Mother deaths prompt protest, call for midwives

Even for Andrea McPherson, who is accustomed to looking at international statistics on maternal deaths, the numbers seemed shocking.

“I’m used to seeing these stats for Third World countries, not at my front door,” said McPherson, who was among about a dozen women and children protesting Friday outside the Richmond County Health Department to call attention to the area’s high maternal mortality rate.

The rally was prompted by an Augusta Chronicle analysis published in June that found the East Central Health District in Augusta had the highest maternal mortality rate in Georgia in 2011 – 93.3 per 100,000 births, three times the state rate and more than six times the national average.

One sign the protesters carried asked, “Did you know birth is safer in Iraq than Augusta?”

Georgia is trying to get to the bottom of why that rate has shot up in recent years and formed a Maternal Mortality Committee in December 2012 to review each death and come up with recommendations for the state, said Dr. Ketty Gonzalez, the director of the East Central Health District and a member of the review committee.

There is probably not one reason, but likely a number of factors, she said.

“What we know is it is closely tied to infant mortality and low birth weight,” Gonzalez said. “It is closely tied to the women’s health status before they get pregnant. That is an issue for us.”

There are higher rates of obesity, diabetes and hypertension, some of it undiagnosed, among women who then get pregnant, she said.

“It creates a major stress to your kidney, your heart, your liver, etc.,” Gonzalez said.

Richmond County is hoping to help address the problem by creating a Centering Pregnancy program. It involves grouping pregnant women by due date and following their care through a nurse practitioner who sees them as a group weekly. The women weigh themselves, check their blood pressure and discuss issues ranging from nutrition to domestic violence, Gonzalez said.

“They have someone looking at the process, but they allow the patients to engage in their own care,” she said.

For the women at Friday’s rally, many of whom have delivered using midwives and at home, the solution is having more mid-level practitioners such as doulas and nurse-midwives.

Laura Selvidio pointed to the midwife-led Birth Centers prevalent in other states that resulted in much lower cesarean rates, and the potential complications involved with that, and zero maternal deaths among the 15,574 women followed in one study.

In Washington state, which encourages midwives and out-of-hospital births, the state saved an estimated $3.1 million a year, said Betsy Alger, who has delivered three children at home and is expecting another in a month.

“It is a significant savings,” she said, adding that it should appeal to Georgia’s fiscal conservatives. “They should be all over this.”

According to a Cochrane Database Systematic Review of 11 clinical trials involving more than 12,000 women, midwife-led care resulted in less anesthesia use and fewer episiotomies and gave women a feeling of greater control during labor.

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