Published on April 01, 2025

doctor using remote monitoring technology on a pregnant woman.

Medicine Over the Miles: Delivering Excellence in Rural Women’s Care

As a health system that reaches across great swaths of prairie, farm and frontier land to meet patients, Avera is designed to provide care, near home, for women and children.

“When you see the services, like birthing, that we keep in rural communities, rather than always bringing patients to Sioux Falls, you can tell that's where our passion lies,” said Mara Hermiston, DO, Chief Medical Officer for Avera Medical Group.

The Need for Expanded, Tailored Care

Women’s health encompasses a tremendous breadth, starting with puberty and continuing throughout the lifespan, encompassing everything from obstetrics, gynecologic health and family building to menopause, bone health, breast health and complex conditions like cancer, diabetes and heart disease.

Women are also often core medical decision makers — for themselves, their children, their spouses and parents.

“Healthy families, healthy moms, healthy women — that is the basis for everything else,” said Katherine Wang, MD, Avera neonatologist and Clinical Vice President of the Women’s and Children’s Service Line. “Our mission of caring for women and children started with the Sisters and we carry this work forward.” Avera utilizes a service line model to unify and bring together clinicians from Avera hospitals and clinics that offer care to women and children.

Close and Consistent Care

Avera’s continuum of care for women and children ranges from family practitioners, family practitioners who offer obstetrics, obstetrician/gynecologists, midwives, maternal-fetal medicine specialists, internal medicine for women, urogynecologist, neonatologists, gynecologic oncologists, breast specialists, pediatricians, pediatric subspecialists and more.

”From the moment I started at my job here in South Dakota, I was automatically connected to all other physicians across the whole footprint, and I really got to develop those relationships. So when my patient needs care at a tertiary center, I know the doctor who's going to be taking care of them. That is just invaluable to them to have that same level of trust,” said Amy Lueking, MD, Avera OB/GYN specialist in Pierre, SD.

Clinicians can count on an integrated network of support and expertise to help care for patients with a wide range of issues. “In Pierre, we cover a large area so we’re isolated, but we’re not an island. We’re not alone,” Lueking said.

The right care at the right time involves ongoing communication between rural clinics, community hospitals, the large referral (tertiary) medical center, highly experienced transport teams and subspecialists. This collaboration leverages everyone’s specialized knowledge, as well as innovative tools including telemedicine.

By keeping care local, when possible, with quality and safety, Avera helps women in rural areas experience the same high outcomes while remaining close to loved ones throughout their care journeys.

Avera's Approach to Women's and Children's Care

Providers at Avera are just a phone call away from a NICU specialist when delivering a baby at any of our 37 hospitals. It's just one example of how Avera provides the "pinnacle" of care during such an important event. Watch as our providers explain the complexities of providing women's and children's care across our rural footprint.

Addressing Maternity Deserts

Imagine driving two to three hours for a prenatal visit, or to the hospital when labor starts. That’s a reality for some living in a rural area.

A pivotal element of Avera’s rural care for women is addressing maternity deserts where maternity health care has been scarce or nonexistent.

“We need to be able to provide great obstetrical care, newborn care and pediatric care in our small towns. That's how our facilities and our communities continue to grow,” said Paul Berndt, MD, Avera family medicine/obstetrics physician in Parkston, SD.

Rural physicians and clinicians stand shoulder-to-shoulder with a network of specialists so that they are not making decisions alone, which is especially important in unexpected cases such as postpartum hemorrhage or the arrival of a premature baby. Careflight air transport has maternal and neonatal specialized staff and equipment to support women and families in emergencies, and a robust telemedicine system offers immediate connection.

“As a system, we’re making sure we’re using our resources wisely, sharing expertise and specialties from larger centers but then also using our clinicians in small towns to their highest capacity and capability,” Berndt said.

Neonatal Support for a Broad Region

Avera’s Level IIIB Neonatal Intensive Care Unit in Sioux Falls supports the entire system footprint. eNICU telemedicine consults and specialized Careflight transport help make that happen.

“One of things that’s unique to Avera is we are very good at being that helping hand,” Wang said. “When the baby decides that now is the time to come, the rural doctor has someone they can call. We have a team we can send, and we can provide eNICU services in the meantime.”

The work rural teams do is impressive, yet help that’s immediately available is reassuring. “Just having that phone-a-friend option helps that physician get through what can be a very stressful event. Sometimes all they need is reinforcement and want to know if they’re on the right track. That is something we’ve been working on for many years and getting better and better at,” Wang said.

Rural Research

Much of what is understood about women’s and children’s health has come from places in the United States with large population bases, such as the coasts. The Avera Research Institute shapes studies around the questions and needs of rural clinicians and carries out cutting-edge research that has immediate benefits to people in the Midwest.

One example is Avera’s involvement in Rural Maternity & Obstetrics Management Strategies (RMOMS), which assists physicians in remote areas and extends expertise through care coordination, remote patient monitoring and virtual nursing.

Risk for disease and complications is higher in rural areas, said Kimberlee McKay, MD, Avera Research Institute Medical Director and Avera OB/GYN specialist. “We see more risk factors like obesity, and chronic issues like diabetes and high blood pressure. Socioeconomic income status tends to be lower in rural locations, and then there’s the impact of food deserts, where people don’t have ready access to healthy foods like fresh produce. Our research projects seek to address these issues and improve the health of moms and babies.”

Specialized Space to Support Women’s and Children’s Care

The construction of the women’s and children’s tower in Sioux Falls is a physical representation of the health system’s dedication to the two populations — a visual cue of the high-level care Avera has already been providing.

While the hospital in Sioux Falls will house a multitude of highly specialized women’s and children’s health services under one roof, that expertise extends beyond the physical building, dispersed to every corner of Avera’s footprint.

“The building lets the whole system know that we're here to support not only Sioux Falls, but our entire footprint,” said Wang. “Should you need us, we are here, and we're ready to go.”

Learn more about Avera’s commitment to rural health.