Despite been an issue for women since
Despite advances in lowering infantmortality rates, maternal mortality rates have risen to an alarming rate in theUnited States over the past three decades. Each year, 700-900 American womendie from pregnancy or childbirth related causes, the worst record in thedeveloped world. This disparity is reflected in comparison to other countrieslike Canada, where an American woman is three times more likely to die frompregnancy and birth complications. Even more striking, an American woman is sixtimes more likely to die than a Scandinavian woman (Martin & Montagne,2017).
The rate of maternal mortality has dropped so significantly in Englandthat a man is more likely to die than his pregnant partner than she is(Lancet). Some of the problems contributing to this disparity are identifiableand potentially remediated, but the subtle undertones require a much deeperlook at the role of institutionalized sexism and racism in the United States. HistoryMaternal mortality has been an issue forwomen since the beginning of time. While modern pregnancy and childbirth isrevered and romanticized, it can also be a dangerous time for women. Thehistory of childbirth in the United States is quite dark and disturbing. Untilthe early 20th century, most women gave birth at home with amidwife. With the advent of the medical study of obstetrics and gynecology,birth moved from home with a midwife, to a hospital with a doctor. Midwivesbegan to be viewed as competition for obstetric doctors as medical universitiesgrew, which banned women from study.
Despite data that showed immigrant andAfrican American midwives provided better health outcomes than physicianassisted birth, the movement gained acceptance and women began to moved tohospitals for male obstetrician assisted childbirth, many of whom had nevereven witnessed a live birth. During this time the preferred method forhospital birth included the use of “twilight sleep,” which involved injectingwomen with morphine and scopolamine, and amnesiac drug (O’Mara, 1999). Thispractice was later found to contribute greatly to maternal death, andscopolamine did not remove pain, just the memory of it. Women were frequentlytied, lying on their backs, to beds at the wrists with lamb’s wool to avoidmarks (Epstein, 2008). They were left for hours unattended, often lying intheir own waste, with bonnets covering their eyes. This abusive and inhumanepractice was widely lauded as revolutionary and advanced by obstetricians andgynecologists. By 1915, maternal mortality in the United States was the highestin the industrial world, with six deaths per thousand births and infant deathsfrom birth injuries rose over fifty percent from the previous decades, due toimproper techniques used by obstetricians during childbirth (O’Mara, 1999).
Itis impossible to look at current maternal mortality rates in the United Stateswithout considering this dark history of obstetrics, and the ways that women’sbodily autonomy was undermined by “modern medicine”. While midwifery has seen an increaseover the past two decades, the vast majority of births in the United Statestake place in a hospital. Feminist frameworks value the perspective of thefemale experience, and so much of the American medical system devalues thatperspective. Even the language used is gendered: Obstetrician’s “deliver” ababy, the woman is passive, while midwives “catch” a baby, the woman does thework of delivering the baby. When the shift from home birth to hospital birthtook place, the United States was the only country where midwives did nottravel into the hospital with women.
Our country has some of the highest ratesof caesarean section, maternal and infant mortality of the industrializedworld. Clearly, there is a relationship between midwifery and healthy birthrates that has been overlooked in the American medical model.Infant mortality is at the lowest pointin history, yet maternal mortality rates continue to be troubling, especiallyin the United states. These rates of reflect that the focus is on fetal andinfant development, safety and medical advancement, rather than a mother’shealth and well-being. The specialization of maternal fetal medicine has driventhis focus, and many medical students often do not spend time learning aboutcare for a mother, and some may even finish their fellowship without ever beingin a labor and delivery unit (Montagne, 2017). Infant mortality has seen a decline of 2.3%from 596 deaths per 100,000 births, to 582 (Guardian). While this is a definiteimprovement, it is still twice the rate of Sweden, Denmark, Japan, Israel andEstonia.
There are several contributing factors tothe current rates of maternal mortality in the United States. Overall,hemorrhage, cardiovascular and coronary conditions, cardiomyopathy, infection,embolism, mental health conditions, and preeclampsia and eclampsia are theleading causes of pregnancy related death in the United States (MaternalMortality Review, 2017). Morewomen are having babies at advanced maternal age (over 35), often with complexmedical histories.
High rates of caesarean sections can lead to furthercomplications, both during the surgery, while recovering in the hospital, andin the post partum period at home in the subsequent weeks and months. Bloodpressure issues are commonly associated with maternal mortality, yet symptomsare either ignored or dismissed by providers, even when mother’s reportsymptoms. Most doctors and providers are notproperly trained to prepare women for the post partum period, and theinformation mothers are given about how to care for themselves and potentialred flags or warning signs are woefully inadequate. The fragmented U.S.healthcare system further compounds these issues as many women are left withouthealth coverage shortly after giving birth. Medicaid covers 48% of births inthe United States, and in most states women lose their coverage sixty daysafter giving birth (Markus, et al., 2013).
Lack of healthcare coverage alsolimits the amount of prenatal care a woman may receive. Despite Medicaid “backpaying” in most states, many low-income women lack the resources or systemsknowledge to apply or receive coverage in the early weeks and months ofpregnancy.