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Broken Halos: Redesigning Maternal Healthcare

Infant Freedom
Grasping New Life

As a public health expert, it is my duty to advocate for healthcare infrastructure solutions. However, the answers to our issues are multi-faceted and require different levels of intervention. To create effective change, we must shift our perspective and support our values through investment. This investment requires multiple systemic policy changes at the state and federal levels. But we are in crisis mode and cannot wait for bureaucracy or medical intervention to save us. Education and empowerment are required for a cultural shift in our attitudes toward reproductive health.

Here's the issue, maternal mortality has continued to trend downward worldwide, yet the numbers in the United States are disturbingly high. The horror is revealed when we understand that more than 80% of pregnancy-related deaths in the U.S. are preventable. As a nation, we can no longer be passive in pursuing fertility; maternal mortality is a part of our sexual and reproductive health rights.

What is maternal mortality? Pregnancy-related deaths that occur within one year of pregnancy. Usually caused by a pregnancy-related complication, events initiated by pregnancy, or stressing an unrelated condition caused by the physiological effects of pregnancy.

In the United States, there are significant differences in the level of treatment and care within populations. Black and Native American/Indigenous women are at much higher risk of maternal mortality nationwide. Black women are three to four times more likely to die from pregnancy-related complications, and Indigenous/Native American women are twice as likely to die than White women. Put into percentage, Black women are 243% more likely to die from pregnancy- or childbirth-related causes than White women.

What's The Solution?

We can start by acknowledging that a healthy body is the foundation for a thriving pregnancy and childbirth experience. Our commitment must focus on nurturing our physical, emotional, and mental well-being through comprehensive healthcare, education, and access to essential resources. Women have an inherent right to control their bodies, health, and fertility. We must cherish the power and responsibility required to make informed decisions regarding our reproductive journeys. Pursuing a healthy pregnancy is an essential aspect of our overall well-being. With unwavering determination, we must resolve to take back our health. To learn more about prepping your body before becoming pregnant, read the post "Redefining Motherhood."

Assemble The Medical Team

Informed decision-making is crucial during preparation season. I want to encourage women to learn and exercise every option available. We will start by acknowledging your right to shop for your medical team. This concept can seem foreign if you have little experience in healthcare. Here are a few recommendations: Take the time to research your medical options; call your insurance carrier or scour their website to find competitive pricing information and the names of physicians in your network. Google doctors to find information on patient experience (online reviews), if they have published any research or interviewed, scan their quotes, and schedule an appointment. Study their level of care, take notes on how much time they spend with you during the appointment, do they ask questions, and listen to your concerns? Do they make you feel comfortable? Are they detailed oriented? For minority women, asking about their experience with birth complications and expressing concern about care bias is essential.

If most pregnancy-related deaths are preventable, we must address the elephant in the room. We want better care; let's demand it. We want physicians who recognize urgent maternal warning signs, provide timely treatment, and deliver respectful, quality care.

Midwives & Doulas

It's no secret the medical system is heavily burdened in America. Most regions of the country have physician and nursing shortages, and lack of exposure to midwife care during training has led to professionally negative views of midwife's skills. Historically, people have responded to things that are foreign as scary or with skepticism. Professionals are not immune to this type of thinking or response. We cannot afford to allow fear and ignorance to limit patient care options.

A midwife is a trained health professional who helps healthy women during labor, delivery, and after the birth of their babies. Midwives may deliver babies at birthing centers, at home, and can deliver babies at a hospital. It's crucial to note licensed midwives typically treat low-risk women. If we want to integrate midwives into our care, we must invest in our health before pregnancy. This lessens the burden on our bodies by decreasing the odds of having a complicated or high-risk pregnancy and increasing our care options.

The Mapping Midwives Integration Study found that states that have done the most to integrate midwives into their healthcare systems have some of the best outcomes for mothers and babies. Conversely, states with some of the most restrictive midwife laws tend to do significantly worse on key maternal and neonatal well-being indicators. "We have established that midwifery care is strongly associated with lower interventions, cost-effectiveness, and improved outcomes."

Nina Martin, an incredible journalist who has invested in reporting on this topic for over a decade, wrote, "Integrating midwives into health care systems could prevent more than 80 percent of maternal and newborn deaths worldwide — by filling dangerous gaps in obstetric services and preventing overuse of medical technologies such as unnecessary C-sections that can lead to severe complications."

According to a CDC report, more than half of maternal deaths occur after the baby is born. The days and weeks after childbirth is a time of vulnerability for new moms, with physical and emotional risks that include pain and infection, hypertension and stroke, heart problems, blood clots, anxiety, and depression. Midwives have publicly advocated to recast the three months after birth as a “fourth trimester.”

