Is Midwifery the Solution to this Healthcare Crisis?
Midwifery is a valid alternative to giving birth in a formal hospital setting. Could it be the solution to the maternal mortality crisis?
While the 2021 Summer Olympics represent a longstanding global tradition, it has been the first international event of its scale in over 16 months and has proven to be anything but conventional. On Sunday, August 1st, Raven Saunders was awarded an Olympic silver medal for women’s shot put. As Saunders — who identifies as Black and gay — stood on the podium, she raised her arms above her head in an X shape, later explaining that it represented the “intersection of where all people who are oppressed meet.”
In the United States, the intersection of being Black and female has proven to be particularly deadly. This is increasingly true in the past year and a half as a result of the syndemic of systemic racism and COVID-19. While the term syndemic originated in 1990, it has recently entered the spotlight as a device to describe the horrifyingly disproportionate health toll on Black American women.
Prior to COVID-19, Black women were 3–4 times more likely to die from pregnancy-related causes than white mothers in the United States, encompassing deaths from pregnancy, childbirth, and puerperium. As a result of the COVID-19 pandemic, the life expectancy of the American people has dropped by 1.5 years. For Black Americans, the life expectancy dropped by 2.9 years — in 2020, Black women died at more than three times the rates of white men and Asian men as a result of COVID-19. However, it’s important to recognize that Black Americans had lower life expectancy to begin with.
When it comes to the effects of COVID-19 on Black women’s maternal health outcomes, we do not yet have codified data to fully grasp the consequences of this syndemic. However, it’s likely that in order to address a syndemic, not only must the afflictions be addressed, but also the forces that tie them together.
While there is no simple explanation for the countless complexities that lend to these disparities, unconscious — or even implicit — biases in our health care providers represent an indisputable factor. Although a multitude of factors contribute to the shortening of an individual’s lifespan, in the American health care system Black patients do not receive the same care as white patients do — “even when insurance status, income, age, and severity of conditions are comparable.”
Due to a historical mistrust of the American health care system, in addition to first-hand experience, some Black Americans feel as though they can’t guarantee equitable care from a traditional doctor, and pregnant women have turned to alternative methods. As a result of negative experience, some Black women have placed their trust in midwives and doulas to assist in giving birth. As chronicled in the documentary “The American Dream,” women felt they were able to have more of a voice in the delivery process, as opposed to traditional medicine and obstetrics where they faced the trauma of having their health needs ignored.
Not only do women who use midwives feel that their needs are adequately met, but data also suggests that access to and use of midwifery improves maternal outcomes. The Institute for Medicaid Innovation states that support by established health systems for out-of-hospital midwifery practices have lower odds of c-sections, preterm birth, and higher birthweights. Hospitals that support in-house midwifery experience similar positive outcomes as well.
Currently, 20+ state Medicaid agencies do not cover home births or allow Certified Nurse Midwives to practice independently of physicians. Even more rare is coverage for Doulas. While state efforts have been slow to expand Medicare coverage to midwifery for individuals with low-risk births, it’s an incredibly valid and safe option, particularly amidst a global pandemic where hospitals are facing increased rates of hospitalizations due to the Delta variant.
As Medicaid policy does not guarantee coverage for out-of-hospital births, there’s a clear need for an improvement on reimbursement rates and expansion of networks. While American policy falls far behind on meeting the needs of Black women, the first step in addressing the syndemic is recognizing how formal medicine has continuously failed one of America’s most vulnerable populations.
Atlas Research’s Health Disparities Working Group is releasing a new series identifying and providing solutions to the complex challenges that underserved Americans face. We look forward to engaging with our readers and driving the conversation on topics such as mental health, Veterans’ health, homelessness, maternal health, economic disparities, racial justice, and more. Opinions expressed are that of the author and do not necessarily reflect Atlas’ position.
