RACHEL MARTIN, HOST:
There aren't a lot of maternity wards in the remote towns of Alaska, including the state's Native villages. That can make pregnancy difficult in a normal year, and the pandemic has only made it more complicated. Claire Stremple from member station KTOO in Juneau reports on one woman who spent months far away from home to keep her community safe.
CLAIRE STREMPLE, BYLINE: St. Paul Island is in the middle of the Bering Sea, 800 miles from the nearest hospital. There is a clinic on the island, so most prenatal appointments happen there. Pregnant people usually visit Anchorage only a few times before they move to the city about a month before their due date.
CARA LESTENKOF-MANDREGAN: That's typically what's done here. But that's not the story that I have.
STREMPLE: Cara Lestenkof-Mandregan is part of the Indigenous Unangan community that lives on the island. She and her boyfriend found out she was pregnant with twins.
LESTENKOF-MANDREGAN: And I had the doctor come in and tell me all these things that could potentially go wrong.
STREMPLE: Pregnant women are already at higher risk for serious illness due to COVID-19. And the doctor told her twins are also considered a high-risk pregnancy.
LESTENKOF-MANDREGAN: And that after 16 weeks, I would need to travel out to Anchorage every two weeks for appointments. My jaw dropped.
STREMPLE: Her island stayed safe while case counts began to rise in Anchorage, where she was traveling for checkups. But that travel started to feel like a gamble. She didn't want to get sick or be the one who brought COVID-19 back from the city. Eventually, doctors at Alaska Native Medical Center advised that she stay in Anchorage.
LESTENKOF-MANDREGAN: I was going to have to go to COVID-ville (ph) and possibly contract the infection.
STREMPLE: As a health aide, she had seen colds and flus spread across her small island like wildfire.
LESTENKOF-MANDREGAN: So we decided that we were going to leave and just stay out in Anchorage until it was time to deliver.
MATT HIRSCHFELD: We really need to start working on how do we support these moms as best we can? Because they're not delivering near their families.
STREMPLE: Pediatrician Matt Hirschfeld leads maternal child health services at Alaska Native Medical Center.
HIRSCHFELD: They're not delivering with their aunties and grandmas and, you know, everybody around them.
STREMPLE: That separation from home and family is hard. But Hirschfeld says it's done for a good reason.
HIRSCHFELD: Back in the '80s and before, Alaska had one of the highest neonatal mortality rates, which is defined as kids who die before the first 30 days, in the country.
STREMPLE: Hirschfeld says the transition to hospital births correlates to a 75% drop in infant mortality over the last few decades. Hospital housing does have communal kitchens and play areas for families to gather when they're away from home, but COVID-19 shut all that down. The pandemic has put a spotlight on the hardships of separation and isolation during pregnancy.
LESTENKOF-MANDREGAN: Kind of just a blur, but we were there for a long time.
STREMPLE: For months, Cara Lestenkof-Mandregan and her boyfriend only left their small room for medical appointments. She says she was grateful her partner was there. Many women make the trip alone.
LESTENKOF-MANDREGAN: We spent our days, you know, keeping to our selves, stayed in our room, watched a lot of Netflix and enjoyed the fast Internet.
STREMPLE: When Cara, her partner and the twins got home, they hadn't seen their families in four months. She says it's a story the twins will hear for the rest of their lives.
For NPR News, I'm Claire Stremple.
(SOUNDBITE OF EPIGRAM'S "THE STRANGERS WE ARE BECOMING")
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