Despite been an issue for women since

Despite advances in lowering infant
mortality rates, maternal mortality rates have risen to an alarming rate in the
United States over the past three decades. Each year, 700-900 American women
die from pregnancy or childbirth related causes, the worst record in the
developed world. This disparity is reflected in comparison to other countries
like Canada, where an American woman is three times more likely to die from
pregnancy and birth complications. Even more striking, an American woman is six
times more likely to die than a Scandinavian woman (Martin & Montagne,
2017). The rate of maternal mortality has dropped so significantly in England
that a man is more likely to die than his pregnant partner than she is
(Lancet). Some of the problems contributing to this disparity are identifiable
and potentially remediated, but the subtle undertones require a much deeper
look at the role of institutionalized sexism and racism in the United States.

History

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Maternal mortality has been an issue for
women since the beginning of time. While modern pregnancy and childbirth is
revered and romanticized, it can also be a dangerous time for women. The
history of childbirth in the United States is quite dark and disturbing. Until
the early 20th century, most women gave birth at home with a
midwife. With the advent of the medical study of obstetrics and gynecology,
birth moved from home with a midwife, to a hospital with a doctor. Midwives
began to be viewed as competition for obstetric doctors as medical universities
grew, which banned women from study. Despite data that showed immigrant and
African American midwives provided better health outcomes than physician
assisted birth, the movement gained acceptance and women began to moved to
hospitals for male obstetrician assisted childbirth, many of whom had never
even witnessed a live birth.

During this time the preferred method for
hospital birth included the use of “twilight sleep,” which involved injecting
women with morphine and scopolamine, and amnesiac drug (O’Mara, 1999). This
practice was later found to contribute greatly to maternal death, and
scopolamine did not remove pain, just the memory of it. Women were frequently
tied, lying on their backs, to beds at the wrists with lamb’s wool to avoid
marks (Epstein, 2008). They were left for hours unattended, often lying in
their own waste, with bonnets covering their eyes. This abusive and inhumane
practice was widely lauded as revolutionary and advanced by obstetricians and
gynecologists. By 1915, maternal mortality in the United States was the highest
in the industrial world, with six deaths per thousand births and infant deaths
from birth injuries rose over fifty percent from the previous decades, due to
improper techniques used by obstetricians during childbirth (O’Mara, 1999). It
is impossible to look at current maternal mortality rates in the United States
without considering this dark history of obstetrics, and the ways that women’s
bodily autonomy was undermined by “modern medicine”.

            While midwifery has seen an increase
over the past two decades, the vast majority of births in the United States
take place in a hospital. Feminist frameworks value the perspective of the
female experience, and so much of the American medical system devalues that
perspective. Even the language used is gendered: Obstetrician’s “deliver” a
baby, the woman is passive, while midwives “catch” a baby, the woman does the
work of delivering the baby. When the shift from home birth to hospital birth
took place, the United States was the only country where midwives did not
travel into the hospital with women. Our country has some of the highest rates
of caesarean section, maternal and infant mortality of the industrialized
world. Clearly, there is a relationship between midwifery and healthy birth
rates that has been overlooked in the American medical model.

Infant mortality is at the lowest point
in history, yet maternal mortality rates continue to be troubling, especially
in the United states. These rates of reflect that the focus is on fetal and
infant development, safety and medical advancement, rather than a mother’s
health and well-being. The specialization of maternal fetal medicine has driven
this focus, and many medical students often do not spend time learning about
care for a mother, and some may even finish their fellowship without ever being
in 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 definite
improvement, it is still twice the rate of Sweden, Denmark, Japan, Israel and
Estonia.

There are several contributing factors to
the 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 the
leading causes of pregnancy related death in the United States (Maternal
Mortality Review, 2017).

More
women are having babies at advanced maternal age (over 35), often with complex
medical histories. High rates of caesarean sections can lead to further
complications, both during the surgery, while recovering in the hospital, and
in the post partum period at home in the subsequent weeks and months. Blood
pressure issues are commonly associated with maternal mortality, yet symptoms
are either ignored or dismissed by providers, even when mother’s report
symptoms.

Most doctors and providers are not
properly trained to prepare women for the post partum period, and the
information mothers are given about how to care for themselves and potential
red flags or warning signs are woefully inadequate. The fragmented U.S.
healthcare system further compounds these issues as many women are left without
health coverage shortly after giving birth. Medicaid covers 48% of births in
the United States, and in most states women lose their coverage sixty days
after giving birth (Markus, et al., 2013). Lack of healthcare coverage also
limits the amount of prenatal care a woman may receive. Despite Medicaid “back
paying” in most states, many low-income women lack the resources or systems
knowledge to apply or receive coverage in the early weeks and months of
pregnancy.