10.02.24

The Maternal Health Crisis: Where We Stand and How We Move Forward

In recent years, the state of maternal health in the U.S. has come under increasing scrutiny. Despite living in one of the most advanced countries in the world, we’re seeing troubling statistics and even more troubling stories of birthing individuals suffering through preventable complications, inadequate care, and devastating outcomes. As someone who navigated the medical system during my own pregnancy, and now as a birth doula working in the heart of Los Angeles, I’ve come to see the gaps between the care we’re being given and the care we deserve.

The Crisis at Hand: Why Are Maternal Outcomes in the U.S. So Poor?

The U.S. is currently grappling with a maternal health crisis that leaves us far behind many other developed nations. While we have the technology, advanced medical procedures, and access to healthcare on paper, we’re seeing rising rates of maternal mortality, particularly among Black women. In fact, Black women in the U.S. are three to four times more likely to die from pregnancy-related complications than their white counterparts. And that disparity doesn’t stop at the delivery room—it extends into postpartum care, where women report being dismissed or not taken seriously by their providers, often with tragic outcomes.

The question is, why?

The root causes are complex, involving systemic issues within our healthcare system, a lack of individualized care, socioeconomic factors, and a heavy reliance on medical interventions over holistic, evidence-based prenatal and birth care. Too often, care providers treat birth as a condition that needs to be managed, and the focus becomes more about minimizing liability than empowering the birthing person. The standardized, one-size-fits-all approach fails to address the unique needs of each individual—physically, emotionally, and mentally.

The Role of Politics in Maternal Healthcare

Politics, while a difficult subject to navigate, undeniably plays a role in the maternal health crisis. We’ve seen policy decisions, like the rollback of reproductive rights, that have added barriers for many women to access prenatal care or make informed choices about their pregnancies. At the same time, there’s a shortage of midwives and a disconnect between hospitals and community-based care providers, which could offer more personalized support.

The issue of Medicaid coverage and healthcare access is another significant barrier. In many states, Medicaid stops covering postpartum care after 60 days, leaving new mothers—especially those from marginalized communities—without the care they need during one of the most vulnerable periods of their lives. Efforts have been made to extend Medicaid coverage to a full year postpartum, and while some states have adopted this, many have not. This lack of continuity in care is detrimental to maternal health, and it’s an area where we can and should be pushing for change.

What’s Working: The Power of Individualized Care and Birth Workers

Within the birth worker community—midwives, doulas, childbirth educators—we are witnessing a different reality. Through individualized care, we see better outcomes, healthier pregnancies, and more empowered birthing experiences. The difference is in the details: building trust with the birthing person, focusing on their physical, mental, and emotional well-being, and respecting their choices at every stage of the process.

This approach works because it prioritizes the birthing person’s needs. We recognize that no two pregnancies, births, or postpartum experiences are the same. We teach that birth is a physiological process, not something to be managed with excessive interventions unless absolutely necessary. And we focus on nutrition, mental health, and lifestyle—because when the whole person is supported, the outcomes are better.

Evidence backs up this holistic approach. Studies show that continuous support during labor—whether from a doula or a midwife—leads to shorter labors, fewer cesarean sections, and more satisfying birth experiences overall. When the birthing person feels safe, heard, and respected, they are less likely to experience complications or traumatic birth outcomes.

What About High-Risk Pregnancies?

For some individuals, particularly those with high-risk pregnancies, the option of home birth midwifery may not be available or advisable. This is where the standard medical system is essential, offering access to interventions that are truly life-saving for both parent and baby. But even in a high-risk situation, there is still room for personalized care and empowerment.

High-risk doesn’t mean you have to relinquish all control over your birth experience. You can still be an active participant in your care. A midwife, doula, or a supportive OB-GYN can help you navigate your options and create a birth plan that works within the boundaries of your health while respecting your autonomy. The key is open, ongoing communication and finding a care provider who listens and works with you rather than for you.

Addressing the Fear-Based Approach to Pregnancy

Unfortunately, many birthing people are led to fear their pregnancies, particularly in medical settings. They’re often told about the risks, the dangers, and all the things that could go wrong, which breeds a sense of anxiety rather than empowerment. This fear can lead to a "fawning" response, where the individual defers entirely to the provider, trusting the system over their own body and instincts.

This fear-based approach is perpetuated by a medical model that emphasizes intervention over trust in the natural process of birth. Too many birthing people are led to believe that their bodies are unpredictable or incapable without medical management. As a result, they lose faith in themselves and their ability to birth.

But here’s the truth: the body knows what to do. While there are always exceptions, the vast majority of pregnancies are healthy and low-risk. The key is to find the right support system—one that encourages you to listen to your body, stay informed about your choices, and feel empowered to advocate for yourself.

A good childbirth education course, access to midwifery care, or hiring a doula are all ways to help overcome that fear. These options focus on knowledge, choice, and support, teaching birthing people about the physiological process of labor, ways to cope with discomfort, and how to advocate for their needs in a medical setting. The more you know, the more empowered you’ll feel, even if your pregnancy becomes medically complex.

What Needs to Change

There’s no single solution to the maternal health crisis. But several areas need immediate attention if we’re going to improve outcomes for birthing individuals across the country.

First, we need to expand access to midwifery care and doula support. States that have done this, like Washington, have seen much better outcomes. This should go hand-in-hand with increasing Medicaid coverage and ensuring that postpartum care extends beyond the immediate recovery from childbirth. A full year of postpartum care should be standard, not a luxury.

Next, we must push for more individualized care within the medical system. This means training doctors, nurses, and other care providers to see birthing individuals as whole people with unique needs, rather than as patients to be managed according to a standardized checklist. It also means addressing implicit bias within the healthcare system, particularly as it impacts Black women and other marginalized groups.

Lastly, education is key. Birthing individuals need access to evidence-based childbirth education, focused on the physiological process of birth and the choices they have available to them. We need to move away from fear-based models of care and instead empower women with knowledge and the ability to make informed decisions about their own bodies.

A New Vision for Maternal Healthcare

The maternal health crisis may seem overwhelming, but there are reasons to be hopeful. Across the country, we’re seeing more birthing people opt for midwives, hire doulas, and educate themselves on their options. We’re seeing community-based care models that are driven by compassion and evidence-based practices, offering a blueprint for what maternity care can and should look like.

It’s time for a shift. We need to embrace a model of care that sees the whole person, empowers them with choices, and supports them with the resources they need for a healthy pregnancy, birth, and postpartum period. We need policies that protect and uplift birthing people, ensuring that no one is left behind in the most vulnerable moments of their lives.

I come from a small town, where a lot of that 'hoodoo-voodoo,' as they like to call it, gets passed off as outdated or unscientific. But what I’ve learned is that a balance between tradition and modernity, intuition and evidence, is not only possible—it’s necessary. And as a young dreamer living in the city, now mother, that balance is what brought me into birth work and what drives my passion for advocating for better care, better outcomes, and most of all, better support for every birthing person.

The journey to change is long, but with the strength of our community, our birth workers, and the evidence behind us, I believe we can create a better future for maternal health in this country.