Every day, more American women are realizing that their lives might be in danger during the birthing process. According to an August 2023 March of Dimes report, many of them live in a maternity desert – a county without a hospital or birth center offering obstetric care.
The report, Where You Live Matters: Maternity Care Deserts and the Access and Equity Crisis, exposes some of the harsh realities faced by women and young children in the United States. In 2020, for example, the United States saw an increase of about 14%. in pregnancy-related deaths in the past year and about 31% in 2018.
The report also highlights an increasing number of maternity-related dropouts. As of August 2023, more than 5. 6 million women lived in counties with no or limited maternity care services. In 2022, a similar report from the March of Dimes found that 2. 2 million women of childbearing age lived far from hospitals and birthing centers that provided obstetric care.
Dr. Elizabeth Cherot, president and CEO of the March of Dimes, said she was discouraged not only by this complex reality, but also by the unwillingness of stakeholders to find meaningful solutions.
“There is an awareness that unfortunately we have to continue to affirm that mothers and their young children are in the middle of our family circle and that they are not doing well in this country,” Dr. Cherov said. “Conversation online and then start tackling everything else. “
With March of Dimes designating an alarming 36 percent of all U.S. counties as maternity care deserts, the lack of collective local, state and national action has been telling.
As the March of Dimes’ first medical leader, Dr. Elizabeth Cherot is the president and CEO guilty of devising and implementing a strategic vision to address the country’s maternal and child health crisis, while broadening awareness and engagement in her work among key stakeholders. .
In the wake of the Dobbs decision, the debate over access to reproductive health care has become heated. The collective reluctance to address birth disorders in the United States is equally questionable and concerning. And as hospitals continue to close since COVID-19, the scenario has gotten worse for families.
In Wyoming, Biglefthand’s circle of relatives lives just two hours from the nearest birthing hospital. For Vanya and Ray Biglefthand, long trips to the doctor and prenatal visits have become part of a normal pregnancy.
Things got more stressful for Vania’s third pregnancy when a 29-week complication led to a more productive total break for just over a month.
In the opening note of the 2022 March of Dimes report, Vania urges families living in the desert of motherhood to continue fighting for their physical condition and that of their babies.
“As a mother, being pregnant, you know your body, you know something is wrong. Talk, not what. Speak for you and your baby,” Vania said.
The Biglefthands’ story is one that Dr. Cherot has heard far too many times. She connected that to the financial cost of birthing in America.
“Many hospitals across the country are facing low birth volumes and issues with recruitment and retention,” Cherov said. “All of this leads to a monetary demonstration that says we’re not going to put a price on our mothers. “
The March of Dimes laid out national, state, and local solutions to ease American families’ hardships during childbirth, adding Medicaid expansion for others at or below the federal poverty point and extending the era of postpartum Medicaid policy to 12 months. . At the federal level, it’s lately 60 days after pregnancy.
The report also recommends expanding telehealth facilities for maternity care and strengthening perinatal regionalization for maternal and neonatal outcomes. Tannaz Rasouli, senior director of public policy at the Association of American Medical Colleges, is a co-author of the initiative.
“Deserts in maternity care pose grave dangers to pregnant women and, for their children, start a cycle of unacceptable disparities in fitness,” Rasouli said.
With non-Hispanic Black women dying at a three-times the rate of their non-Hispanic white counterparts, March of Dimes has been laser-forced on addressing the social determinants of health to reduce disparities.
Tonya Lewis Lee, director and producer, author and advocate for women’s and children’s fitness, said this inequality exists for Black women in and out of motherhood deserts because of subconscious biases and long-standing inequities in the U. S. physical care system.
“It’s not necessarily about worrying, it’s about the type of attention you get,” said Lewis Lee, maker of “Aftershock. “
Lewis Lee points out that either women who give birth are getting too much attention too soon because of fear of poor outcomes, leading to more Black and brown mothers going through C-sections too quickly, or that families of color are getting enough care. early care. Enough is enough, and doctors dismiss your pain and concerns.
This is why Dr. Cherot has championed the progress of midwifery. As an organization, the March of Dimes believes that the presence of a midwife during the prenatal, labor and postpartum era will lead to positive outcomes and mortality for patients.
