This is the dark stuff, just before the light. Then comes growth.

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Image source: World Health Organization

I don’t think midwives knew quite what we were in for when the World Health Organization declared 2020 the Year of the Nurse and the Midwife.

I, for one, imagined it would be a relatively easy year for midwives in the United States, when we could finally be celebrated and start seeing the policy changes we have been working on for decades. I imagined a nice crescendo to a rising tide for midwives, with unprecedented recent interest in our care models and our contributions to quality, equity, and…


The time for policy action is now.

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As we think about how to rebuild from whatever depths the COVID-19 crisis will bring us, I would like to propose Medicare for All Pregnancies as a policy priority. Here’s why.

Even before COVID-19, the need to fix maternity care in the United States was urgent. Alarm bells were ringing and major commitments were being made to focus resources on maternal health, especially eliminating racial disparities.

The maternity care crisis has been looming and growing for decades, but finally there was political action. Presidential candidates debated plans to address it, and there was…


The research is weak. The industry is corrupt. And there are alternatives that work.

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I recently got curious about what ever happened with Makena, the once controversial but now mainstream progesterone drug that promises to prevent preterm birth. My curiosity turned out to be timely. Makena is about to go before the FDA to review new data, and stands to lose its approval for use in preventing of preterm birth.

It turns out Makena doesn’t work for the one indication for which it is FDA approved: prevention of a subsequent preterm birth in a person who has had a spontaneous…


Honestly, it may be our only hope.

Woman holding newborn baby with midwife by her side.
Woman holding newborn baby with midwife by her side.
Photo: @kayp via Twenty20

We need a new maternity care system in the United States.

The one we have is irreparably broken, scarred by a history steeped in misogyny and white supremacy, where women’s bodies have been subject to involuntary experimentation, obstetric violence, and a parade of interventions proven to cause harm only after decades of being hailed as standard practice — interventions ranging from DES and Thalidomide, to twilight sleep, routine episiotomy, and the still-entrenched continuous electronic fetal monitoring debacle.

It’s no wonder our maternity care system produces dismal results.

In the United States we have the highest maternal and infant mortality rates among industrialized countries, widening racial disparities, no access at all in…


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For years it has been my full time job to think about how to transform and improve maternity care, so my only challenge when deciding to March for Moms this Mother’s Day is which of the myriad possible things to put on my sign and t-shirt.

But if you’re new to maternity care as part of your resist and persist efforts, here are five videos to get you started learning the issues and igniting your activism to make change.

Racism creates access barriers. It also “gets into the body” and physically harms women and fetuses. And it affects families’…


My parents *almost* didn’t have maternity coverage with their first pregnancy. If they hadn’t, it would have ruined them financially, and there’s a chance our family would have been in poverty, at least temporarily. There’s also a chance my sister wouldn’t have survived her birth.

But they had insurance, so that alternative reality never happened.

Technically, my mom wasn’t eligible for my dad’s company maternity coverage, because she was already pregnant when he started work. (That, btw, was because her Dalkon Shield had failed her, along with enough other women that it became the largest class action medical lawsuit of…


When my daughter was in 5th grade, her response to the growing conflict around her was to retreat from the drama, stay quiet, and read. For most of that year she was reading and rereading The Hunger Games.

I knew nothing about The Hunger Games except that kids were fighting other kids. Once I asked her if she was on Team Peeta or Team Gale because I had seen it on Instagram, and she said, “Mom. I’m on Team Katniss.” My feminist heart sang.

Then I watched the movie, and my perspective on my daughter was turned upside down. I…


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A lot has been said about the fact that we are on the brink of electing the first woman to be President. But I have been thinking more about electing the first mother.

Motherhood can be defined in as many different ways as there are people on this planet. But no matter the form, it provides a perspective and experience that none of our previous presidents can lay claim to.

This gap matters. The democracy our Founding Fathers created all but shut down our ability to tap into what mothers could bring to the table. Throughout our ensuing political experiment…


Almost any way we look at it, maternal and infant health outcomes in the United States are far worse than they should be. Our infant mortality rate is on par with Poland, our maternal death rate just above Iran. We’re one of just eight countries in the world with rising maternal death rates, a distinction we share with Chad and Afghanistan. Our preterm birth rate has nudged down in recent years, but it’s hardly much to celebrate when we rank behind 53 other countries and still have a point to go to return to where we were in 1990.

What is driving these poor outcomes?

To…


For my MBA capstone project, I set out to examine care model innovation in maternity care. My assignment was to put together a syllabus for myself, and then to teach myself from that syllabus over the semester. The first “lesson” in my class-of-one was to dig in to the broader healthcare landscape to see what frameworks and lessons I could find there. Here’s what I gave myself to learn from:

Amy Romano

Midwifing the system. CEO at Primary Maternity Care. www.primarymaternitycare.com

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