The art of birthing, as she calls it, is one that never grows old for Rose Horton.
Six years ago, Horton, a registered nurse from New York City, found herself at Emory Decatur Hospital when it was then known as DeKalb Medical Center. Horton said that she realized working in the Atlanta area would mean having a place amongst one of the largest collections of Black health care workers that she had ever experienced. “It made me want to be here,” she said.
Today, Horton is the executive director for Women and Infant Services at Emory Decatur, where she’s focused on fighting for equity in maternal health for Black women. Through her research, Horton gained national attention and was selected by the Biden administration to serve on the Black Maternal Health Stakeholder Group.
Georgia is the most dangerous state for pregnant women, according to data from the Centers for Disease Control and Prevention. With a maternal death rate of 66.3 deaths per 100,000 live births from 2013 to 2017, expecting mothers are two times more likely to die during their pregnancy and up to one year postpartum. Black women in Georgia are three times more likely to die from pregnancy-related complications than whites.
For Black Maternal Health Week, we spoke with Horton, who broke down five of the most important issues and recent developments facing Black maternal health in the state.
1. Racism in the health care system
In the Black community, Horton said, the common misconception is that the risk of complications before, during, and after pregnancy depends on your socioeconomic status, ZIP code and education level. However, that’s not the whole picture.
“All Black mothers are at risk,” Horton said. “The consistent and prevalent issue is centered around racism.”
Horton said when medical practitioners focus on race rather than addressing an actual illness or pain level, there’s a disconnect, which increases the risk of both maternal mortality and morbidity. Maternal morbidity is any instance in which a pregnancy strays from the original plan. “For example, if you planned to have a vaginal birth and end up having a cesarean section, that’s maternal morbidity,” she said.
“Maternal morbidity isn’t something that we really talk about all the time, but it’s a rising issue because of racism,” Horton said.
Horton said that, historically, the health care system has ignored Black patients when it comes to pain and illness across all specialties, and that leads to a heightened risk of complications during pregnancy and labor.
“Racism can be especially dangerous for obstetrics,” Horton said. “It’s important that we listen to any complaints from Black women in the prenatal stage because response time is the determining factor a lot of times when it comes to maternal morbidity. That response time is just as important in the postpartum period to ensure that our ending result isn’t maternal mortality.”
2. Closing hospitals in rural Georgia
Out of the 159 counties in Georgia, Horton says, there are 89 that don’t have a hospital. She added that Black women living in these communities are experiencing long commutes to seek prenatal and postpartum care. For mothers in low-income areas, Horton says, this task becomes even more difficult.
“When the hospital closes in rural Georgia, you effectively lose access to an OB practitioner, creating a health care desert,” she said. “That puts families at risk if you have to drive for health care. What happens to those that don’t have access to transportation?”
Horton also says that loss of hospitals in rural areas means the loss of specialty practitioners.
“If a baby needs surgery, you may need an orthopedic surgeon or a maternal-fetal medicine specialist,” Horton said. “Hospitals also house auxiliary professionals who are just as essential to the birthing team, like the registered nurses who assist the OB during the birth or the lactation specialists who teach a new mother how to breastfeed. All those key parts are lost when a hospital closes.”
3. Medicaid Expansion
Earlier this month, the state House voted unanimously to approve Senate Bill 338, which will raise the postpartum care benefits period from six months to one year in an attempt to curb the state’s high maternal mortality rates.
As the bill awaits approval from Gov. Brian Kemp, Horton says that the legislation is a huge step toward expanding necessary care for low-income mothers.
“We know from day 42 to day 365, that’s a vulnerable time for women,” Horton said. “If you don’t have insurance and you are concerned about going to the hospital and having a huge bill, that has an impact on your want to seek medical care.”
At one point, Horton said, new mothers were covered by the state-funded insurance for only 30 days, an issue that she says has been a priority for the Biden-Harris administration. Horton hopes that by extending the coverage period, Georgia will join the national effort to ensure access to vital health care services.
4. More Education for Providers
Horton said that federal lawmakers are working to pass legislation that would promote needed education for practitioners to encourage maternal health equity for all.
If passed, the Build Back Better Act promotes initiatives specific to maternal health, like four weeks of paid family and medical leave for employees for new parents. There are also incentives for providers to better coordinate quality of care during the perinatal period, which Horton said is a great opportunity for state health care systems to have that information readily available for its workers.
“We know, as a system, we can do better when it comes to educating our physicians and medical staff on the importance of maternal health and safety,” Horton said. “Through education, we can help staff become more aware of the risks of pregnancy and also introduce new and alternative solutions dependent on the patient and their unique journey.”
However, Horton acknowledged that local government support for the Build Back Better Act is up in the air.
“When you get to the nitty-gritty of it, it just is not a priority for everyone right now,” Horton said. “You have some states pushing it more than others. It’s up to the states to take advantage of that and put dollars behind it to move forward with those initiatives.”
5. Exploring Alternative Options
Horton says it’s time to change the narrative and inform new and potential Black mothers on the alternative solutions that are growing in popularity and becoming more accessible to all: doulas, birthing centers, and at-home births.
“All mothers need a network of their choosing to go on this amazing and life-changing evolution with,” Horton said. “When you meet with your doula, you bring them into your home and you have conversations about what the plan for birth looks like, and the doula’s role is to amplify your voice while in labor.”
Horton also says that options like birthing centers and at-home births grew out of the pandemic when hospitals became more restrictive in an effort to curb the spread of COVID-19. She touts normalizing alternatives to the traditional hospital delivery method because women deserve the right to choose.
“Giving birth is unique to each mother,” Horton said. “It’s an experience that should be joyful. We can be healthy, build a village and take care of our bodies physically and holistically. In order to do that, we must choose the best option for ourselves at the end of the day.”