Maternal care should begin before conception and extend well beyond labor and delivery, but it is often not achieved in the United States. Jacqueline McMillian Boehler, who leads education excellence at a healthcare organization, notes that countries with fewer resources have made maternal care a priority and have lower rates of mortality. In the US, mortality rates are high, particularly among Black and American Indian women. Meanwhile, Hispanic women have slightly higher rates than white women. Wednesday night’s EQUALibrium Live forum, hosted by WFAE and WFAE, discussed why these disparities exist and what can be done to address them.
Dr. Jalima Nanton, an obstetrician at Novant, spoke about how “unnecessary suffering” frames the CDC’s report that over 80% of maternal deaths are potentially preventable. Women in the US are two to three times more likely to die from complications of pregnancy than in other high-income countries. This is due in part to a shortage of maternal and child care providers in North Carolina, particularly in rural areas, where 80% of counties are challenged with access to care. Eleven rural hospitals have closed in the state since 2005, and some maternity wards have also shut down.
Racism is another major factor behind rising maternal mortality rates. Professor McMillian Boehler notes that racism can creep into medical training, with textbooks promoting stereotypes such as the idea that black people exaggerate pain. She suggests that objective standards for responding to issues such as sepsis and bleeding can help narrow the gap. The North Carolina Perinatal Quality Cooperation Agency, a network of healthcare providers, is working towards this by strengthening nurse and doctor training and recruiting more people of color into maternal and child health.
Midwives and doulas can also play a crucial role in maternal care. McMillian-Bohler notes that midwives were once the standard of care. Strengthening training for these professionals and recruiting more into the field could help address the disparities in maternal care. Lisa Leffler, who heads the culture-based Native Health Program at Western Carolina University, highlights the Selous Mothering Project, which is run by two Cherokee women and is helping to make progress in addressing maternal health issues.
Ultimately, individuals can also play a role in improving maternal care by speaking up and helping family and friends understand their options regarding pregnancy and childbirth. As McMillian Boehler notes, individuals know their bodies best and can be active in advocating for their own healthcare needs.