Answer — After two young women died from complications of childbirth, two grieving families are mobilizing activists, midwives, and doctors to address one of America’s most urgent crises today: the maternal fitness crisis in America. Executive Maker Tonya Lewis Lee shown. (Photo by: Matt Sayles/Hulu)
March of Dimes board member Lewis Lee echoed this sentiment.
“The U. S. is the only industrialized country that doesn’t integrate midwifery care with women’s physical care, and we have the worst outcomes,” Lee said. “We’re asking doctors to perform a task they’re not trained to do. “
Unfortunately, the use of midwives in hospitals and births has declined particularly since the mid-20th century due to the professionalization of obstetrics and the pressure for more hospital births.
“Physicians wanted those women in the hospital to give birth, and they successfully pulled people into the hospital,” said Karen Jefferson, a Certified Midwife and director of practice and education at the American College of Nurse-Midwives. “And they decimated the vibrant culture of midwifery we had here that was primarily practiced by indigenous, immigrant, and black midwives.”
In the United States, nurse midwives (CNMs), or registered nurses trained and qualified as midwives, are licensed to do so in all 50 states and the District of Columbia.
The other category is skilled birth attendants (CMs), or other people who are not registered nurses and who are still trained as midwives. They are licensed to practice in 10 states and the district. Both can provide the number one care to women, adding physicals, education, disease prevention, family planning, and common gynecological health issues.
When licensed to practice with the most sensible license, NJC and CM professionals can provide independent physical and emotional care during childbirth and reduce the rate of headaches and surgeries.
Jefferson said medical professionals can also prescribe certain medications and refer them to doctors and other providers.
“Midwives and doctors have complementary skills,” Jefferson said. “Doctors deal with surgery and medical complications, other people are medically complicated, and midwives are specialists in physiological childbirth and relational care. “
Dr. Cherot agreed.
“Let’s be frank: we want to diversify our workforce. And that means letting them [midwives] work at the most reasonable level of their license,” Cherov said. “It’s well established that we may not have enough obstetricians and gynecologists in this country. “, so we want to expand our strength of birth paints to more midwives and nurse practitioners and place them in the category of complex professionals. “
Fountain Valley, California – June 29: Midwife Angie Miller listens to MyLin Stokes’ heartbeat. . . [ ] Kennedy’s bathroom with his wife Lindsay and their 21-month-old son Lennox at their Fountain Valley home. Black women turn to midwives for racism, death rates, and unnecessary C-sections in hospitals. In Los Angeles County, death rates among black mothers due to perinatal headaches are 4 times higher than among white women. (Photo via Sarah Reingewirtz/MediaNews Group/Los Angeles Daily News via Getty Images)
A recent Commonwealth Fund report found that a fully integrated midwife workforce could provide 80 percent of essential maternal care worldwide and “avert 41 percent of maternal deaths, 39 percent of neonatal death and 26 percent of stillbirths.”
Jefferson and Lewis Lee that this statistic deserves to be the starting point for a broader debate about maternal care in the United States.
“If you increase the use of midwives, primarily by expanding the number of birth attendants of color, the effects will change,” Jefferson said. “Midwives in hospitals and worried about the birth procedure can lead to fewer preterm births and fewer low birth weight births. “, higher rates of breastfeeding, and higher patient satisfaction. “
“Midwifery care is yielding better outcomes than what we’re seeing now, given the increase in maternal deaths,” Lee said. “Now we want to implement policies so that midwives are covered through insurance companies. “
Due to the lack of fair insurance reimbursement, midwives are paid less for the same deliveries performed through doctors, leading to pay inequity and a reluctance of hospitals to hire them. In addition, they only gain privilege advantages identified due to express legal restrictions at the local level.
Beyond expanding obstetric care, the March of Dimes report also calls for strengthening network needs for the Affordable Care Act marketplace, investing in the Perinatal Quality Collaborative’s (PQC) birthing infrastructure, and expanding equitable access to doula services.
By completing its first investment circular in September 2022, the March of Dimes is also striving to be part of the responses in the fight to end maternity deserts and maternal deaths through the March of Dimes Innovation Fund.
“The challenge of maternal fitness in the United States can be solved,” said Lewis Lee. “It takes a lot of education. Innovation is needed. It takes other people to put women and birthing people first and allow them to have the kind of birth they want and deserve, so that they are guided through their desire.