. They generally tellyou to go in when they’re 5 to 7 instants apart. They tell me to come in whenthey’re 10 to 12 minutes apart. So I actually used to work that morningbecause they weren’t that close more, but by the time I reached it to the hospital Ihad my daughter within an hour of getting checked into the hospital, so itwas cutting it really close. I’m glad we saw it, and everything used to work ok, butyeah, there’s just a lot of extra things that we have to strategy with ..