‘It isn’t sustainable.’ Casper, Wyoming, OB-GYN weathers maternity care shortage

Longtime obstetrician Susan Sheridan understands well that on-call coverage is part of her vocation. But with the number of OB-GYNs who serve Wyoming’s second-largest city plunging from an average of six to just two, the schedule has become overwhelming.

“When there’s five of us, every fifth day you’re responsible for ER coverage and consults, in addition to whatever you have scheduled in your day,” Sheridan said. “At this point, it’s now every other day for my partner and I to cover that.”

Because the doctors must first take care of deliveries and medical emergencies, Sheridan said, essential but nonurgent services like annual exams get pushed back.

And even though she always practices under safe conditions, she said, it can feel like the demands on her time and attention are so great that it’s impossible to give any single patient the full spectrum of her presence.

She’ll be in an exam room with a patient, for example, but part of her brain is thinking about a recent call regarding a mother with concerning vital signs laboring at the hospital.

“I’m trying to finish up with this patient who’s talking to me about her menopausal symptoms and her depression, and I’m waiting to be called any second to have to walk out of her room to run over to the hospital in an urgent situation,” Sheridan said. “So it doesn’t really feel like anyone ever gets the very best care they could be getting, and that’s one of the biggest frustrations.”

Three years after a WyoFile investigation revealed severe gaps in Wyoming’s maternity care system, deficiencies remain for women seeking prenatal, delivery and postpartum care and resources in the Equality State.

Since 2022, four Wyoming hospitals have closed labor and delivery wards, leaving 16 birthing hospitals for a state spanning 97,000 square miles. Medical workforce shortages, onerous on-call doctor schedules and mounting financial challenges for hospitals continue to challenge maternity care resources.

Shifting conditions have brought relief to certain communities with the hiring of obstetricians or implementation of pregnancy support programs. But the situation is getting worse in other places.

That is the case in the Casper area, where Dr. Sheridan has practiced for 19 years. Through most of that time, she noted, there were five or six practicing OB-GYNs serving the central Wyoming community of roughly 80,000 residents. But a collision of events in recent years has whittled it down to two: Sheridan and her partner, Dr. Melissa Hieb.

“If you do a population-based study (based in) our population and the surrounding areas that we serve, ideally you would have about nine or 10,” Sheridan said. “So we struggle a lot with covering multiple different places between the two of us.”

Sheridan’s experience underscores the reality that despite lengthy legislative study and statewide concern, Wyoming’s maternity care issues remain acute.

A complex challenge

Maternity care gaps are not unique to Wyoming. Nearly 150 rural labor and delivery units in the U.S. have closed or announced closures since 2020, and more than 35% of U.S. counties are considered maternity care deserts.

But the rural nature of the Equality State further complicates the difficulties of recruiting doctors and the justifications for hospitals to continue providing delivery services, which are not lucrative. For the Wyoming obstetricians who remain, the pressures can be intense.

Dr. Sheridan, who grew up in Douglas, discovered an affinity for obstetrics and gynecology during a rotation in Rock Springs amid her third year of medical school.

In Casper, the private-practice OB pool began to shrink about five years ago, Sheridan said. One provider closed their practice, one retired and in 2024, another died by suicide. His partner moved out of Casper not long after.

That left Sheridan and Hieb, who operate Casper Obstetrical & Gynecological Associates. Though they aren’t employees of the Banner Wyoming Medical Center, the OB-GYNs have hospital privileges and cover call schedules. (While Casper is also home to family practice doctors with obstetric training and midwives, OBs must back them up on the chance that complications require cesarean sections.)

The shortage impacts many aspects of Sheridan’s life and work, she told WyoFile.

Between the variability of the work and the inherent unpredictability of birth, it’s nearly impossible to map out a day. Work could take her to the hospital to perform a circumcision; to the outpatient surgical center for a scheduled C-section; to a hospital bedside to consult a patient with a gynecologic need; to the delivery ward to start an induction; to the ER for an obstetrical emergency or to her office to see a patient for pelvic floor pain.

