Why Georgia’s maternal well being disaster requires a number of options

Researchers and community organizations are exploring ways to support women in the critical first few months after childbirth to reduce the disproportionately high maternal mortality rate in Georgia.

The postpartum period is a time when signs of complications like high blood pressure can appear and which should be monitored to help women avoid serious consequences like death, proponents said.

Georgia is consistently one of the states with the highest maternal mortality rates in the United States, with black women being disproportionately affected. According to a 2019 analysis of the Center for Reproductive Rights’ state health data, they were 3.3 times more likely to die from pregnancy-related complications than white women.

“Over half of these deaths are considered preventable, and a major cause of preventable deaths is a lack of knowledge of the warning signs of complications and the inability to communicate with and be heard by one’s own doctor,” said Dr. Elizabeth Mosley, Doula and Clinical Assistant Professor at Georgia State University School of Public Health.

State health officials found that between 2012 and 2016, 70% of pregnancy-related deaths were preventable.

According to a 2020 study by the Commonwealth Fund that analyzed the causes of maternal mortality in the United States, approximately 52% of maternal mortality occurred after childbirth or postpartum. The most common signs of complications in the first week after delivery are high blood pressure, infection, and heavy bleeding, according to the study.

Proponents point to many causes of the state’s long-term maternal health crisis: a lack of reproductive health providers particularly in rural parts of the state, an underinsured population, and a lack of information and support for new mothers in the critical weeks after childbirth.

Why Georgia’s maternal well being disaster requires a number of options

“It’s a systemic problem. There is no reason for us in the state of Georgia in 2021 to have the maternal near miss (where death almost occurred) rates that we continue to see, ”said Angela D. Aina, co-founder and executive director of Black Mamas Matter Alliance, an advocacy organization focused on equal opportunities for black mothers in health.

Health technology a tool in support of the mother

Community organizers, health advocates, and maternal health researchers are exploring a variety of solutions to provide more support and information to women during pregnancy and after delivery.

Researchers at Morehouse School of Medicine, Emory University, and Georgia Tech University developed a mobile health application for black women to improve access to social support, community health resources, and postpartum health information. The app, called Preventing Maternal Mortality Using Mobile Technology, or PM3, will be tested with Fitbit built-in devices starting December, said Sherilyn Francis, Ph.D. Student in the Human-Centered Computing program at Georgia Tech University. A randomized clinical trial is scheduled to begin in the middle of next year.

Francis was funded by the Fitbit Health Equity Research Initiative to integrate the app with Fitbit devices. The team also received funding from Johnson and Johnson to develop the app. Women participating in the study can use the PM3 app, which is connected to their Fitbit devices, to monitor “key health indicators” such as physical activity, blood pressure and weight, said Dr. Andrea Parker, the founder of the Wellness Technology Lab at Georgia Tech University and a lead researcher on the project. It also provides social support and resources to improve mental health wellbeing.

The researchers also want to provide post-partum discharge instructions that women typically receive from the hospital via the app, tailored to women’s needs, said Dr. Rasheeta Chandler, who is also the project’s lead researcher and assistant professor at Emory University’s Nursing School.

“If you’re leaving the hospital with a new baby and you’re getting poor sleep, the last thing you want to do is read an information pack,” she said.

The team spoke to women in mostly rural communities who are facing multiple health care barriers, including access to adequate providers, lack of insurance and broadband access, Francis said.

Although Francis’ research focuses on how technology can be used to solve health stock problems, she acknowledged that the app is “just one possible solution to addressing the health crisis of black mothers in the United States.”

“I understand that problems caused by racism (and) caused by structural inequalities cannot magically be fixed with an app,” she said.

Francis hopes the PM3 app will help researchers collect data specifically on African American women during bedtime, thereby improving the health outcomes of black mothers. Those data are currently limited, she said.

Create an ecosystem of support with doulas

Lawyers are also looking for ways to bridge the gap in access to health care in communities where hospitals are closed and providers are limited.

Healthy Mothers, Healthy Babies Coalition of Georgia founded the Doula Access Working Group to help raise awareness among patients and providers about the critical service they offer.

