In our first 18 months of the project, we’ve made incredible strides toward improving health outcomes for women and their children in one of the most rural parts of the state.
Daisy J. Goodman, DNP, MPHNow into its second year, Dartmouth Health’s Rural Maternity and Obstetrics Management Strategies (RMOMS) grant has made significant strides in its mission to improve outcomes for pregnant and parenting mothers in New Hampshire’s North Country. Resources made possible by the grant include a doula/community health worker (CHW) program, supplementary training for obstetric nurses who work at rural critical access hospitals, and enhanced coordination between providers at Dartmouth Health’s Dartmouth Hitchcock Medical Center (DHMC) and a consortium of local providers in the North Country, one of the most rural areas of New England.
RMOMS is a program of the U.S. Health Resources & Services Administration. Dartmouth Health received a four-year grant from RMOMS in 2023 to fund the North Country Maternity Network (NCMN), a consortium of hospitals, community-based services and state agency partners to create and support the maternal health infrastructure in northern New Hampshire.
“We sought the RMOMS grant to help fill the gaps in maternal care in northern New Hampshire. Three of the five critical access hospitals in the North Country closed their inpatient labor and delivery units in the last 20 years,” said Daisy J. Goodman, DNP, MPH, a certified nurse-midwife at DHMC. “In our first 18 months of the project, we’ve made incredible strides toward improving health outcomes for women and their children in one of the most rural parts of the state. This is going to be a big year for us, and I’m so proud of the commitment and collaboration of NCMN and Dartmouth Health to improvement of rural health equity.”
NCMN’s doula/CHW program launched in December 2024 with the hiring of Rikki Chapman, Natalie Marquis and Becca Sanders. Rebecca Hill-Larsen, a CHW and coordinator for the NCMN doula/CHW program, said that the doula/CHW role is unique because they not only perform the typical role of a doula, serving as a pregnant woman’s supporter and advocate as she gives birth, but also help women access resources necessary to their health and medical care during pregnancy and postpartum.
“Our doula/CHWs are trained to recognize signs of postpartum depression in new mothers and make referrals for appropriate, accessible care,” Hill-Larsen said. “They also screen for social drivers of health, like transportation barriers and food insecurity, and connect them with resources like groceries, arranging rides, or help connecting them to telehealth, all intended to fill these gaps and improve health equity for rural mothers and their children.”
Alison C. Willard, RN, a DHMC obstetrics and gynecology nurse and NCMN’s high-risk nursing care coordinator, joined in September 2024 to serve as liaison between maternal-fetal medicine at DHMC and women in the North Country needing high-risk maternity care. Willard assists these women with getting the care they need from DHMC that often isn’t available close to their homes, while reducing the burdens from traveling long distances for care.
“So far, we’ve mostly seen women in the postpartum period who deliver with us at DHMC and require frequent follow-up visits,” Willard said, adding that most of these patients get the majority of their care at Androscoggin Valley Hospital (AVH) in Berlin, Littleton Regional Hospital, and Northeastern Vermont Regional Hospital in St. Johnsbury. Working with these hospitals and others in the North Country, Willard ensures that patients are scheduling and attending these higher-risk postpartum visits. Utilizing telehealth, women are able to have many of their appointments from home without the five-hour roundtrip drive.
Willard is also overseeing a program for nurses at rural hospitals to learn from fellow nurses at DHMC. As of January, AVH labor and delivery nurses have the opportunity to travel to Lebanon to shadow a nurse working in DHMC’s Birthing Pavilion for two shifts on a weekend.
“Not only does this give critical access hospital nurses exposure to a higher volume of patients and complex cases, it also goes a long way to foster good relationship between our nurses and nurses in the North Country,” Willard said. “When a mother requires care at a high acuity hospital far from home, it can be very stressful and scary for the patient and her family, especially when she’s in such a vulnerable state. When the nurse at her local hospital can tell her, ‘I’ve been to DHMC and worked with those nurses, and you will be in great hands,’ that reassurance is invaluable.”
About Dartmouth Health
Dartmouth Health, New Hampshire’s only academic health system and the state’s largest private employer, serves patients across northern New England. Dartmouth Health provides access to more than 2,000 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, NH, as well as across its wide network of hospitals, clinics and care facilities. DHMC is consistently named the #1 hospital in New Hampshire by U.S. News & World Report, and is recognized for high performance in numerous clinical specialties and procedures. Dartmouth Health includes Dartmouth Cancer Center, one of only 57 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the only such center in northern New England; Dartmouth Health Children’s, which includes the state’s only children’s hospital and multiple locations around the region; member hospitals in Lebanon, Keene, Claremont and New London, NH, and Windsor and Bennington, VT; Visiting Nurse and Hospice for Vermont and New Hampshire; and more than 24 clinics that provide ambulatory and specialty services across New Hampshire and Vermont. Through its historical partnership with Dartmouth and the Geisel School of Medicine, Dartmouth Health trains nearly 400 medical residents and fellows annually, and performs cutting-edge research and clinical trials recognized across the globe with Geisel and the White River Junction VA Medical Center in White River Junction, VT. Dartmouth Health and its more than 13,000 employees are deeply committed to serving the healthcare needs of everyone in our communities, and to providing each of our patients with exceptional, personal care.