And because the triage system prioritizes higher medical demands, it’s those office visits that suffer the most. When Sheridan or Hieb get pulled away, their staff tries to fit patients in later in the day, but even that doesn’t always work out.

In those instances, patients can get pushed further out, “which is always tricky because all of the time spots are already booked, and booked way out months in advance,” said Sheridan, who has not accepted new gynecological patients for years.

It feels like they are constantly running behind, Sheridan said, and because the practice relies on in-office work for its primary source of income, the situation also disrupts the bottom line.

The obstetrician routinely works 12 hour days, bouncing from the hospital to the office and surgery center. Her own family sees less of her, and while she and Hieb are doing their best to provide safe care to as many patients as they can, she said, “it isn’t sustainable over the long term.

Cascading impacts

On top of the struggle to care for patients, Sheridan and Hieb have been working to recruit a provider to join their practice for a year and a half, she said. Recruiting to Wyoming is always hard, she said, and the shrinking provider pool — which creates a more burdensome call schedule — only makes it a harder sell to a potential newcomer. So far, they haven’t had any takers.

The situation spurred Sheridan to testify in May before the Joint Labor, Health & Social Services Committee, which for the third year running has named maternity care as a priority for the legislative interim. During that meeting, Sheridan explained obstacles such as the enormous medical malpractice risk involved in covering providers who don’t have a similar level of training. She suggested expanding or refining Wyoming’s participation in the WWAMI Medical School at the University of Washington. Up to 20 Wyoming students are accepted annually into the program, which has clinical sites in Wyoming — and which offers financial incentives for graduates who chose to provide healthcare in Wyoming.

With 20 Wyoming graduates per year going into medicine, she said, it feels like Wyoming should be welcoming more new doctors within its boundaries. But many seem to be going elsewhere.

Banner Wyoming Medical Center CEO Lance Porter also spoke of OB recruitment challenges in that meeting.

“We are competing for candidates with every other state in the country,” Porter told the committee. Again, he said, many alternative job prospects come with a more favorable call schedule.

The Wyoming Medical Center spent over $3 million to establish a night laborist program, Porter said. That program staffs the hospital’s labor and delivery ward with OBs to cover night births, “so that our local independent OBs don’t have to work a hard day in the clinic, and then be up all night.” That program, he added, is “very expensive, and very few hospitals in the state of Wyoming can afford something like that.”

Despite extensive policy discussion, the state lags behind others in embracing and implementing maternity care solutions, according to a 2025 Wyoming Women’s Action Network white paper. A 2026 bill aiming to raise state Medicaid payouts to maternal healthcare providers failed, though another that authorized Medicaid reimbursements for licensed, freestanding birth centers passed.

The issue is “so complicated and so multifactorial,” Wyoming Primary Care Association Executive Director Jen Davis testified in May. She noted that progress has taken place in certain realms of maternity care, but said the stakes are too high to continue discussing it ad nauseam.

“It really is critical,” Davis said. “We need to do better, and this is a time that we need to do something.”

If Wyoming’s trend continues, experts worry that mothers will put off or forgo prenatal care, travel long distances in difficult weather or give birth in emergency rooms with nurses who aren’t trained in labor and delivery, which could have dangerous or even deadly results.

The erosion in care also poses existential threats to communities, as adequate healthcare is crucial to attracting young families to rural towns, state leaders say.

Wyoming was recently awarded $205 million from the Trump administration’s Rural Health Transformation Fund to address gaps in the state’s fragile rural health system. A stated goal of Wyoming’s application is bolstering maternity care.

The Wyoming Health Department is currently inviting hospitals, emergency responders, education programs and other services to apply for money to create physician residency positions; pool emergency medical resources; prioritize basic hospital services; or implement a statewide telespecialist platform. Applications close on Aug. 2 and Aug. 3.

This story was originally published by WyoFile and distributed through a partnership with The Associated Press.