As the November election approaches, I am anxious to use my vote and my voice to influence future health care policies. How will these policies affect pregnant women in North Carolina? The current statistics are discouraging, and there is much room for improvement. Most women don’t expect to die in childbirth these days, but we know the maternal mortality rate in this country is rising. The World Health Organization defines maternal mortality as “the death of a woman while pregnant or within 42 days of birth, from any cause related to or aggravated by the pregnancy or its management.” African American women die at the highest rates, and it is race that seems to affect them the most.
There is a myth in this country that childbirth is safe, believed to be more so since the process has become increasingly medicalized. But routine medical procedures are complicated by the effects of the constant stress of systemic racism. Cesarean section is a surgical procedure more common for African American women than in any other racial category in the United States. With a rising cesarean rate, and few professionals willing to support VBACs (vaginal births after having a cesarean), the risk of life threatening complications increases. Research featured in the short film Precious Loss is looking at why the mortality rates for African American women is higher, despite economic and education levels. Scientists found that daily effects of “racism is associated with higher reported rates of stress, inflammation, and infection.” By studying the levels of the stress hormone, cortisol, found in a woman’s hair, researchers Kelly Teter and Dr. Hoffman from Denver Health hope to learn more about the connection of stress to poor birth outcomes for African Americans. The answers seem to point to physiological changes from stress as a result of institutionalized racism.
The rising maternal mortality rate is a failing of our healthcare system. Statistics point to healthcare deficits, such as in the recent report in the NY Times which indicates limited access to reproductive care negatively impacts maternal mortality. This is especially true of the states refusing to implement Medicaid expansions, available under the Affordable Care Act. North Carolina is among the 19 states not adopting Medicaid expansion. Texas is among the 19 as well, and the state’s maternal mortality increased at alarming rates, from 17.7 per 100,000 live births in 2000, to 35.8 in 2014. But there is also a failing in the way maternal mortality is reported and addressed in this country. While Great Britain leads the way in its review policies with its Maternal Newborn and Infant Clinical Outcome Review Programme, the United States relies solely on the judgment of hospitals to report maternal deaths. Instead of a system of inquiry into causes of maternal mortality in this country, and how to correct them, the problem of underreporting masks the magnitude of the issue. Midwife Ina May Gaskin says it’s an “honor system” at this point, with “no statutes providing for penalties for misreporting or failing to report maternal deaths.”
Our state representatives must address the crisis of maternal mortality and implement policies that will make investigating and improving death rates part of a ubiquitous system. Expanding the scope of maternity health care to address the need for supportive care before birth, during birth, and in the weeks following with paid family leave would benefit underserved communities who are at the most risk. Labor and Delivery units are often understaffed, with nurses managing two or even three women in active labor at the same time. Many women face isolation after the birth of their baby, some of whom are still healing or recovering from complications or surgeries, or are pressured to return to work. Aside from a six week check-up, there is usually very little postpartum support or care, unless the mother can afford to hire a doula, or has family who can help care for her. But positive birth outcomes should not be the prize of the privileged. In collaboration with our state and national leaders we can reverse the rates of maternal mortality and improve maternal health nationwide.