Born in the USA: A hard look at how we care for moms and babies

Being born in the United States is risky – for both mom and baby. More than 50,000 mothers have life-threatening complications every year.

Birth outcomes for both mom and baby depend on where you live but also on race. It should not be the case that black mothers are three to four times more likely to die in childbirth than white mothers and that black infants born to college educated parents are twice as likely to die as white infants born to college educated white parents. This is an unacceptable disparity. Disparity in outcomes is even true for very wealthy black women, as demonstrated by tennis star Serena William’s harrowing story of giving birth to her daughter. The PBS miniseries Unnatural Causes discusses this gap and explains the key role of the chronic stress of racism in depth here. Many other news outlets highlight individual stories including in Shalon’s story told by the New York Times here and in Erica’s story told by Vox here.

The American College of Obstetricians and Gynecologists recently released new recommendations urging clinicians to see women after they have given birth (the post-partum period) earlier than the current standard of four to six weeks saying, “To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.” More than half of maternal deaths occur in the week after delivery and women face a multitude of issues include depression, pain and infection, heart problems, and other issues. A greater focus on the baby rather than mom’s health is partly to blame as in Lauren’s story told by NPR here.

Others argue for a greater role for midwives, citing the higher rates of midwife-assisted births in the United Kingdom and Canada and associated better outcomes and use of doulas to support women and families through the birth process.

Our first set of recommendations was directed at improving maternity care in our state. We are lucky to have dedicated groups of clinicians and others who look at systematic ways of improving maternity care including the Washington State Hospital Association’s Safe Deliveries Roadmap and the Obstetrics Clinical Outcomes Assessment Program.

I hope everyone is enjoying the summer. For a more lighthearted look at maternity care watch Call the Midwife or The Mindy Project.

Ginny Weir, MPH
Program Director, The Bree Collaborative