Maternal Mortality Rates

A recent report from the Centers for Disease Control and Prevention shows that maternal mortality rates in the United States continue to rise, from their already high level. 2019’s rate was higher than 2018’s, and 2020’s subsequently higher than the two prior years as well.


The causes of the recent rise are not entirely known, and are likely attributed to a myriad of factors including COVID-19 infections and continued racial disparities (which have been a problem for many, many years in the United States). The increasing rates are definitely more than just a pandemic problem though, because they pre-date COVID’s arrival too, as maternal mortality in the United States has always been historically high.


When we look at other similarly developed countries and consider their maternal mortality rates it becomes clear that the rates are not a matter of resources and the development of the country itself but rather the system and methods of delivering maternity care. There has to be more going on.


The Netherlands, a country with one of the lowest maternal mortality rates, prioritizes the midwifery model of care. The country steers clear of the over medicalization of birth and instead utilizes a midwife-centered model of care. Where in the United States, pregnancy care is usually defaulted to OBs, the Netherlands typically defaults to midwives.


The reasons this works so well and produces such great outcomes in the Netherlands are that 1. All pregnancies are treated as low-risk, unless there’s a reason to believe otherwise. This is in contrast to the United State’s system where pregnancies and births are often medicalized by default, even in the absence of risk factors. And 2. Midwives are able to function independently and are not seen as second rate to obstetricians. Again, in contrast to the U.S. system where midwives have been long fighting for autonomy to practice independently (not under a physician) and to be covered equally by insurance plans.


Midwifery care has been shown to produce excellent outcomes and high satisfaction for birthing parents. Additionally, midwives are highly educated and able to provide a full spectrum of care. Although midwives may not use some interventions OBs do, this does not suggest a lack of attention or care to details. Highly trained midwives recognize the importance in preventing adverse outcomes in utero.


For example, while many OB providers do not routinely test for Hepatitis C in pregnant patients, or Vitamin D in pregnancy, Best Start DOES. Midwifery care is not about avoiding all medical intervention or being totally hands-off, it’s about prioritizing what makes sense and what offers the most benefit and least harm to patients. FAQs about Best Start.


In celebration of World Doula Week, here in San Diego, we want to draw attention to a pilot program to expand access to doulas has recently been approved. This program will expand access to doulas for birthing people across the county. This is major because doulas can cost hundreds to thousands of dollars out of pocket, which can certainly be financially inaccessible for families.


Doulas are essentially professional support people, here to help you through your pregnancy, labor, and postpartum. Where midwives focus more on the medical side of your birth and delivery, doulas are there to offer a second set of hands focused exclusively on cheering you on and providing you support. The goal of the program is specifically to address the disparities we continue to see in maternal outcomes by helping clients’ needs be heard and met.


We are excited about this program and hope it allows more families access to the birth experiences they desire. We’d also like to share the California Nurse-Midwives Assocation’s March newsletter which celebrates women’s history month and reminds us of its purpose to be “with woman” and make California a state with equitable access to high-quality, evidence-based reproductive care, a purpose we certainly stand behind!

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