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88 maconmagazine.com | DECEMBER/JANUARY 2023 B acked by data, more and more medical practitioners and independent services are lining up to provide holistic support for birthing and postpartum parents. "We have to realize this is a process and it continues on," said Dr. Raymond E. Betcher, chair for the Department of Obstetrics and Gynecology at Atrium Health-Navicent/Mercer University, discussing the shift in practice from seeing birth as the finish line of pregnancy. "The order of birth doesn't go baby, placenta, owner's manual." This crucial period is referred to as what Betcher calls "the fourth trimester," encompassing the birth and postpartum period, a time increasingly focused on healing and wellness. According to the Centers for Disease Control and Prevention (CDC), about 60% of pregnancy-related deaths are preventable, and 33% happen one week to one year after delivery. Georgia itself has high infant and maternal mortality rates compared to the rest of the United States: in 2020, the CDC documented 6.28 infant deaths per 1,000 live births; and from 2014 – 2017, the Georgia Department of Public Health reported 68.9 pregnancy-associated deaths and 25.1 pregnancy-related deaths per 100,000 live births, with Black women dying at two times the rate of white women. For context, in the United States in 2020, the CDC reported an average infant mortality rate of 5.4 deaths per 1,000 live births and an average maternal mortality rate of 23.8 deaths per 100,000 live births. Citing these maternal mortality statistics, Georgia expanded Medicaid coverage in 2021 during the postpartum period from 60 days to six months. MAJOR INSTITUTIONS The process of postpartum healing and support starts even before birth. At Navicent, Betcher encourages proactivity with education, like courses in infant safety, childbirth, and breastfeeding, that make the transition stage easier. Erin Raine, a certified personal trainer in Warner Robins who specializes in pregnant and postpartum corrective exercise, suggested early intervention for an easier time after baby arrives. "Every single pregnant person — it doesn't matter if you have known issues or not — should try to get an evaluation with a pelvic floor therapist while they are pregnant, and then again six to eight weeks postpartum. Seeing someone during pregnancy is huge because they can show you what your muscle might look like." Even with preparation, the intensity of labor and delivery present unexpected challenges. Traumatic experiences during birth, either physiological or emotional, can carry over into struggles during the postpartum period. There are options for birthing parents and their support partners to try to make this time easier. "A lot of people talk about labor and delivery. We call it a family birth center," Betcher said on Atrium Health-Navicent's family-centered approach. "We're looking at this as a unit. Mom and baby, not mom or baby." Innovative services that come with that label include skin-to-skin contact for bonding after birth and accommodations for waterbirths. Central Georgia also has ObGyne Birth Center for Natural Deliveries in Forsyth, which opened in 2019 as a spa-like alternative to hospital care that is one of only three physician-led birthing centers in Georgia. SUPPORT PROFESSIONALS To assist with birth and beyond, many soon-to-be parents are opting for a birth support professional called a doula. Keyona McCarthy, a labor and postpartum doula, noted that the origin of the word comes from Greek for servant. "I assist or serve women with their emotional, mental, spiritual health throughout their birthing journey. Birthing people need the utmost support. They need to be heard. They need someone to advocate for them," McCarthy explained. The doula can be there during either birth or in the transition to new parenthood, sometimes both, as a source of knowledge and an active caretaker. Erin Swart, a certified doula through the Best Agency, explained her process this way: "People hire me during their pregnancy, and I help them form a birth plan, answer questions they may have, and provide communication throughout their pregnancy that leads to continuous support throughout their birth." Swart said that she stays until "mom is feeling comfortable and everyone is settling in," and then provides several check-ins in the days and weeks that follow. McCarthy said she believes one of the most important reasons to have a doula is to have an advocate during a vulnerable time. "I try to make sure I know Georgia's legal policies on birthing rights. A lot of people are told PICTURED LEFT TO RIGHT: ERIN SWART AND ERIN RAINE