A great test of any society is whether it takes good care of pregnant women and babies.
The State of Georgia is currently failing that test.
Georgia has the worst maternal mortality rate in the country—that is to say, more women die in childbirth in Georgia than in any other state.
The financial website WalletHub just released a report that lists Georgia as the fifth-worst state in which to have a baby. Among the factors considered were the number of midwives and ob-gyns per capita, prenatal care access, and rates of postpartum depression.
Looking at these rankings, you’d think Georgia’s leaders would be desperate for change. One state senator recently called the maternal mortality rate “the bane of my existence.”
Why, then, is Georgia allowing hospitals to block new childbirth services that the state’s own Department of Community Health has deemed necessary?
When Katie Chubb was pregnant, she started visiting an Atlanta birth center two and a half hours from her home in Augusta, Georgia.
Birth centers are facilities where midwives and doulas help families through the childbirth process, from prenatal care through delivery and postpartum recovery.
For Katie, who’s originally from the U.K., the Atlanta birth center was a godsend. She and her husband, Nick, had tried visiting a traditional hospital maternity ward. The hospital office separated Katie from Nick, then cycled through information Katie already knew.
The birth center was different. The staff asked Katie and Nick questions to find out how the center could best help the couple prepare for, deliver, and take care of their baby. At birth centers, the supervising physicians, certified nurse midwives, and doulas view themselves as partners, not directors, of the process.
“A doctor will say, ‘I’m delivering this baby,’” Nick explains. “The midwifery way is to say: ‘You are going to be having this baby.’ The midwife is there to make sure you are okay and to assist in the process.”
Katie found the birth center’s approach empowering. Nick liked how family oriented it was. “I thought, ‘This is significantly better for the family. Not just for the mother, but for the family,’” Nick says.
The couple stuck with the birth center throughout the pregnancy, driving two and a half hours to Atlanta for all of Katie’s prenatal visits. “I just thought, ‘Man, we don’t have anything like this here in Augusta,’” Katie says.
Later, at home in Augusta, Katie turned to Nick. “I was like, ‘How hard would it be to start a birth center here? And why do we not have one?’”
Katie and Nick are the kind of people who instinctively try to fill holes in their community.
They’re foster parents and are on the list to adopt. The couple is not originally from Augusta—a city of 200,000, the third-largest city in Georgia—but they’ve made a happy home there. “We’re very tied into this community,” Katie says. “I don’t think either of us can go out for a meal without seeing someone that we know.”
Katie and Nick met in Virginia Beach when they were just 20 and 23. Nick was in the Navy. They got engaged after only a couple months of dating. “This is the short version of the story: He took care of my dog,” Katie quips.
Katie works as a personal trainer, focusing on prenatal and postnatal exercise. Many of her clients are pregnant or postpartum servicewomen from the nearby Army base. Some of her clients are doctors and nurses. Many of them are black—and, tragically, the black maternal mortality rate in Georgia is even worse than the overall rate.
Katie started asking her clients what they thought about opening a birth center in Augusta. They were universally enthusiastic.
Nick—who works for a bank and performs weddings as a minister—started planning dad groups he could host at the center.
“Nick wants to do a Daddy Doula class,” Katie explains. Nick’s working name for the class is pure dad-joke: “It’s UterUS, not UterYOU.”
Katie already had experience running her personal training business, and the couple built a network of couples and families interested in the birth center. They pushed forward with the logistics of setting up the Augusta Birth Center: Katie formed a board of directors, chose a location, and secured funding. The center would staff licensed physicians, certified nurse midwives, and doulas who’d work one-on-one with mothers and host classes—including classes like, “How to introduce your baby to your dog,” because, Katie says, “there’s a high incidence of dog bites in kids.”
Because Katie and Nick are foster parents, they also started thinking about parents who become completely overwhelmed and can’t care for their children. “We have had babies left on the side of the road, abandoned,” Katie says. That gave Katie the idea to have a “baby box” at the birth center, where parents can safely leave babies in accordance with the Safe Haven Law. A staff member would be at the birth center 24/7 to admit low-risk laboring mothers and care for any abandoned infants.
Everything was coming together. People in Augusta seemed fully supportive of Katie and Nick’s plans. Clearly, Georgia had childbirth and parenting problems that a new birth center could help solve.
But then Katie hit a roadblock: Georgia’s Certificate of Need law.
Georgia’s Certificate of Need regulations require any new childbirth services to secure transfer agreements with hospitals—meaning, a hospital must agree in writing to accept patient transfers from the new service in an emergency.
Never mind that federal law requires hospitals to accept all patients in an emergency. Georgia law still required Katie to secure a transfer agreement with a hospital.
And none of Augusta’s three area hospitals would agree to sign a transfer agreement with the Augusta Birth Center.
Katie was stunned when she found out none of the hospitals would sign the agreement. She was friendly with several doctors and nurses at these hospitals. And she knew firsthand that emergency patient transfers between birth centers and hospitals were standard practice: After all, that’s what happened to her. Katie was in labor for 36 hours at the Atlanta birth center; then her midwives and doula decided she needed to go to the hospital to get fluids. She ultimately had a C-section at the hospital. The transfer was handled smoothly, and the birth center staff continued to check on her every couple of hours.
Why wouldn’t Augusta hospitals agree to the same arrangement? When women choose to give birth at home—the only alternative to hospitals in Augusta—hospitals accept patients in cases of emergency. So why were hospitals refusing to partner with the birth center, a safer option than home birth?
Perhaps because the Augusta Birth Center would be a direct competitor to the hospitals—taking money away from hospitals’ bottom line, and providing an alternative to the hospital’s one-size-fits-all approach to childbirth.
Katie was able to enter into a transfer partnership with a physician with admitting privileges to two local hospitals, but even that wasn’t enough to satisfy Georgia’s Certificate of Need regulations. Even though the Department of Community Health determined that the birth center was needed, financially feasible, and cost-effective, Katie’s application was ultimately rejected.
Katie is now working with Pacific Legal Foundation to challenge Georgia’s Certificate of Need law. Her lawsuit, filed in August, seeks to dismantle protectionist regulations that allow industry insiders to veto a new competitor.
In a press release announcing the lawsuit, PLF senior attorney Anastasia Boden called Georgia’s Certificate of Need law “an unconstitutional restriction on both Ms. Chubb’s right to provide critical childbirth care and the right of Georgia mothers to access those services.”
She added: “Mothers, not the state, should be able to choose the safe and comfortable circumstances under which they give birth.”
While Katie’s lawsuit plays out, Katie and Nick’s plans for the Augusta Birth Center are on hold—and unfortunately, Augusta women have limited options for how to safely bring children into the world.