U.S. Maternal Mortality Rates
The United States is ranked last overall among other industrialized countries and their maternal mortality rates. The Commonwealth Fund reports that the U.S. maternal mortality was 17.4 per 100,000 pregnancies in 2018.
A significant and severe disparity exists between the maternal mortality rates of women of color and white women. The maternal death ratio for Black women (37.1 per 100,000 pregnancies) is 2.5 times the ratio for white women (14.7) and three times the ratio for Hispanic women (11.8).
There are many factors that could contribute to the high mortality rate of Black women, but the common denominator is centuries of systematic racism and oppression. Black women are less likely to be taken seriously by medical professionals, more likely to be pressured into making decisions, and often prematurely return to work due to unpaid family leave.
The National Partnership for Women and Families documented disparities in how women are treated during childbirth in their “Listening to Mothers” surveys. They found that:
Compared with white women, non-Hispanic Black women were more likely to report:
- Being treated unfairly and with disrespect by providers because of their race
- Not having decision autonomy during labor and delivery
- Feeling pressured to have a cesarean section
- Not exclusively breastfeeding at one week and six months
Compared with women with private health insurance, women with Medicaid coverage were more likely to report:
- No postpartum visit
- Returning to work within two months of birth
- Less postpartum emotional and practical support at home
- Not having decision autonomy during labor and delivery
- Being treated unfairly and with disrespect by providers because of their insurance status
- Not exclusively breastfeeding at one week and six months
Maternal mortality rates are lower for white, educated, and insured women. Meanwhile, women of color who may not have a college education, are covered by Medicaid, and likely lack maternity leave, maternal mortality rates are a lot higher. The U.S. continues to let down women, especially women of color, as they struggle to financially, physically, and emotionally survive.
The Commonwealth Fund acknowledges that “reducing it [U.S. maternal mortality rates] will require an integrated effort involving policy and practice changes to improve hospital and community care for all women while advancing racial equity.”
The Harvard Business Review encourages employers to become active in lowering mortality rates. Employers should: select health care plans that prioritize maternity care, provide pregnant mothers with high-value care that can reduce maternal mortality rates, and offer paid maternity leave.
With all of these facts and statistics aside, we recommend that you come up with a birth plan, advocate for yourself, and have a designated person to be there to support you. Ideally, you would have a birth plan months ahead of time in place with your family and doctor who will be delivering your baby. The doctors and nurses in your delivery room should be respectful of your wishes.
Advocate Children’s Hospital outlines questions that a birth plan should answer:
1. What are your wishes during a normal labor and delivery?
These range from how you hope to handle pain relief to fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.
2. How are you hoping for your baby to be treated immediately after and for the first few days after birth?
Do you want the baby’s cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breastfeed or bottle feed? Would you like the baby to sleep next to you or in the nursery (if the hospital has one)?
Hospitals have widely varying policies for the care of newborns — you’ll want to know what these are and how they match what you’re looking for.
3. What do you want to happen in the case of unexpected events?
No one wants to think about something going wrong. But if it does, it’s better to have thought about your options in advance. Since some women need cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.
Once you have created your birth plan, it’s a good idea to make copies of it and provide it for your chart, your doctor or nurse-midwife, and one for your partner or support person.
Labor and delivery can’t always be controlled and might not always go to plan either. Just understand and reassure yourself that you have autonomy over your decisions, your body, and your baby. The best thing that we can do is continuously advocate for ourselves and other women in all aspects of our lives. A healthcare environment that encourages mutual respect shouldn’t be a luxury and it certainly should not be unattainable for women of color.