Bringing new life into the world can be a death sentence. The United States is in the midst of a massive maternal mortality epidemic. While other wealthy nations have seen pregnancy-related deaths plummet to nearly zero, maternal mortality in the United States has steadily risen over the last two decades. An American woman giving birth today is 50% more likely to die than her mother was a generation ago. We are the only wealthy nation with rising maternal mortality. Despite this crisis, legislators have done virtually nothing to slow the epidemic—and media coverage of pregnancy-related deaths often gets basic facts wrong, blaming pregnant people for their own lost lives rather than highlighting a broken system of care.
It should come as no surprise, then, that most people believe a wide range of myths about maternal mortality. And some believe that making the right choices will prevent disaster. The chilling reality is that anyone can die giving birth. In a broken maternity care system, no one is safe. Individual solutions will not solve this problem. We need systemic change.
Maternal mortality is inevitable
Before antibiotics, blood transfusions, and other life-saving interventions, giving birth was one of the most dangerous things a person could do. With current technology, that’s no longer the case. Dismissing childbirth deaths as inevitable lets systems of care off the hook. Many European nations have reduced maternal mortality to nearly zero. In Belarus, Finland, Israel, and numerous other countries, maternal deaths are so rare that a doctor will likely never see one, will never know a colleague who witnessed one, and may work at a hospital or birth center where such a death has not occurred in years.
A wide range of interventions have been shown to reduce maternal mortality:
- Reducing unwanted pregnancies, including by providing access to abortion clinics.
- Lowering the c-section rate. This requires both preventing medical issues that render a c-section necessary, and lowering the rate of unnecessary c-sections performed for doctors’ convenience. At least half of c-sections are medically unnecessary.
- Reducing the use of unnnecessary medical interventions. Every intervention increases risk, and this risk is only worth it if the intervention treats a specific condition, thereby reducing overall risk. At least 90 percent of people who give birth in the United States receive at least one medically unnecessary intervention.
- Addressing racist and sexist bias. Black women are four times more likely to die giving birth than white women, and the data show that racism, not race, is the reason. One study found that half of medical residents believe racist stereotypes about Black patients. Numerous studies have shown that doctors often ignore women’s pain and other health symptoms.
The U.S. is still one of the safest places to give birth
The U.S. has the worst maternity care system in the wealthy world. It ranks 33rd overall in maternity care. That’s just part of the story, though. Some states have such catastrophically bad maternal death rates that it’s actually safer to give birth in war-torn or deeply impoverished countries. It is safer to give birth in more than 90 other nations than it is to give birth in Georgia.
Despite having one of the worst maternity care systems in the world, people living in the U.S. pay more to give birth than people everywhere else across the globe.
People who die from pregnancy usually die during labor
Movies and television shows depict birth as the most dangerous part of pregnancy, and it makes sense to believe this. After all, most people give birth in a hospital, usually under near-constant monitoring. The research tells us that the postpartum period is actually the most dangerous time. At least 60 percent of deaths happen after birth, after the birthing person is discharged from the hospital. And this is the time when we provide the least care to birthing people. Most don’t see their doctor until 6 weeks postpartum. Until then, they’re on their own.
At the end of pregnancy, many people see their doctors once or twice a week. During birth, it can be difficult to get privacy even in the bathroom. The message here is clear: pregnant people only matter when they are carrying a baby. When there’s no longer a baby in there, they don’t count. We know when women are most likely to die, and we have elected to provide them with absolutely no medical care during this time.
Doctors are doing their best to solve the problem
In the popular imagination, doctors are as concerned about maternal mortality as pregnant people are. The data show otherwise. Instead, doctors play a key role in maternal mortality. They lobby for tort reform to reduce the power of abused women and their families to sue. They push back against policies to introduce evidence-based care. They refuse to examine their c-section practices. And many stories of maternal mortality feature tales of doctors ignoring women until it’s too late. Delayed treatment for postpartum hemorrhage is so common that there’s a term for it: denial and delay of care.
One study of birth workers found that a third said they had witnessed a doctor commit a serious medical error in the last 30 days. The same study found that a similar percentage reported hearing a doctor use racist language in the delivery room.
At least 30 states do not closely examine pregnancy-related deaths, or asses whether medical neglect or malpractice could be the culprit. This is in spite of data showing that provider and institutional factors are the leading cause of maternal death. Hospitals and medical lobbies are powerful, and can push for less scrutiny. The birthing people whose very lives depend on that scrutiny have comparatively less power.
