More than a decade after the birth of my child, I worry about people giving birth in this country. Why is there still such a high level of risk involved—for Americans? Why must birth-givers take on the burden of protecting themselves from the dangers of the medical establishment?
Birth is Risky
In most things related to modern medicine, we know that things are better than in previous ages. Doctors used to treat the infirm with leaches! Lobotomies were used to treat mental illness! Yet we can't say that as confidently about childbirth in the U.S.—far greater numbers people die before, during, and after childbirth here than anywhere else in the world.
In 2018, 17 people died out of every 100,000 people who gave birth in the United Sates. This is more than double what goes down in most other high-income countries (see Exhibit 1, below). Comparatively, there are 3 deaths per 100,000 in the Netherlands, Norway, and New Zealand (Source: The Commonwealth Fund report).
It's Becoming Riskier
And these rates are going up. In 2019, the rate of mortality was 20 deaths per 100,000 birth. In 2020, the rates increased again, to nearly 24 deaths in 100,000 births. (Source: CDC 2019-2020.)
Image: The Commonwealth Fund report
Doctors: "You're Fat, Old, and Diabetic." Us: "You're Pushy."
Some factors that impact the high maternal morbidity death rate include:
Increase in the interventions used by doctors—induced labor and more C-sections
Low rates of postpartum support
Rising preexisting health issues, like diabetes and obesity
Age
Stress
There's one more: Being black.
Birthing While Black: It's High-Risk
But all bodies are not equal in the eyes of the medical establishment. What the data do not clearly reveal, but we must see: the majority of these deaths were among Black people. In fact, Blacks die in childbirth at a rate two times higher than whites. (If that shocks you, you are probably white.)
You've got to ask yourself, if more Black people die before, during, and after childbirth than white or Latine people—what is the real cause? The underlying cause is racial bias among healthcare providers. Even if there are contributing factors such as age of the birth-giver, or diabetes, that alone just cannot account for such a dangerous disparity. (The study did not track or report on additional ethnicities.)
Shouldn't a key risk factor in childbirth be made plain: racism?
Midwives Make a Difference
The presence and work of midwives makes a significant difference. Midwife care is more common in countries with low maternal morbidity rates (see Exhibit 3, below).
Image: The Commonwealth Fund report
(I skipped Exhibit 2. You'll find it in The Commonwealth Fund's report.)
The level of risk involved in childbirth is unacceptable, not to mention costly. The solution is going to involve several interrelated steps—a few urgent ones:
Helping doctors unlearn their biases and examining how racism shows up in their work
Employing more midwives
Reducing the divide between home birth and hospital birth so that people giving birth are served well by both, not in spite of the other
Increasing maternity/paternity leave
We can learn from the childbirth playbooks of those countries with extremely low maternal morbidity rates. What are they doing differently in, say, Norway or New Zealand?
I speak from experience.
In January of 2009, I almost died giving birth to my child—more accurately, right after giving birth. I describe it in the essay, "Your Birth Plan," recently published in Fatal Flaw.