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Shortly after she received her doctorate in 2018, Medical College of Georgia associate professor Dr. Marlo Michelle Vernon experienced something that refocused her research.
“I … had a cousin who was 38 weeks pregnant with her second baby, and she woke up the day after her baby shower with a excruciating headache that would not go away,” she said.
Vernon had worked on maternal and child health for years, but had never focused specifically on maternal mortality. She says she now knows that a headache like that can be a sign of pre-eclampsia, a pregnancy-related high blood pressure disorder.
But her cousin and her family did not know it at the time. Once they decided to visit a hospital, it was too late.
“They were able to save her baby, who’s now a 5-year-old, wonderful little boy. But they weren’t able to save her,” said Vernon.
Despite years in the field, Vernon had not known Georgia’s maternal mortality rates were so bad.
To prevent what happened to her from happening to others, Vernon set out to do something. She won a grant for a pilot project that would help women learn about and monitor their own symptoms, including blood pressure and mental health — the second leading cause of maternal mortality in Georgia.
What the studies say about maternal mortality in Georgia
Maternal mortality rates in Georgia are getting worse, according to the most recent studies. While comparing data across states can be difficult, according to one research paper, Georgia is among the bottom five states. Other studies list it as the seventh worst.
The state Maternal Mortality Review Commission found that between 2018 and 2020, there were 113 pregnancy-related deaths up to a year after birth, of which with 89% were at least somewhat preventable. That’s a rate of 30.2 pregnancy related deaths per 100,000 live births.
In 2012-2014, the rate was 25.9 deaths per 100,000 live births, according to the report. Georgia was among the five states with the greatest increase in maternal mortality between 1999 and 2019 for almost every racial and ethnic group.
“Unfortunately, yes, we’ve gotten worse,” Vernon said. “… but I think lack of access is a really big driver of that.”
The Augusta area saw seven of these deaths for a rate of 37.7 deaths per 100,000 live births, while Savannah saw a rate of 24.1 and Columbus a rate of 65.7.
These rates fall disproportionately on those on Medicaid, as well as Black mothers and other people of color. The MMRC report found that Black women were twice as likely to die from pregnancy-related causes at non-Hispanic whites; 60% of those who died had a high school degree or less.
Long-term health problems can plague new mothers
Although the maternal deaths may grab the headlines, a lack of proper care can also lead to long-term health issues well after a pregnancy is over.
Tina Marsden had just moved to Georgia from Indiana 21 years ago with her two sons, one of whom was just 2 months old when she went to the hospital. She was told it was walking pneumonia and sent home. Days later she was back.
“I couldn’t breathe,” she said.
Marsden was diagnosed with postpartum cardiomyopathy, a form of heart failure. As a new arrival to the state, she scrambled to get childcare and deal with her new condition. Now she has a defibrillator and a left ventricular assistance device, a pump attached to her heart with an external battery.
“I’m glad we’re focused on the maternal mortality rates, we actually are not putting enough emphasis also on mothers who are left with lifelong conditions as a result of a maternal health crisis,” Marsden said.
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Accessing care, improving care both challenges
Accessing care is a major factor in maternal health outcomes, and one that multiple experts brought up. Part of this is insurance coverage and paying for care.
Marsden, who is on the legislative committee for the Georgia American Heart Association, testified at the Georgia Capitol before state lawmakers expanded Medicaid for a full year after birth — something multiple experts said was a critical improvement for mothers in the state.
But extending Medicaid during and after a pregnancy may miss a critical moment to catch chronic health problems before they lead to issues for mothers.
“Something that we learned is that what we can do to really reduce not only mortality, but also severe complications, is that the first visit for prenatal care starts before conception,” said José F. Cordero, department head for epidemiology and biostatistics at the University of Georgia.
Many counties also have few or no places where expectant mothers can receive care.
Shelmekia Hodo, maternal and infant health director with the Georgia March of Dimes, said that March of Dimes found 85 out of 159 counties in Georgia are maternity care deserts, with little to no access to obstetric care. A report from March of Dimes in August found about 5% of babies in Georgia were born in these maternity care deserts, while 15.8% of women lived more than 30 minutes from a birthing hospital.
“Those women living in those counties are sometimes challenged with traveling up to two hours in order to receive prenatal care and to deliver their babies,” Hodo said. “Well, we also know that if that’s the case, that some of these women are not receiving adequate prenatal care, which directly impacts birth outcomes.”
Those who can access care may still run into structural issues.
“We also know that there are other causes like structural racism, know lack of respectful care, implicit bias within the healthcare system,” Hodo said.
Improving access across Georgia
Georgia’s congressional delegation has been taking action on maternal mortality this year.
U.S. Sen. Raphael Warnock (D-Georgia) joined with fellow Democrat Alex Padilla of California in introducing the Kira Johnson Act, part of the Black Maternal Health Momnibus Act of 2023. The legislation would focus particularly on reducing disproportionate rates of maternal mortality for Black people and other people of color by providing funds for training to help eliminate bias and racism for people working in maternity care and to fund a program to allow patients to report bias.
On the House side, Georgia Reps. Sanford Bishop, a Democrat, and Buddy Carter, a Republican, are backing the “Healthy Moms and Babies Act,” which they say will increase access through things like telehealth and understanding the social determinants of health.
But federal legislation is not the only place people are working to make changes.
Marsden has continued advocating for changes beyond expanding Medicaid, including broader heart-related issues.
“I really don’t want another mother to have to experience what me and my children have experienced,” she said. “… I know we can’t prevent 100%. But we can prevent a lot of this.”
Vernon now has state funding to expand her at-home monitoring program, along with coordinated medical care, including connections to other resources and primary care for 106 women mostly in the Augusta area. Many have already reported issues during and after their pregnancies that required attention.
Recently one participant noticed abnormal swelling in her legs and feet shortly after her baby was born. The woman took her blood pressure following the guidelines of the program, realized it was concerningly high, went to the emergency room and was admitted with postpartum preeclampsia for 10 days.
“She told us that we saved her life, because if she hadn’t known what to do, and to recognize that that was a problem, she would have waited too long to go to the doctor,” Vernon said.
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