First I want to say that this article contains statistics that could be upsetting to some birthing people. My intent with this information is to inform, not scare. We have to look at birth outcomes, and I believe that knowledge is power. Some people feel like birth is an everyday thing, and while that is true. It is also something to approach with a thoughtful and informed stance. We can do better when we are armed with information. These are things that people need to bear in mind, as it impacts every single birthing person in this country. When we know what the facts are, we are better equipped to make the best possible decisions for our family and situation.
According to the Centers for Disease Control and Prevention provisional data from 2019 (released May 20, 2020) 31.7% of all births in the country were by cesarean and 25.6% of the NTSV (low risk) population had cesarean births. The CDC also reports that babies being exclusively breastfed through 3 months of age sits at 46.9%. The American College of Nurse-Midwives reported that in 2017 CNM’s/CM’s attended 9.1% of total US births. Every Mother Counts reports that the US is the only industrialized nation with a consistently rising maternal mortality rate, despite spending more per capita on health care than any other country. READ THAT AGAIN. The Educated Birth reports that as of 2019, there are only 6% of the midwife population that is black. One thing is for sure, we NEED more black midwives. Among 11 developed countries, the United States has the highest maternal mortality rate, an undersupply of maternity care providers, and is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period. (Reporting from the The Commonwealth Fund.) More than 50% of pregnancy related deaths in the United States occur after the birth of the child, or post partum. In the United States, Black women are more than 4 times more likely to have a maternal death than White women. Black women are also more likely to have a severe maternal morbidity event at the time of delivery. The United States and Canada have the lowest overall supply of midwives and OB-GYNs. Why does this matter? Let’s talk about it.
How are midwives and OB’s different? Midwives manage a low risk pregnancy, assist with childbirth, and provide care in the postpartum time. OB’s are physicians trained to identify issues and intervene should abnormal conditions arise. OB’s typically provide care in hospital based settings. Midwife services are not uniformly covered by private insurance plans in the United States, in comparison to other countries where midwifery and OB care are covered by universal health insurance in some other countries.
Here are some things that I have seen since Covid. In the beginning, postpartum appointments were done virtually, most of my clients felt rushed, and some even reported that their appointment had been repeatedly canceled, but guess what. Guess whose appointments remained in place, ensuring post partum care and recovery….that’s right, midwives. Post partum care saves lives. It’s important. Post partum care, including home visits by midwives improves outcomes. It improves mental health, breastfeeding outcomes, and is associated with reduced health care costs. So why isn’t this being addressed?
We need change, and we need it now. What are solutions? We need strategic and strong post partum care, guaranteed maternity leave, and we need to work to close the racial disparity gap that exists. Addressing systemic racism so that Black and Indigenous people are not at risk when they are pregnant is critical to reducing mortality. Paid Maternity leave to all birthing people would contribute to their health of of their babies, while also strengthening the financial security of families. Families are making choices that they should not have to. The most concerning part to me is that the United States is willing to invest in health care, but does not invest enough into birthing people and birth outcomes. We need to invest in the outcomes of birth, to make sure that not one more mother dies a preventable death.
What can you do? Ask questions. Educate yourself on the process of birth. Decide what environment is right for your family. Hire a doula. Have difficult conversations with your provider. TAKE A CHILDBIRTH ED CLASS. Here are a few questions to ask:
What is your c-section rate? What circumstances would you do one? (hospital birth)
What if any appointments will be done via tele-health?
What is the likelihood that you, yourself will attend my birth?
Where are your hospital privileges?
Will you accommodate my birth preferences?
What are your transfer rates? (birth center)
What clinics provide services and backup for situations beyond your scope of practice? (birth center)
Is this center accredited by the Commission for the Accreditation of Birth Centers?
At the end of the day, your goals are my goals. If you want a VBAC, then I want you to have a VBAC. If your goal is to have a medicated birth, then that is my goal. I want you to be informed and feel like you have all the information that you need to have the birth that YOU want. The best way to do that is to know what you are up against, and to know that you have choices. When you understand the anatomy of your body, the physiology of birth, the statistics that surround birth and post partum, you are in a much better position. We spend so much time preparing for baby, I feel there is much work to be done surrounding post partum. Spend some planning and understanding what you and partner expect for the post partum time. Understand the healing process so you are better equipped to deal with what is to come. Birth is amazing, and even more amazing when we are able to impact our own outcomes. You can do this. We can do hard things! XOXO
You can find more birth statistics below.