Giving Birth in America Today
Hello everyone,?
Recently the Doner Family ERG hosted a session on childbirth. Elizabeth “Tish” Roeske (CNM, MS, BSN, RN) a nurse-midwife spoke about the state of childbirth, issues with inequity in care, and potential solutions. You can watch a recording of her presentation HERE. This prompted our team to make the focus of this week’s newsletter “Giving Birth In America Today.”
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Submitted by Noah
According to reports from the Milken Institute and March of Dimes (both released in August 2023), it’s becoming increasingly dangerous to give birth in America, particularly for at-risk communities such as Black women, older women and women living in rural areas. Two of the most critical issues facing expectant mothers in the United States are access to care and maternal death rates. More than 5.6 million women live in counties with minimal (or zero) access to maternity care services. Since 2018, over 300 hospital birthing units have closed, and there has been a 4% decline in hospitals offering labor and delivery services since Summer 2022 alone. Together, these factors are only exacerbating the problem for expectant mothers in-need.
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Regarding maternal death, the national maternal mortality rate has skyrocketed in recent years—From 2018 to 2021, the maternal mortality rate more-than-doubled to 32.9 deaths per 100K live births in 2021, from 17.4 deaths per 100K live births in 2018. These figures aren’t fully representative of the differences between certain populations, however. Black women had a rate of 69.9 deaths per 100K live births in 2021, which is more than 2.5 times the 26.6 deaths per 100K live births among non-Hispanic white women. Consequently, giving birth in the United States still poses a challenge from health and access standpoints, among other factors—to millions of expectant mothers each year, particularly those in marginalized groups and communities.
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Submitted by Peter
The Affordable Care Act stipulated that employers charge the same health insurance premiums for men and women in what was lauded as a key move to provide equity and access for women. A new report shows that employed women are spending 20% more on healthcare services out of pocket, compared to men, in a review of 2021 claims. That difference only dropped to 18% when excluding maternity care and pregnancy. "If you said births cost $20,000 per woman, that's 750,000 deliveries we could do for free if we could actually capture the value of this money," Gebreyes said. The report tried to whittle down to the root cause of this excess in spend, including more frequent imaging and scans, especially for breast cancer, which cost more than other cancer scans, and more frequent doctor's visits, such as annual gynecological appointments and menopausal transitions, among other reasons.
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Submitted by Rachel
The number of people dying in the U.S. from pregnancy-related causes has more than doubled in the last 20 years, according to a new study, published in JAMA, the Journal of the American Medical Association. And while the study found mortality rates remain "unacceptably high among all racial and ethnic groups across the U.S.," the worst outcomes were among Black women, Native American and Alaska Native people.
The steady increase in maternal mortality in the U.S. is in contrast to other high-income countries which declining maternal mortality rates. These other wealthy countries approach the problem differently, says Dr. Elizabeth Cherot, chief medical and health officer at the maternal health nonprofit March of Dimes. “They give them [support for] everything from mental health, cardiovascular, diabetic, pelvic health. These things are just considered standard," but are not universally offered to individuals postpartum in the U.S.
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Most maternal deaths are deemed preventable by state review committees, and researchers say doctors would have a better chance of dealing with these health conditions, if more women had access to healthcare after their babies were born. About half the births in the U.S. are paid for by Medicaid and "the majority of the deaths are in the immediate postpartum period," Roth says. "If you don't have easy access to health care in this period, you're at very high risk.” For those who get their healthcare through Medicaid, medical coverage lasts at least two months after the birth of a child.
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Submitted by Chris
Rural hospitals are closing maternity wards. People are seeking options to give birth closer to home
A growing number of rural hospitals have been shuttering their labor and delivery units, forcing pregnant women to travel longer distances for care or face giving birth in an emergency room. Fewer than half of rural hospitals now have maternity units, prompting government officials and families to scramble for answers. One solution gaining ground across the U.S. is freestanding midwife-led birth centers, but those also often rely on nearby hospitals when serious complications arise. The closures have worsened so-called “maternity care deserts” — counties with no hospitals or birth centers that offer obstetric care and no OB providers. More than two million women of childbearing age live in such areas, the majority of which are rural.
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Ultimately, doctors and researchers say, having fewer hospital maternity units makes having babies less safe. One study showed?rural residents?have a 9% greater probability of facing life-threatening complications or even death from pregnancy and birth compared to those in urban areas — and having less access to care plays a part.
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The issue has been building for years: The American Hospital Association says at least 89 obstetric units closed in rural hospitals between 2015 and 2019. More have shuttered since.
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Submitted by Kayce
She never set out to turn the world of maternal health care on its head, but local anesthesiologist Dr. Tracey Vogel may do just that. The rosy image pregnant people see on social media neglects to highlight the trauma and emotional pain that often go hand-in-hand with pregnancy. When Vogel noticed this gap, she began to expand her view of what pain management could truly look like — a novel concept in obstetrics. "My underlying thought is that Western medicine has stripped so much away to make it a medical procedure, to make it convenient and fast and physical, rather than the emotional experience that it is,” she said. She’s calling for “a shift back to treating women with respect in terms of birth.”
Lately, these tales in television and podcasting have proliferated and expanded their scope to reckon with how pain in pregnancy and childbirth can be compounded by flawed and patriarchal systems: A family system in which the father is encouraged to prioritize a child over a partner and mother, a medical system that’s overstretched and blatantly ignores women’s pain. Set against the backdrop of last year’s Dobbs decision, the horror of being caught up in an uncaring system without true autonomy takes on new resonance. Whatever the reason, our storytellers are confronting us with a reality that flies in the face of Instagram photos of mothers serenely breastfeeding perfect babies. With each gruesome birth, tragic miscarriage, and instance of abuse, these shows dismantle what TIME once dubbed the Goddess Myth. Fertility, pregnancy, birth, and motherhood involve pain. It’s time we confront it.
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September 29, 2023 | 5.24