The licensed midwifery model can solve shortages of maternity care, disproportionately affecting rural and low-income mothers. Investing in midwifery prenatal and postpartum wellness improves health outcomes by emphasizing community-based care and enriching close relationships between providers and patients. Encouraging active listening and compassionate care is a valuable tactic in reducing the impact of systemic racial bias in medicine.

We have lost the value of these basic interpersonal skills because our healthcare system is overburdened and exhausted. Suppose our healthcare professionals are experiencing caregiver burnout on a systemic level. In that case, the population experiences insufficient care, and a cycle of crisis continues. We must reinvest in medical care support to affect systemic change.

We can encourage support through doula services to increase diversity and expand the maternal health workforce. Doulas are trained non-clinicians who assist during prenatal and postpartum care by providing physical assistance, labor coaching, and emotional support. Pregnant women who receive doula support have been found to have shorter labors and lower C-sections rates, and fewer birth complications.

Assembling a formidable medical team with compassionate practitioners, skilled healthcare providers, and culturally sensitive professionals is vital to improving the outcome of a healthy pregnancy. Healthcare professionals must develop partnerships based on trust, empathy, and open communication. When patients educate themselves, they can demand personalized care that respects individual needs, preferences, and beliefs.

Social and Political Responsibility

What if we shifted our perspective on healthcare? Maturing from an individualistic model to considering health a shared responsibility within our society. What we are experiencing in maternal and infant health makes it glaringly obvious health starts before birth.

Being healthy means more than not being sick. We have systemic barriers influenced by complex social factors, something as simple as your neighborhood can create a 20-year difference in life expectancy. Those influences are stable housing, steady income, quality of education, and access to healthcare, all of which are not equally shared across society. And when everyone does not have the chance to live the healthiest life possible, we all experience the weight of that burden. The rise in chronic health conditions, depression and anxiety rates related to unfulfilled needs, and lacking the resources to create a robust support system because the demand is becoming too great. Social determinants of health prevent many people from racial and ethnic minority groups from having fair opportunities for economic, physical, and emotional health.

In June 2022, the Biden Administration's Blueprint for Addressing the Maternal Health Crisis outlined priorities and actions across federal agencies to improve access to coverage and care, diversify the perinatal workforce, and increase incentive training to support women being active participants in their care before, during and after pregnancy. Biden's Blueprint budget develops a maternal care pipeline to provide scholarships to students from underrepresented communities in health professions and nursing schools to grow and diversify the maternal care workforce (this includes doula services through Medicaid).

I want to remind you that the power is within the people. When we prioritize and protect our rights, we assert the value of life. We have to build a culture of health. Education and advocacy initiatives work and we can affect change through legislation and policymakers. By recognizing the strength in our collective voice and commitment to empowering one another, we can highlight the public health crisis of maternal mortality and the unconscionable racial disparities within our American culture. Let's share our stories, knowledge, and experiences, lifting each other to overcome challenges and celebrate successes.


I want to publicly acknowledge and celebrate the organizations actively working to save lives in our vulnerable populations. The Changing Woman Initiative, a Native American midwifery organization in New Mexico, providing culturally centered care to address maternal health disparities, high rates of gestational diabetes, and low birth weight deliveries among Indigenous women. Cradle Cincinnati is an organized collaborative effort between parents, caregivers, healthcare professionals, and community members committed to reducing infant mortality in Cincinnati, Ohio. Wellness centers like Chicago Birthworks Collective, Chicago Family Doulas, and the Holistic Birth Collective are investing resources into neglected communities of birthing people and their families.

There are many ways to support the pursuit of maternal and infant wellness. You can do this by choosing different. Take control by knowing your options, preparing your body for the journey, and investing in community support. We can do this by championing policies safeguarding and promoting women's reproductive health, increasing access to affordable prenatal care, comprehensive sexual education, contraception, and fertility treatments. Our collective power can demand legislators and policymakers to prioritize and protect our rights throughout our reproductive journeys. Together, we can showcase our values by redefining societal narratives, dismantling barriers and stigmas, and building supportive medical teams.

The work lies ahead, acknowledging the battles to be fought and victories to be won, demands a commitment to resilience. By doing so, we will foster a future where everyone can embark on their journey towards a healthy pregnancy, empowered and free.

Additional Resources

Organizations Working to Save Black Mothers: Provided by the Black Maternal Health Caucus of the United States House of Representatives

Ancient Song: Providing culturally aligned, high-quality care to Black and Latinx people

Black Mamas Matter: Advancing Black Maternal Health, Rights & Justice

Sista Midwife Productions: a birth advocacy training and consulting agency based in New Orleans, LA. Check out their Midwife and Fertility Support Directory and Doula Directory


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