Radical Doula

My latest article is up at Colorlines, about the issue of maternal mortality in the United States, particularly for women of color.

The United States spending more money per capita than any other country in the world on health care, but we rank behind 40 other countries when it comes to maternal mortality. Ina May Gaskin, in her new book (review to come!) says that women today are two times more likely to die from childbirth than their mothers were.

A report recently released by the New York City Department of Health examining maternal mortality in the city between 2001 and 2005 found striking disparities for women like Eady: black, non-Hispanic women were more than seven times more likely to die from pregnancy-related causes than white, non-Hispanic women. Such disparities recur nationally. In a March 2010 report entitled “Deadly Deliveries,” Amnesty International explained, “African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years.”

But as Rita Henley Jensen explains, the New York report also points to something more than the usual indicators for maternal mortality—poverty, lack of prenatal care and preexisting conditions. Maternal mortality is not just restricted to women of color; we’re actually seeing a rise in maternal and fetal mortality rates overall. California has reported a near tripling of their maternal mortality rate in just the 10 years between 1996 and 2006. The U.S. ranks behind 40 other countries in terms of maternal mortality rates, despite spending the most money per capita on health care.

So how have we created the world’s most expensive maternity care system while still putting women and babies at risk? The answer lies in two of our culture’s biggest influences: money and technology. And now, even as Republican legislators aim to gut the Medicaid program that millions of women depend upon, a movement is growing to make maternity care both cheaper and safer by giving poor women greater access to home births.

I have to say I didn’t like the title of the piece (determined by the editors) because it isn’t just about home birth–it’s about normalizing midwifery care, and particularly expanding access to out of hospital birth, which includes birth centers as well as hospitals. It also includes midwife-provided prenatal care, even if women eventually birth in hospitals.

Home birth is still a dirty word in this country. It’s considered backwards, it’s considered unsafe, it’s considered what someone does when they have no option. This ideology is part of a calculated campaign on behalf of doctors to convince women to give birth with them in the hospital, something that actually killed more women than home births in the initial decades of hospital birth.

Home birth isn’t the problem, and never has been. The problem is making sure all women have access to skilled attendants who know how to care for pregnant women, know how to detect problems, know when to transport to a hospital or when someone might need an obstetrician–someone who is trained specifically to deal with the minority of cases that need specialized medical attention.

Women in the United States are dying in spite of having access to hospital-based maternity care (98%).

That means that women in the US are dying because of hospital-based maternity care.

Either that care is inadequate (like Akira Eady, who I wrote about in the piece, who died from a complication after being released from the hospital postpartum ), or it’s simply too reliant on interventions and surgeries that are harmful. A 33% c-section rate is simply too high. Mothers are dying because they are getting too many surgeries, too many interventions, too many inductions.

We know clearly what isn’t working. The status quo. The 98% hospital birth, the only 9% midwifery care. My article tries to explain how we got here, and what might just help us go in a different direction–back toward patient-centered care that minimizes the use of technology rather than emphasizing it. That only employs tools like c-section when they are really necessary, not just when they are convenient or used to preemptively prevent litigation.

I can’t say definitively that a move back to midwifery care (or home birth) would eliminate disparities. It probably wouldn’t–because racism and classism still exist and still effect our health outcomes. But out-of-hospital midwifery care has some pretty amazing successes both in the US and abroad in terms of reducing maternal mortality. Let’s give it a shot–see if we might not be able to improve these statistics instead of seeing them get worse and worse and worse.