Doulas are trained professionals who provide emotional, physical and informational support to mothers during and after the birth. HMHBGA also launched the Building Perinatal Support Professionals Project (BPSP) in 2018 to support people who want to become certified doulas. So far, they have trained 47 people, said Ky Lindberg, the managing director of HMHBGA.

Ky Lindberg, Executive Director Healthy Mothers, Healthy Babies Coalition of Georgia

“We found that many Georgians do not fully understand what exactly perinatal workers do or why they are important. These types of occupations have been shown to have a significant impact on reducing maternal and child health problems,” she said.

The aim is to create an “ecosystem” that supports not just doulas but a non-traditional perinatal workforce as a whole. This also includes improving the work they do in communities faced with multiple barriers to entry to prenatal and postpartum care. Lindberg and other community partners are also examining how comprehensive guidelines can be drawn up to improve payment structures and increase the number of perinatal specialists in low-income communities.

Mosley, who has worked as a doula for 11 years and is part of the Doula Access Working Group, said this workforce has a passion for caring for low-income, high-risk women, but at the same time, it can be difficult. to keep the business viable when customers cannot afford these services.

She said doulas offer a variety of accommodations to make services affordable, including a sliding payment model, but structural solutions are needed to expand doula care in the state.

Because of this, HMHBGA is one of several organizations in Georgia advocating and advocating the reimbursement of Medicaid reimbursements for prenatal, childbirth, and postpartum doula services, Lindberg said.

Why maternal health access is complex and unequal

Earlier this year, proponents celebrated the expansion of Medicaid postpartum coverage from 60 days to six months. It was a hard-won victory, proponents said. Georgia is among the 12 states that haven’t expanded Medicaid coverage, according to the Kaiser Family Foundation.

Georgia Governor Brian Kemp signed the extension in July and issued a statement addressing the maternal health crisis.

“We recognize maternal mortality is a serious public health concern, and Georgia’s approval of the Postpartum Extension Waiver underscores Georgia’s commitment to continuously improve the level of care for young mothers in Peach State,” he said.

While experts say this will help improve postpartum health outcomes, access to reproductive health specialists and maternity wards nationwide is challenging.

According to a March of Dimes report published last year, nearly 37% of counties in Georgia were “deserts of maternity care” in 2018. These are counties with no hospital or birthing center that offer obstetrics and no obstetricians. The report estimates that approximately 436,000 women live in counties with little to no obstetrics in the state.

After working in an OBGYN office in Albany, southwest Georgia, Lacey Carmon saw firsthand the limited resources available to women.

“The office was crowded and crowded with women in need of care. As for reproductive medicine, it’s very low, ”said Carmon, who now serves as the director of rural health equity at SOWEGA Rising, a community-based advocacy group focused on southwest Georgia.

“The appointments are stacked and the rush is on, so women don’t have time to explain what they might be dealing with,” she said.

Albany was one of three parishes included in the PM3 study. The city has a hospital and several field clinics and acts as a health center for residents of the surrounding rural areas, said Sherrell Byrd, the co-chair of SOWEGA Rising. But the offerings for pregnant women in the surrounding communities are limited.

Dr.  Natalie Hernandez, executive director of the Center for Maternal Health Equity at Morehouse School of Medicine.

Dr. Natalie Hernandez, executive director of the Center for Maternal Health Equity at Morehouse School of Medicine and lead investigator on the PM3 project, spoke to women in Albany and two other communities with higher poverty rates and uninsured. These are communities with higher rates of obesity, high blood pressure, and diabetes – all leading diseases that contribute to maternal death, she said.

Some women she spoke to had to drive up to two hours to get to medical care.

“Imagine if you are at work or have a high-risk pregnancy,” she said. “A shortage of hospitals and doctors creates greater barriers and impediments to care. In some areas, there are people becoming pregnant with chronic health problems that contribute to these maternal morbidity and mortality rates. “

Maria Clark is a general affairs reporter for The American South. Story ideas, tips, questions? Email her at mclark@gannett.com or follow her on Twitter @ MariaPClark1. Sign up for the The American South newsletter. Follow us on Instagram, Facebook and Twitter.