People only die when they are poor, unhealthy, or make bad decisions
Unhealthy people, poor people, and those who make bad decisions should not die giving birth. A good medical system is equipped to serve all people. Not just ideal patients. The reality is that most people who die giving birth are healthy, or have only minor medical complications that should not be fatal. A respected maternal mortality expert even died giving birth. Drugs, drinking, smoking, and other lifestyle factors are not major players in maternal mortality.
So what is? Medical error. Anyone can die giving birth. Maternal mortality review committee data shows that doctors and hospitals cause the majority of deaths. Many advocates say these review committees are skewed in favor of doctors, so may actually underestimate the role providers play in maternal deaths.
Pregnant People Need to Be Better Advocates
This is another flavor of victim-blaming. The idea that a pregnant person should know the symptoms of every disease, know how to treat it, and know how to correctly ask for treatment while experiencing a potentially life-threatening complication is absurd.
It’s also a paradox of maternal health: doctors routinely dismiss pregnant people as too stupid and hysterical to make their own decisions, while simultaneously insisting that those people must take responsibility for their health care. Listen to the doctors, except don’t. Do everything you can to advocate for yourself, except when you disagree with your doctor. It’s a terrible bind.
Let’s be clear: a hemorrhaging person cannot break down an emergency room door and put pitocin in their own vein. They can’t put a knife to a dismissive doctor’s chest and demand treatment. They cannot self-diagnose. Advocacy only goes so far in a broken system—and in a quality care system, birthing people wouldn’t need advocacy at all.
Maternal mortality is the biggest issue in maternity care
The crisis of maternity care hardly begins and ends with maternal deaths. Each year, about 50,000 additional people are disabled by or nearly die during childbirth. As with maternal mortality, almost all of these injuries are preventable. Less severe injuries are even more common, often diagnosed, and almost entirely treatable.
After giving birth in the U.S. 29% of women in one study had undiagnosed, untreated bone fractures. The majority of women who give birth experience incontinence a year later. Pelvic floor physical therapy can treat this, and most countries include it as part of routine postpartum care. In the United States, this care is a luxury few insurers cover and few families can afford. Sixteen percent of people who give birth have PTSD symptoms after birth—most often because of mistreatment by their providers.
Survival is not enough. Many women are left broken and suffering after birth. They deserve better.
People with ‘good’ maternity care don’t need to worry
In a broken care system, it doesn’t matter how good your doctor is. They might not be the one to attend your birth, and even if they do, you’ll still be at the mercy of nurses, aides, and hospitals that may undermine a doctor’s decision-making authority or endanger patients. Medical errors are extremely common—so common, in fact, that they are the third-leading cause of death in the United States. These errors figure prominently in the maternal morbidity and mortality crisis.
Moreover, lionizing some providers as “good” and others as “bad” misses the point. There are only good and bad experiences, and a provider’s excellent history does not necessarily mean they will not make mistakes. Labeling a provider as good, though, may make it more difficult to notice their mistakes, and easier for them to escape blame. “But I had a good experience with that provider/at that hospital!” is the rallying cry of people who disbelieve women.
Birthing people can trust their doctors to make good decisions
Twenty-eight percent of birthing people report some form of abuse—including physical and sexual assaults, sexist or racist language, or threats—by their providers. This, coupled with high rates of unnecessary interventions, malpractice, and neglect suggest that it is not safe for women to trust their providers. This leaves them trying to research things on their own—a dangerous and time-consuming undertaking.
As a result, most families enter the obstetric care system with no way of knowing which interventions they need, whom to trust, and whether they are at risk of being injured. And lest you think medical boards will screen out the worst providers, think again: Analysis after analysis shows that medical boards are failing to protect patients. They’re letting incompetent doctors practice. They’re restoring privileges to doctors who have raped patients. They are compounding the problem.
Medical neglect and malpractice are rare
When ninety percent of birthing people receive at least one medically unnecessary intervention, it should be clear that medical malpractice is anything but rare. But that’s just part of the very bleak picture:
- Black women are routinely subjected to racism in the health system. Doctors are more likely to discourage them from breastfeeding, to recommend dangerous interventions, and to give their babies formula without their permission.
- 1 in 20 patients experiences a preventable medical error.
- More than half of birth workers say they have seen a doctor perform a procedure when the patient said no.
- Delay and denial of treatment remain common—even at supposedly good hospitals. Kira Johnson was told by practitioners at Cedars-Sinai Medical Center that she was “not a priority” as she slowly internally bled to death from a botched C-section.
We can stop this epidemic. We have chosen not to because, in a misogynist country, people who give birth just don’t matter.
