Where you live matters for maternity care in Georgia

Georgia’s rate of death from pregnancy has long ranked among the nation’s worst.
Executive office manager Antonia Harris holds 16-day-old Prince Jasper Lee Holder as she works in her office at Wayne Obstetrics and Gynecology in Jesup on Thursday, February 6, 2020. (PHOTO by Hyosub Shin / Hyosub.Shin@ajc.com)



Executive office manager Antonia Harris holds 16-day-old Prince Jasper Lee Holder as she works in her office at Wayne Obstetrics and Gynecology in Jesup on Thursday, February 6, 2020. (PHOTO by Hyosub Shin / Hyosub.Shin@ajc.com)

More than one in three Georgia counties where thousands of Georgia mothers give birth each year is a “maternal care desert,” according to a report released Tuesday by the March of Dimes. Partly as a result, the report found, 17% of those who gave birth received no or inadequate prenatal care.

The finding on Georgia’s lack of resources for pregnant women, especially those in rural and lower-income communities, is the sober backdrop to the recent announcement that Georgia’s rate of maternal mortality remains among the worst in the nation, and surged during the early pandemic. The state’s Maternal Mortality Report found that almost all maternal deaths in Georgia were preventable.

It also found Black women were more than two times as likely as white women to die from pregnancy.

“I think that it’s time to move forward and find ways to ensure that all across Georgia as well as in the U.S. we have access to maternity care,” said Dr. Jose Cordero, a professor of public health at the University of Georgia and former board member of the March of Dimes.

The Georgia Department of Public Health, which is tasked with monitoring and combating maternal mortality in the state, said it would not comment for this story.

Overwhelmingly, when women die during pregnancy or for reasons related to pregnancy in the year after giving birth, there were symptoms that could have been avoided or treated better, the state has found. The main causes in Georgia included hemorrhage, mental health conditions, heart and vascular conditions and blood clots, and high blood pressure associated with pregnancy. More than half of maternal deaths happen in the year after giving birth. Georgia has recently extended Medicaid, the health insurance program for poor children and some poor adults, to all low-income pregnant women for 12 months, up from six months, after they give birth.

A maternal care desert was defined by the March of Dimes as a place lacking a hospital or birth center with obstetric care and lacking enough obstetric providers such as ob/gyns, certified nurse-midwives or family physicians. This year the organization changed the definition slightly, allowing not just ob/gyn’s but family practice doctors to be defined as maternal care.

Separate research by the Georgia Board of Health Care Workforce has found that about half of Georgia’s counties have no ob/gyn.

The poor numbers are no surprise to Michelle Arp. Arp is a midwife who works at multiple locations in metro Atlanta and has for more than 25 years. She said shortages of caregivers exist even in the state’s most populous areas.

“The problem is, the system doesn’t value maternal care,” she said, reimbursing doctors too little for treating Medicaid patients, and making it complicated for midwives to be reimbursed at all.

Medicaid funds more than half of deliveries in Georgia. Yet Medicaid’s reimbursement rates to doctors is so low, Arp said, that obstetric practices will lose money if they don’t mix in other services. Ob/gyns who opt instead to work for bigger companies find themselves stacked with exhausting patient loads.

And that’s when low-income patients manage to get on Medicaid at all, she said. Arp recounted seeing Georgia’s Medicaid program over the years go through periods where it took three to five months to enroll patients. All the while, those patients waited for the state to process the paperwork, and they would not get prenatal care, Arp said.

“And then you may get to a point where no practice will take them because they’ve got too far along,” Arp said. “Then they show up at the hospital and say ‘I’m 32 weeks.’”

For twelve years Arp helped deliver babies at Atlanta Medical Center, which had a thriving labor and delivery unit. That unit drew a network of ob/gyn and midwife offices to establish themselves around the hospital over the years. That network was wiped away when AMC closed, the medical professionals told the AJC, because they couldn’t justify staying open at that location without a hospital to anchor them.

A doctor moving a dozen miles away, as some AMC doctors did, can have a huge impact on lower-income patients who take the bus or work multiple jobs, Arp said. It can cause them to make it to fewer appointments and thus impact their health.

Arp left AMC a year or two before the closure. But now the private practice she left for is preparing to drop its labor and delivery practice and only do gynecology.

“And other places have it worse,” Arp said, pointing to rural areas with no hospitals or doctors at all. “People are more and more not receiving prenatal care.”

Maternal care in Georgia

• In Georgia, 35% of counties are defined as maternity care deserts compared to 33% percent in the U.S.

• 16% percent of women had no birthing hospital within 30 minutes compared to 10% percent in the U.S.

• Overall, women in Georgia have a high vulnerability to adverse outcomes due to the scarcity of reproductive healthcare services in some areas

• 17% percent of birthing women received no or inadequate prenatal care, greater than the U.S.rate of 15% percent.

• Women with chronic health conditions have a 48% increased likelihood of preterm birth compared to women with none.

Source: March of Dimes