Bridging the Gap in Maternal Care: A Call to Action
Two of My Hats
Three years ago, I began my position as medical director of the Atlanta Birthing Center. I also serve as a hospitalist for a major hospital here in Atlanta. These two positions give me a unique perspective on a dangerous situation I see playing out currently in the birthing landscape.
As a hospitalist, I’m like a fighter pilot. I help with the most extreme, dangerous birthing situations. Patients who need the highest level of care (like blood transfusions, being put on oxygen, specific medications) come to our hospital. And I’ve worked in settings like this one for a while, so not only am I familiar with them, I thrive in situations like these (see “Medicine as Service” blog post, only if it’s been published before this). The hospital provides true obstetrical care (read: more medically involved).
At the same time, the Atlanta Birthing Center is focused on midwifery. We are not a hospital and don’t have a hospital’s amenities. Because of that, we are very careful and selective about who is allowed to give birth here, because we want to make sure women are at the lowest risk. This is much less a reflection of the skill of the midwives and more a reflection of the fact that we don’t have quick access to the advanced interventions that a hospital would have (the blood transfusions and specific meds, etc). So we want to set women up for a healthy, smooth delivery and a healthy baby.
Disturbing Trend in Medicine
However, as I mentioned earlier, there is a dangerous situation taking place that I have alluded to in an earlier blog post (see “Crisis in Plain Sight from Aug. 18). In the last few years, new research has been published showing that maternal mortality rates are up for women giving birth in the US, especially women of color. This is not surprising, considering what we know about the ongoing inequalities in information about health and access to healthcare in communities of color, but a lot of fearmongering press has been generated about it.
This has understandably made many women, especially women of color, distrusting and even fearful of receiving medical care in a hospital setting. As a result, so many women, who may be at a higher risk for birth complications, are seeking out care at community healthcare providers (such as midwives or community birthing centers). And as the medical director for a birthing center, I appreciate that they are trying to receive care that is less medically involved.
But, the fact is, women with higher risk pregnancies need the capabilities of a hospital, where we can treat higher-risk situations. The majority of OB-GYNs are safe and provide good care to mothers and their babies. It’s hard to help patients reckon with the fear that something dangerous will happen to them if they go to a hospital versus the real danger of them giving birth in a setting where an emergency can occur and their needs can’t be met quickly.
As someone who has worked in the birthing community for many years, it’s heartbreaking for me to see this mistrust in medicine. I hate to know that people are running away from care that they need.
My hope for the future
To combat this mistrust and fearfulness, my hope is that in the future we can create a bridge between community birth workers and OBGYNs/hospitals, because we all want the same thing. We want mothers and babies to get through labor and delivery safely, with a healthy mom and a healthy baby at the end.
Right now it feels like these groups of people are on two different teams, and that’s partially a legacy of sexism. As I’ve written about before, OB-GYNs have been a historically patriarchal community, along with the rest of the medical profession. And hospitals have been a place where (mainly) male doctors were telling (exclusively) female patients that “This is how it works, this is what we have always done.”
At the same time, there is an ancient tradition of very skilled women working as midwives in their communities to help bring children safely into the world. Women have served as midwives since before recorded history, and in many places around the world, are still the best option mothers have when giving birth.
But women have been entering the OB-GYN field for at least 50 years now. The more people who have given birth are caring for people giving birth, gives them more perspective on the birth process and how it should look for patients, especially in a hospital. So the bridge can be built, but we need to move quickly.
We have no time to waste, because OB-GYN units and labor and delivery units are closing across the country every day. This means we must rely on the care of community birthing centers, while maintaining that communication with the hospitals to give the best care possible. We have to find ways to facilitate the transfer of care, which varies from city to city and state to state. That’s a bigger problem than I can solve here, but hopefully by bringing it to the world’s attention, I can help start the conversation.
