We can’t fix birth in the United States until we confront our sexism, racism and classism
KATE O’PHALEN | 9/19/2019, 5:31 p.m.
The United States is the only industrialized country in the world where maternal death rates are rising, a fact that finally seems to be permeating the national consciousness. New York State recently codified its Maternal Mortality Review Committee, which will analyze every pregnancy-related death in New York State to provide recommendations on improving safety. Exciting, right?
The trouble is, we already know how to improve safety. We know that having a doula decreases C-section rates. We know that waiting for labor to begin naturally reduces complications. We know that taking postpartum symptoms seriously saves lives. We know we have to listen to the person in labor and that person’s body. We have to impose fewer rules, protocols and systems and do more listening.
What’s difficult about actually improving birth is that it requires a radical shift in the thinking of families, hospital administrators, nursing staff, and most of all, providers. And that radical shift in thinking is going to push against the deeply entrenched sexist, racist and classist medical hierarchy maintaining medical professionals’ authority over people giving birth.
The good news is we can change by committing to three fundamental (and free!) beliefs:
The person giving birth is the expert. I had two very different pregnancy experiences—one in which my high-intervention obstetrician’s office induced labor unnecessarily and emotionally abused me throughout, leading to a C-section delivery and birth PTSD; and one in which my midwife knitted my soul back together by treating me like the expert in my own body. That key philosophical difference manifested in tiny ways, like—weirdly to me at first—letting me test my own urine at each visit and report back to her if everything looked okay, instead of handing over that responsibility to an off-site lab that would send the doctor digital test results I would never learn. Or by spending a whole visit collaborating on my birth plan, instead of mocking the idea and warning that it could never be honored.
All pain is valid, especially the pain of Black women and non-binary folks. The CDC recently confirmed what birth advocates have known for a long time: Black women are three times as likely to die from pregnancy-related complications than white women. One reason is the persistent myth that Black women have a higher tolerance for pain, resulting in providers taking their symptoms less seriously. Believing a Black woman in pain catches a postpartum hemorrhage in time to save her life.
People giving birth deserve respect, choices and excellent care, regardless of class. The trappings of a “good birth” are expensive. It takes financial resources to have quality health insurance, make smart provider choices, recover from delivery in a private New York City hospital room, and even live within several hours of an obstetrician in many states. Everyone deserves outstanding care.
Why should we care? Even if we overlook the ethics of traumatizing families, consider the costs. Preventable birth complications are exorbitantly expensive. My unnecessary C-section was billed at $80,000, while an uncomplicated vaginal delivery costs less than $10,000. With nearly 4 million births a year in the United States, the potential cost savings is astronomical. Studies
show that mistreatment during labor also leads to avoiding doctors later, compounding the health effects and costs over a lifetime.
Additionally, simply reducing maternal mortality, while absolutely critical, misses a huge part of the story, like the life-altering injuries of maternal morbidity the CDC estimates affect over 50,000 people a year. Even more widespread is the problem of birth trauma, which studies estimate affect 1 in 3 birth parents, with 1 in 10 developing diagnosable PTSD. In New York City alone, that’s an estimated 12,000 parents a year who are developing PTSD from giving birth.
Incremental reforms and the funding to study maternal deaths, hard-won by birth justice advocates, are not going to save us. They are band-aids on the wounds of sexism, racism and classism. Until we learn to truly trust the people giving birth to know what’s best for themselves and their babies, we will continue to spend more healthcare dollars per person than any other country, while killing and traumatizing increasing numbers of parents with our ignorance.
—Kate O’Phalen is a birth justice advocate and Colin Powell fellow researching birth trauma.