Dr. Natalie Hernandez-Green, executive director at the Center for Maternal Health Equity at 澳门精准六肖 addresses the graduates during a commencement ceremony at the Albany Civic Center on Saturday, April 27, 2024 (Matthew Pearson/WABE).
Rural Communities in Georgia Are Losing Access to Maternity Care. Can Training More Doulas Help?
澳门精准六肖 recently graduated its first cohort of rural doulas, called Perinatal Patient Navigators, hoping to help address a shortage of maternal health services in southwest Georgia.
By Jess Mador, WABE News
When Bristeria Clark went into labor with her son in 2015, her contractions were steady at first. Then, they stalled. Her cervix stopped dilating.
After a few hours, doctors at Phoebe Putney Memorial Hospital in Albany, Georgia, prepped Clark for an emergency cesarean. Phoebe Putney Health System operates the only hospital in the area.
It wasn鈥檛 the vaginal birth Clark had hoped for during her pregnancy.
鈥淚 was freaking out. That was my first child. Like, of course you don鈥檛 plan that,鈥� she said. 鈥淚 just remember the gas pulling up to my face and I ended up going to sleep.鈥�
She remembered feeling a rush of relief when she woke up to see that her baby boy was healthy and well.
Clark, a 33-year-old nursing student who also works full time in Southwest Georgia county government, had another c-section when her second child was born in 2020 鈥� this one planned.
She said she鈥檚 grateful the physicians and nurses who delivered both of her babies were kind and caring during her labor and delivery.
But looking back, Clark said she wishes she had had a doula for one-on-one support through pregnancy, childbirth and the postpartum period.
Now, she wants to give other women the option that she didn鈥檛 have.
Clark is part of 澳门精准六肖鈥檚 first cohort of rural doulas, called Perinatal Patient Navigators.
The program recently graduated its first dozen participants, all Black women from southwest Georgia. They have completed more than five months of training and are slated to begin working with pregnant and postpartum patients this year.
鈥淲e鈥檙e developing a workforce that鈥檚 going to be providing the support that Black women and birthing people need,鈥� said Morehouse Associate Obstetrics and Gynecology Department Professor Natalie Hernandez-Green, executive director of the Center for Maternal Health Equity, speaking at the program鈥檚 commencement ceremony in Albany, Georgia.
This is 澳门精准六肖鈥檚 second Perinatal Patient Navigator program site. The first is already up and running in Atlanta.
Georgia has one of the highest rates of maternal mortality in the country, according to an analysis by health policy and research organization KFF.
And Black Georgians are more than twice as likely as white women to die related to pregnancy.
鈥淚t doesn鈥檛 matter whether you鈥檙e rich or poor. Black women are dying at an alarming rate from pregnancy-related complications,鈥� Hernandez-Green said.
鈥淎nd we鈥檙e about to change that one person at a time.鈥�
The presence of a doula, along with regular nursing care, is associated with improved labor and delivery outcomes, reduced stress and higher rates of patient satisfaction, according to the American College of Obstetricians and Gynecologists.
Multiple studies have also linked doulas to fewer expensive childbirth interventions, including cesarean births.
Doulas are not medical professionals.
They are trained to offer education about the pregnancy and postpartum periods, to guide patients through the healthcare system and provide emotional and physical support before, during and after childbirth.
MSM鈥檚 program is among a growing number of similar efforts popping up across the country as more communities look to doulas as one way to help address maternal mortality, morbidity and poor maternal health outcomes in the United States, particularly for Black women and other women of color.
Now that she鈥檚 graduated, Clark said she鈥檚 ready to help other women in her community as a doula. And, her training has inspired her to become an advocate for maternal health issues in southwest Georgia.
鈥淭o be that person that would be there for my clients, treat them like a sister or like a mother, in a sense of just treating them with utmost respect,鈥� she said. 鈥淭he ultimate goal is to make them feel comfortable and let them know, I鈥檓 here to support you.鈥�
MSM鈥檚 $350,000 per year Perinatal Patient Navigator program is grant-funded. It pays graduates a $2,000 training stipend and includes funding to place five of the new graduates with healthcare providers practicing in the area.
