CHEYENNE -Pregnant women in Newcastle and Weston County must travel nearly 80 miles to have their babies because high medical malpractice insurance rates forced three local physicians to abandon their obstetrical practices.

Yet at the other end of the state in Afton in the Star Valley, six family practice physicians deliver an average of 100 babies a year at the 16-bed Star Valley Medical Center.

Steve Perry, the chief executive officer of the center, said the hospital employs the physicians and pays their malpractice insurance premiums. He said that's why the hospital is in such good shape with obstetrical service.

If the physicians had decided to practice individually, they probably couldn't afford the insurance. Perry said he was told it would cost $35,000 per year.

Perry couldn't give a figure for the total amount the physicians' medical malpractice insurance costs the hospital because it is rolled into the hospital's total insurance bill.

When the hospital's insurance carrier, Farmers' Insurance, pulled out of the medical malpractice business nationwide, the hospital formed a self-funded pool along with other rural hospitals in Colorado, Idaho, Montana, North Dakota and Wyoming.

"It's a strategy that works for us," Perry said.

At Weston County Health Services in Newcastle, three family practice physicians delivered 20 to 25 babies a year before they quit that part of their practices at the end of June because of high insurance costs.

Most of the pregnant women in Newcastle and Weston County now go to Gillette nearly 80 miles away or to Rapid City, S.D., to deliver their babies.

Shirley Parks, the Newcastle hospital's human services coordinator, said the only exception is emergencies. One baby had been delivered at the Newcastle hospital since the end of June.

"It was a normal birth, she wasn't going to make it 80 miles," Parks said of the mother.

Robert Kidd, executive director of the Wyoming Hospital Association, said four of the 25 general hospitals in Wyoming do not deliver babies - at Newcastle, Lovell, Sundance and Basin.

Pregnant women in the Lovell area travel 22 miles to Powell for delivery or go 46 miles to Cody, said a spokesman at North Big Horn Hospital in Lovell.

Although Niobrara County officials are hoping to reopen the hospital at Lusk in a year, the facility will not offer obstetrical services.

"Delivering babies in Niobrara County is not in our plan," said Mel ZumBrunnen, a Niobrara County Hospital board member and former legislator.

Health care providers will refer the Niobrara County patients to Memorial Hospital of Converse County at Douglas, 56 miles west of Lusk.

While Lusk has a population of 1,447, according to the 2000 census, Douglas has a population of 5,288 and two obstetricians.

Lusk women now also travel to hospitals at Torrington, Casper or Scottsbluff, Neb., said a Niobrara County Hospital District spokesman, Cheryll Christianson.

The Converse County Hospital at Douglas, meanwhile, opened its new labor, delivery, recovery and postpartum suites on Oct. 3. Each has a private bathroom with its own shower, a sleeper chair for the mother's support person, a rocking chair for the mother to hold and feed the baby, and a television set.

The options for pain control include epidural anesthesia available 24 hours a day.

The only other hospital with this type of birthing center is at St. John's Medical Center at Jackson, said Amy Irene-Sonesen, marketing/foundation specialist for the Converse County Hospital.

She said about 100 babies are delivered at the Douglas hospital every year and the number is growing.

"For awhile we didn't have a full time obstetrician and a lot of women went to Casper," she said.

Now, she added, quite a few women from Casper are traveling 50 miles to Douglas to have their babies.

Members of the medical community blame the loss of obstetrical services in some pockets of the state on the cost of medical malpractice insurance.

They are pushing for a constitutional cap on noneconomic damages in medical malpractice lawsuits - known as tort reform.

Wyoming has been labelled a medical liability crisis state because of the cost of malpractice insurance.

The trial lawyers counter there is no proof that tort reform will lower insurance rates for medical professionals. Insurance companies increase their rates, they say, because their income from investments has eroded.

Wyoming has 11 certified nurse-midwives, who work with physicians, and 19 women's health care nurse practitioners, who care for women throughout their reproductive lives, said Mary Calkins of the Wyoming Board of Nursing.

Although the state board still gets inquiries about lay midwives, they have disappeared from the health care scene since they lost their attempt years ago to persuade the Legislature to change state law so they could practice legally.