Powell understands how risks can increase with every mile a pregnant woman must travel to receive medical care. He still remembers the patient from about 16 years ago who came through the double doors of the hospital with blood dripping down the side of her wheelchair. The woman had suffered a placental abruption and she had to undergo an emergency cesarean section. Powell thought the baby would not survive, but both mother and newborn survived.
“That situation, while rare, is not uncommon,” Powell said. “Driving a distance of 40 or 90 miles to try to receive that care puts the lives of both mother and baby at risk.”
Powell grew up in Gilbertown, Alabama, in a county considered a maternity care desert. Her father was a businessman and her mother ran an auto shop where Powell sold auto parts, but from a very young age she knew she wanted to be a doctor.
After medical school, in 1997, she moved with her husband and young son to Monroeville. She began practicing as a family medicine physician at Monroe County Hospital and also opened a private clinic. She and her husband soon also had a daughter.
Some of his patients were in cribs, while others were eligible for Social Security. Her training in obstetrics meant that, in addition to providing primary care, she was able to care for patients throughout their pregnancy and deliver their babies.
Monroeville, a city of about 6,000, is known in literary tradition for one of its most famous natives, Harper Lee, author of “To Kill a Mockingbird.”
Vestiges of the unequal Alabama society that Lee wrote about in 1960 still resonate in national racial and socioeconomic disparities. Black children are 2.4 times more like die in infancy than white newborns. As adults, African Americans have one of the lower life expectancies.
This fall, the recent wave of maternity unit closures across the United States reached Monroe County Hospital.
Powell was in the operating room one afternoon in late September when he saw a missed call from the hospital’s CEO. The head of surgery and an anesthetist also had missed calls. Powell knew something was wrong.
As he walked to his car, he called back. She listened as Kirby told her the board had decided to end labor and delivery services.
Memories of emergencies his team had worked on flashed through Powell’s mind.
She couldn’t speak. When she finally did, she asked about the last day of the unit.
He turned around, walked back to his office, and began checking his patients’ records so he could call them. She would start with those that had an expiration date after November 15th. There were 83.
Over the past few weeks, Powell held out hope that the hospital would reconsider its decision, or perhaps someone outside of it, like the state, could come with a last-minute bailout.
He also began having serious conversations with his patients. If they go into preterm labor and can still feel the baby moving, she told them, they should probably head to the nearest birthing hospital in another county. But if they do bleed, they should get to a local emergency room quickly; Monroe County Hospital will continue to deliver babies under urgent circumstances.
There wasn’t a day when I didn’t have an “ugly cry,” she said.
In the hospital’s final days, before the start of each C-section, a nurse reminded her colleagues that it might be their last time together.
“Stop,” Powell told him. “You’re going to make my glasses fog up.”
The labor and delivery team was very close-knit and had developed rituals. After the birth, they played Brahms’ “Lullaby” over the hospital loudspeaker.
On Monday, Powell discharged the unit’s last newborn. As he had done before, he went over the ins and outs of having a baby at home, such as what sounds parents should worry about.
As he had done before, he assured the mother: “The path that takes you home brings you back.”
But it won’t bring many more pregnant women. And Powell wonders if she should look for work elsewhere so she can continue delivering babies.