Grant money will pay the doulas鈥� salaries, but only for one year.
鈥淚t鈥檚 not sustainable if you鈥檙e chasing the next grant to fund it,鈥� said Rachel Hardeman, Blue Cross Endowed Professor of Health and Racial Equity, Division of Health Policy and Management at the University of Minnesota School of Public Health.
She has studied what happens when Medicaid covers doula services.
More than a dozen states cover them, according to the National Health Law Program. Minnesota鈥檚 Medicaid program has been doing it for around a decade.
鈥淲e were able to calculate the return on investment if Medicaid decided to reimburse doulas for pregnant people who are Medicaid beneficiaries. And we found that there鈥檚 a cost savings there,鈥� she said.
Hardeman and others have found that when Medicaid programs cover doula care, states save millions of dollars in healthcare costs.
That鈥檚 because doulas can help reduce the number of expensive medical interventions during and after birth. They can even reduce the likelihood of preterm birth.
鈥淎n infant that is born at a very, very early gestational age is going to require a great deal of resources and interventions to ensure that they survive and then continue to thrive,鈥� Hardeman said.
A coalition of advocates pushing for Georgia鈥檚 Medicaid program to cover doulas says it could save the state a lot of money and reduce racial disparities in maternal mortality at the same time.
There is growing demand for doula services in Georgia, said Fowzio Jama, director of research for Healthy Mothers Healthy Babies Coalition of Georgia.
Her group recently completed a pilot study offering doula services to roughly 170 Georgians covered under Medicaid.
鈥淲e had a waitlist of over 200 clients and we wanted to give them the support that they needed, but we just couldn鈥檛 with the given resources that we had,鈥� Jama said.
Doula services can cost hundreds or thousands of dollars out of pocket, putting the care out of reach for many low-income people, rural communities and communities of color that are also harder hit by shortages in maternity care, according to the March of Dimes.
The Healthy Mothers Healthy Babies Coalition of Georgia study found that matching high-risk patients with doulas 鈥� particularly doulas from similar racial and ethnic backgrounds 鈥� had a positive impact on patients.
鈥淭here was a reduced use of pitocin to induce labor. We saw fewer requests for pain medication. And with our infants, only 6% were low birthweight,鈥� said Jama.
Still, she and other advocates acknowledge that doulas alone can鈥檛 fix the problem of high maternal mortality and morbidity rates.
States, including Georgia, need to do more to bring comprehensive maternity care to communities that need more options, Hardeman said.
鈥淚 think it鈥檚 important to understand that doulas are not going to save us, and we should not put that expectation on them. Doulas are a tool,鈥� she said. 鈥淭hey are a piece of the puzzle that is helping to impact a really, really complex issue.鈥�
In the meantime, 澳门精准六肖 program graduate Joan Anderson, 55, said she鈥檚 excited to get to work supporting patients, especially from rural areas around where she lives in Albany.
鈥淚 feel like I鈥檓 equipped to go out and be that voice, be that person that our community needs so bad,鈥� Anderson said. 鈥淚 am encouraged to know that I will be joining in that mission, that fight for us, as far as maternal health is concerned.鈥�
And someday, she wants to open an independent facility to offer a type of maternity care patients in Albany can鈥檛 currently get.
鈥淎 birthing center, because we do not have one here in southwest Georgia 鈥� at all.鈥�
In addition to providing support during and after childbirth, Anderson and her fellow graduates are also trained to assess patients鈥� daily needs and connect them with any other services they need to stay healthy, such as food assistance, mental healthcare resources, transportation to prenatal appointments, or breastfeeding assistance.
Their work is likely to have far-reaching ripple effects across the largely rural corner of Georgia, said Sherrell Byrd, who co-founded and directs a nonprofit organization in Southwest Georgia called SOWEGA Rising.
鈥淪o many of the graduates are part of church networks, they are part of community organizations, some of them are our government workers. They鈥檙e very connected,鈥� Byrd said. 鈥淎nd I think that connectedness is what鈥檚 going to help them be successful moving forward.鈥