ATLANTA – Rose L. Horton came to Atlanta for what was supposed to be a three-month interim job. Instead, she’s stayed five years and found her life’s work.
As executive director of Women and Infant Services at Emory Decatur Hospital, Horton, RN, has made it her mission to combat maternal mortality and morbidity. Her use of a simple hashtag, #notonmywatch, has helped draw attention to a health crisis underscored by a deep racial divide. In the United States, statistics show, Black women are two to three times more likely to die from pregnancy-related causes than white women.
Her work has received national attention, and Horton has been tapped by the Biden administration to participate in the Black Maternal Health Stakeholder Group, which will help guide the administration’s work in this area. The stakeholder group is part of a public-private partnership between the U.S. Department of Health and Human Services (HHS) and the March of Dimes. Their focus: hospital-based quality improvement activities to advance equity in maternal health.
In March, HHS, the March of Dimes and the National Birth Equity Collaborative convened the inaugural meeting of the stakeholder group. Horton was one the 36 members who participated via Zoom.
“It was a very robust and engaging conversation,” Horton says. “I think you will see recommendations funneled up quickly because we understand the urgency to act is now.”
The United States has one of the highest maternal mortality rates in the developed world. And, within the U.S., Georgia ranks among the worst states, according to the most recent data available. Per capita, deaths are the highest among mothers who are Black as well as those who live in rural parts of the state. Seventy percent of the deaths were preventable, according to the Georgia Mortality Review Committee.
Horton, who grew up in New York City, discovered her love of obstetrics at the Christ Hospital School of Nursing.
“I was mesmerized by birth and the whole birthing process,” she says. “I knew right away that this this is what I want to do, forever!”
She began her career as a labor and delivery nurse, at one point working as a high-risk obstetrics transport nurse and becoming a nurse leader. She also rose in the ranks of the Association of Women’s Health, Obstetric and Neonatal Nursing (AWHONN), a national nursing association, serving as its president in 2012.
Horton took a sabbatical from hospital employment in 2015. An interim job in Dekalb Medical Center two years later was supposed to be a stepping stone as she re-entered the nursing work force. (Emory merged with DeKalb Medical in 2018 creating Emory Decatur Hospital)
After arriving in Atlanta, Horton began to grasp the full extent of the maternal mortality problem. Preparing to meet her new colleagues, she began to assemble slides for a presentation on hot topics in labor and delivery. As she dug into the research she came upon article after article about the alarming rates of morbidity and mortality, especially among women of color.
“The more I looked the more frustrated and disgusted I became,” she says.
A savvy user and consumer of social media, she coined the #notonmywatch hashtag to help drive home a message of empowerment for health care providers.
“I want every clinician to recognize they have an impact on outcomes and that every interaction matters” she says.
Horton was able to use her role in AWHONN to amplify the message, talking about it at their national conference. Word began to spread.
“I said ‘this hashtag is going to go viral.’ And it did,” she says.
So, how can we achieve healthier outcomes for moms?
Horton says the stakeholder group is discussing many options. Among them, the expansion of Medicaid to give poor moms access to care for a longer period of time after childbirth, the expanded use of midwives and doulas and more birthing centers, especially in rural areas where hospitals are scarce.
But another solution, Horton says. is recognizing that some of the problem is fueled by race. She’s doing her part.
At Emory Decatur Hospital, the team collects data on birth outcomes by race. They meet monthly to dig into what the numbers say.
“It’s an uncomfortable conversation and I ask everyone to lean into the discomfort, because that is when learning occurs” she says.
Horton says one of the biggest problems she encounters is implicit bias. For example, if a Black woman in labor comes in complaining of pain is she given the same treatment as other women? Why or why not?
One solution is to standardize care so that some of the guesswork is taken out of the equation. There are many tool kits and bundles that are evidence based to guide the healthcare team in managing labor and birth. If there is a template to follow it’s less likely that there will be variations in care.
But some of it is more intuitive.
“Language matters. What are the words that you’re saying? Are you listening? Are you empathetic? Are you compassionate? If this were your mother or your sister would you do things differently?” she asks.
“I want every clinician and provider to recognize that they have power and that they need to use that power cautiously and with good evidence-based information because women’s lives are depending on it.”