Standing in front of an empty lot one afternoon in the Georgia heat, Katie Chubb gestures to the place where she's been trying to open a birth center for six years.
"We'd have parking along the road," she says, describing her vision for a place that would offer a more home-like alternative to a hospital birth.
Chubb is a community organizer in a state with some of the highest rates of maternal and infant mortality in the country. She says a birth center is badly needed here — Augusta, Ga., is surrounded by maternal health care deserts, where pregnancy care can be difficult to find and few alternatives exist outside of hospitals.
Her vision is for a freestanding clinic that employs mostly midwives and works in partnership with obstetricians.
But despite widespread community support and even offers of investment, Chubb has encountered obstacle after obstacle to her mission to offer more safe birth options for women.
Birth in the U.S. can be dangerous
The Trump administration has called for Americans to have more children. But advocates have been warning for years that maternal and infant mortality rates are high in the U.S., showing how dangerous giving birth can be. Distrust of medical institutions and hospitals is also growing across the country. And some people want more options.
When Clarissa Viens was pregnant, she did not want to have her baby in a hospital. She worried that doctors would pressure her into a cesarean section or drugs to speed labor. Viens had previous births both at home and in a birth center in Alaska, where she used to live. " You are better off at a birth center," says Viens. "The baby's better because they're more relaxed at birth. They get skin to skin contact right away. They don't get bright lights," she says.
With no similar center available in Augusta, Viens decided to give birth at home. When things started to go badly, she did go to the hospital, but it was too late.
Her baby was born in the car.
During his birth, she says, he experienced a cord prolapse — that causes the baby's brain to be deprived of oxygen — and her son suffered a brain injury.
He came home from the hospital with a ventilator and a feeding tube. Doctors are still assessing his diagnosis at 18 months, says Viens.
In retrospect, she says, she would have made different decisions. "But there is only one way to go and that is forward from here." She and her husband are planning to have more children, and Viens says she still doesn't want to go to the hospital for the next one. She would happily go to a birth center, and wishes she could've gone to one for her son's birth.
"If we had had a birth center, it would've changed his outcome," says Viens.
Birth centers still uncommon in the U.S.
There are about 400 birth centers across the U.S. in more than 40 states, according to the American Association of Birth Centers. While still relatively rare, demand has been growing across the country in recent years for these centers, which can provide a safe alternative to hospitals, for low-risk pregnancies.
Katie Chubb wanted to find a birth center when she was pregnant, but there wasn't one nearby. So, she drove more than two hours to have her son. Realizing the need, she formed her own organization, obtained an ambulance transfer agreement, recruited a doctor to partner with her, and even went so far as to successfully advocate for a change in Georgia law, allowing birth centers to open without the permission of local hospitals.
Still, birth centers require partnerships with hospitals and obstetricians in order to transfer patients when necessary.
Hospitals won't cooperate .
Chubb says hospitals don't want to give up potential revenue by surrendering patients to a birth center. "They are putting their profits over patient needs," she says.
None of the three hospitals in Augusta responded to interview requests, though one hospital — part of the larger Wellstar Health System — issued a statement via email that said they offer their own "complete women's health services."
Augusta is not the only community to battle with local hospitals. Similar struggles to open birth centers have played out in states including Alabama, Mississippi, Kentucky and Iowa.
Another reason for resistance is concern over malpractice. Obstetricians are more likely to be sued than other kinds of specialists, says Andrea Braden, an obstetrician who works in Atlanta with both midwives and hospitals.
"That is really unfortunate, but that is where a lot of the resistance comes from," she says. Braden is not involved with the effort to open a birth center in Augusta.
She says obstetricians often don't want to partner with midwives for fear of being handed patients that are already in crisis and could result in a malpractice suit. "The obstetricians who have really high malpractice rates end up being stuck with the liability," she says. The American Medical Association says OB-GYNs average 162 liability claims for every 100 physicians.
High-risk pregnancies are generally not considered good candidates for birth center deliveries.
For Black women, a unique set of concerns
Giving birth is even more dangerous for Black women, who are three times more likely to die from pregnancy-related causes than white women, according to the CDC. The disparity has grown worse in recent years.
Jonquette Sanders-White went to the hospital two years ago in labor with her fourth baby. The baby was fine, but Sanders-White had both a cesarean section and a hysterectomy. Hours after the surgery, she recalls, her belly was "getting more distended by the second."
She was hemorrhaging. The doctors and nurses had missed it. Postpartum hemorrhage is one of the leading causes of maternal mortality.
" All I remember," she recalls, "is that nurses and doctors rush into my room and they're screaming and shouting and they say, 'She's crashing. She's crashing, she's dying. She's dying!'"
Her husband, Treston White, recalls one nurse coming in to tell him "it wasn't looking good," and to "be prepared to tell her goodbye."
White says he didn't believe the nurse and chose instead to pray. He didn't think God would take his wife. "I had no room for doubt at all," he says.
Though Sander-White made it, she is now suing the hospital and practice of surgeons who operated on her. The complaint alleges she still has serious complications from the event two years later. NPR reached out to attorneys for the doctors and the hospital and did not hear back. Medical records included in the legal complaint show she was hemorrhaging the day of the birth.
Reflecting back on the event, Sanders-White says one of the many upsetting things on that day was that she never interacted with a staff member of color.
" I do think if I was another race, they would've been proactive," she says. "A little more quick to react versus waiting until I'm crashing and dying."
Sanders-White says her experience has shown her that hospitals are not necessarily the safest place to be. She believes a more holistically minded birth worker would have been more attentive to her needs and prevented her near-tragedy. "We absolutely need options outside of hospitals," she says. "My eyes are open now."
It's stories like this that motivate Katie Chubb to keep fighting for her birth center. She says she gets weekly calls from people asking when it will be open.
Chubb grew up in the U.K., where births attended by midwives are more common. She moved to Augusta after she met her now-husband on a vacation to the U.S. She says she never imagined this would be her life's work, but says she thinks her outsider perspective helps. " It makes me see the amount of injustice and inequality there is in the U.S. healthcare system," she says.
"Especially with lack of patient autonomy," and choices.
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