The State Of Obstetrics In The USA, Part Two


Did you know that low-income mothers, and mothers of color, are up to three-to-four times more likely to die from labor and postpartum complications than their white or wealthy counterparts? This is honestly a topic in and of itself - it deserves its own dedicated focus. I would be remiss not to mention this astonishing disparity when discussing the state of obstetrics in the United States. The fact that women of color are more likely to die in the process of becoming mothers is appalling and deeply alarming.

The fact of the matter is the United States has the worst maternal and fetal outcomes of any developed country in the entire world! To put it another way, the only countries that have worse maternal and fetal outcomes are countries that are in the second or third world. Even some of those countries have better outcomes in certain instances. Let that sink in for a moment. 

So what is America doing differently from the rest of the developed world when it comes to obstetrics and maternal health?

Quite a lot.

We're the only developed country that does not provide maternity leave. Women are being forced to return to work before their bodies have had a chance to recover, which complicates the healing process in a best-case scenario. In the worst case scenario, this can exacerbate conditions and lead to under-diagnosis of preventable medical emergencies - and even death. We're also unique in the way we handle healthcare on a more general level. Because healthcare is not available freely to anyone in the United States who might need it, many expectant mothers are foregoing or skimping on proper prenatal care. Ultimately, the lack of access to affordable healthcare means that some mothers have high-risk pregnancies or potentially foreseeable complications that simply go unnoticed.

We also have a remarkably low rate of home birth. The normalization of hospital birth has created a culture in which many women feel that they won't be capable of achieving vaginal birth. Like many things, labor is a battle first won or lost in the mind! If you are pregnant and you believe that your body is simply not capable of achieving vaginal birth, then the odds of successfully achieving a vaginal birth are not in your favor. I don't mean to say that you can wish your way into the birth that you want. That's simply not how it works (although it'd be great if it were). What I mean to say is: there's a sort of pre-determinism around what American mothers can expect during labor and delivery and that presupposition is inherently shaped by the hospital system.

Since healthcare is a profit-driven market in the United States, there is inherently a motivation to avoid low-cost birth situations. Simply put, a hospital will make more money from a mother that receives multiple interventions and a C-Section surgery than it will from a mother who gives birth without any significant medical intervention. I don't mean to imply that hospitals or individual doctors are motivated exclusively or even primarily by the profit motive. I just think it would be misleading not to include this factor when we look at the state of obstetrics in the United States.

To be quite honest, I feel like I've glossed over quite a lot of information and omitted even more. There simply isn't room in this format to delve into the extremely nuanced state of obstetrics for American mothers.

If you are a pregnant woman in the United States, know this: you are the only person who can advocate for yourself. Your doctor is not necessarily going to advocate for you, your hospital is not necessarily going to advocate for you, your partner is not necessarily going to advocate for you. It's up to you to ask questions, to demand answers, and to ceaselessly seek out the absolute best care that you can get. I strongly recommend that you look into Evidence Based Birth as well as the standards of the American College of Obstetricians and Gynecologists.

The best care providers in any field encourage their patients to become as informed as possible about their own conditions, because it allows them as doctors to provide better care. So if your care provider suggests something that makes you uncomfortable, voice your worries. If you feel that they dismiss those concerns, or they aren't taking you seriously, you are well within your rights to demand better treatment. You are your doctor's employer; you hired them, you can fire them. Trust your gut. If you don't feel that they are practicing in a way that relies on evidence-based care and the most up-to-date information regarding maternal and fetal health, ditch them. 

Great OBs are out there. In the United States, not every OB is a great one - but by soliciting the best care possible, the industry will be forced to adapt. This is the current state of obstetrics in the United States. It doesn't have to be our future.


What other aspects of the OB system in the United States worry or confuse you? Share your insight with me on Twitter @pi3sugarpi3 with #ObstetricsInTheUSA



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