I’m pregnant with my second child, and I live in Georgia. This is a terrifying combination because Georgia has the highest maternal mortality rate in the United States—and the rate is rising. In my state, the death rate is 43.2 per 100,000 for white women, and 66.6 per 100,000 for black women. Friends and family reassure me that I’m young, healthy, and affluent so I have nothing to worry about.
But as a healthcare writer who runs a maternal health nonprofit, I know better: I know that most maternal deaths are preventable, and that many healthy women who had no reason to die still perished giving birth. I know that affluence will not protect me. It didn’t protect Kira Johnson, who slowly bled to death while her doctors told her she just wasn’t a priority. My white skin gives me an advantage, but Georgia loses white women at a higher rate than the nation as a whole loses black women, so that advantage is tempered in a state that is letting women die at such an alarming rate.
In the wake of this crisis, my state has done nothing. Our legislators are working hard to close abortion clinics—a measure all of the data shows will increase maternal mortality in a state where women die at higher rates than they do in Iran, Ecuador, Vietnam, and 100 other nations.
But maternal mortality isn’t what really scares me. Because although this crisis is stunning and although the U.S. is the only developed nation in which maternal mortality is rising, maternal mortality is still relatively uncommon.
Instead, what’s common is for women to leave birth with catastrophic injuries that affect them for the rest of their lives. More than 50,000 women a year suffer life-threatening childbirth complications that leave them disabled or severely injured. More than a quarter of women say their births were traumatic, and 1 in 10 leave childbirth with PTSD. This isn’t an inevitable outcome of childbirth. Childbirth, for the overwhelming majority of women giving birth in industrialized nations with good healthcare, is neither inherently dangerous nor inevitably traumatic. This is only the case in the U.S.
So what’s happening in the American healthcare system? The data suggests that there are many factors at play—an unresponsive healthcare system, racism, sexism, a refusal to listen to women, a refusal to embrace evidence-based maternity care. Ninety percent of women giving birth receive at least one unnecessary birth intervention, and each such intervention increases the risk of injury.
Women leave hospitals with lacerated bladders following botched C-sections. They suffer catastrophic pelvic floor damage from doctors who force them to push out babies flat on their backs, or from providers who perform medically unnecessary episiotomies. At least a quarter are mistreated by their providers, with an alarmingly high number reporting assaults, racist or sexist language, or sexual violence.
And then we tell them, “At least you have a healthy baby,” as if it is selfish for women to care about their own health. In the American maternity care system, women don’t matter.
Babies don’t matter much either. The United States ranks 68th for first-day newborn deaths, with 2 out of every 1,000 babies dying during their first day of life. Many women leave the hospital without a healthy baby—or any baby at all.
As protesters picket outside of abortion clinics, they do nothing about the real places where women and babies are dying, suffering, and being butchered at the altar of for-profit medical care: hospitals.
And despite the overwhelming evidence that hospitals and doctors are ignoring, abusing, and injuring women, most coverage of the maternal health crisis still blames the victim. Reproductive choice does not end with abortion. The right to control one’s body and one’s destiny is a fight that continues in the delivery room and beyond.
I’m fighting that fight as a pregnant person now, and it’s scary.
I write about health for a living, and I advise people about their health rights as part of my nonprofit work. This should put me at an advantage. But I, too, am vulnerable—just like all women.
I’ve had four prenatal appointments so far. During my first appointment, my provider was unable and unwilling to answer simple prenatal healthcare questions, and finally told me I was taking up too much time. She refused to even take my full medical history.
At my second appointment, my provider told me the baby was measuring extremely small for its gestational age. This can mean birth defects or miscarriage. I had to wait two weeks—checking every hour to see if I had started bleeding and miscarrying—to get a second provider to double-check the scan. It turned out the baby was fine. My provider just did the measurements wrong. She didn’t care enough to get them right.
At the third appointment, my provider recommended a test and a procedure that I knew were contraindicated. No medical organization or guidelines supported her recommendation. So I asked her one simple question: “Why?”
It was clear this was a query she was not accustomed to hearing. She became flustered and unable to justify her recommendation. And then she became angry and threatened to cancel my appointment.
These experiences are typical. They’re so typical, in fact, that entire websites and message boards are dedicated to helping women find workarounds for ill-informed or abusive providers.
I didn’t consult a website or a script. I didn’t try to find common ground with my garbage provider. I fired her.
My fourth appointment was a breath of fresh air. I’m now receiving care at a birth center with an exceptional reputation. They’ve never lost a mother. Their rate of complications is extraordinarily low. People use words like “life-changing” and “strength-affirming” when describing their births there. It’s costing us a ton of of money.
I’m grateful for the birth center. I’m grateful I had an alternative. I’m grateful I knew enough to know that my doctor was putting me in danger. Many, perhaps most, women do not have this privilege. And that is why they are dying and being injured.
We spend years socializing women to be compliant, to be nice, to defer to authority. These are the very traits that kill them when they give birth. I knew my provider was wrong and putting me in danger, but I found myself shrinking in that small exam room. Maybe I was being unreasonable. Maybe I was being rude. Maybe the problem was me.
This is the train of thought so many women before me have entered into right before they died or suffered a serious complication. Sexism, medical abuse, and bad maternal health outcomes are inextricably linked. And the attitudes that color our views of women giving birth are the very same attitudes that narrate anti-choice sentiments.
We don’t trust women. We don’t think they’re smart or capable, and we certainly don’t think they should get to make decisions about their own bodies. We call them hysterical when their doctors fly off the handle or get aggressive. No wonder we ignore them when they are dying.