The space at Atlanta Birth Center in Midtown has almost no harsh, overhead lighting. A small patient exam room at the back of the center is decorated with colorful artwork. A shelf in the corner is stacked with children’s toys and books.
Faith-Tomi Wilson is here for a regular prenatal visit. She’s dressed in all black, wearing red eyeglasses and dangly earrings. She’s about five months pregnant.
“I am 22 and two. So, 22 weeks and two days,” she says. “This baby was a surprise, a little sooner than I had desired. But overall, I’m feeling very grateful and feeling good.”
She leans back on the exam table and inches up her shirt so Certified Nurse Midwife Cat Dymond can begin an ultrasound.
A pulsating sound soon fills the room.
“Sounds wonderful,” Dymond says, moving the handheld gadget across Wilson’s belly to check the fetus’ development and listen to the heartbeat.
“A normal baby heart rate is between 110 and 160. Baby’s heart rate tells us baby’s oxygenation status, which tells us baby’s neurological status,” says Dymond. “That’s why it’s important.”
Then, Dymond reviews some of Wilson’s other recent test results for conditions such as gestational diabetes, preeclampsia and other potential pregnancy complications.
So far, everything looks good, Dymond says.
“I always think, what is the spark here that I can try to ignite in someone else? Am I giving enough information? And everyone knows I run late because I will answer every question because I don’t want you going on TikTok or something.”
Certified Nurse Midwife Cat Dymond
Atlanta Birth Center Certified Nurse Midwives, the only recognized type of midwife licensed to practice in Georgia, can see patients before, during and after their pregnancies.
This is Atlanta’s only independent, nationally accredited birth center. And it’s one of only a few in the entire state.
Dymond encourages patients to advocate for themselves and ask questions.
“I always think, what is the spark here that I can try to ignite in someone else? Am I giving enough information? And everyone knows I run late because I will answer every question because I don’t want you going on TikTok or something,” Dymond says.
Prenatal appointments here last up to 60 minutes. That’s four times longer than many typical hospital or clinic checkups. Postpartum visits are an hour long.
It’s the kind of personalized support experts say Georgia needs more of to help improve maternal and infant health, especially because more than a third of counties in the state have no pregnancy or childbirth providers at all — at birth centers like this or even at hospitals.
Research shows that when midwives are part of maternity care teams, they can help improve pregnancy outcomes. And midwife-led birth centers are associated with fewer C-sections, medical interventions and preterm births.
The large, private childbirth rooms at Atlanta Birth Center offer regular beds and birthing tubs for the option of a water delivery.
Center Cofounder and Midwife Director Anjli Hinman says it’s not easy to keep their doors open and meet the demand for care.
“There is inequity with reimbursement rates for birth centers and for midwives. Birth centers are closing, you know, and it doesn’t matter whether it’s Medicaid or any other insurances. It’s not sustainable. And it’s just it’s frustrating because we know what the outcomes are,” Hinman says.
Georgia lawmakers loosen requirements for birthing centers
Georgia isn’t the only place in the country seeing payment disparities.
Across the country, states set their own rules when it comes to the services midwives are permitted to perform, how they’re licensed, and how they’re paid.
Hinman points to the example of an uncomplicated, low-risk vaginal birth.
“To do a birth [a hospital facility] gets maybe $18,000 to $20,000,” she says. “That same birth happening in a birth center setting gets maybe $2,000 to $3,000. “
Until recently in Georgia, there was also another problem — longstanding state Certificate of Need regulations over where new facilities could open in relation to existing hospitals.
But last year, state lawmakers loosened those requirements for birthing centers.
Now, Hinman says she’s cautiously optimistic that more Georgians could eventually see easier access to birthing centers that offer midwife care — care that was also easier to access in Atlanta before Wellstar’s Atlanta Medical Center abruptly shut down in 2022.
“So I’m hoping, and I think there’ll be good things for the future,” Hinman says. “That was one barrier that I was really glad to see removed.”
‘A hospital was never an option for me’
As Wilson’s prenatal visit winds down, Dymond checks Wilson’s blood pressure levels.
“102 over 70,” Dymond says, loosening the velcro armband on Wilson’s arm.
Wilson, a licensed mental health therapist, says she’s also been taking her own blood pressure every day at home. She’s aware of the public health data showing Black women like her face the highest risk for severe pregnancy complications.
And she is thankful that her pregnancy is low-risk. Under state and federal rules, licensed birth centers can only accept patients with low-risk pregnancies.
Wilson had her first two children at the birth center and says she is hoping to have her third here, too.
“A hospital was never an option for me. I was experiencing anxiety. I was thinking about if I had to really give birth at a hospital,” Wilson says. “I didn’t know what I was going to do.”
She wants every pregnant Georgian to have the same option.
There’s a long way to go before that is possible.
Gov. Brian Kemp and some top lawmakers say they’ll make expanding maternal health care a priority during the ongoing legislative session.
