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Opinion: Maternity’s “Most Dangerous Time” Calls for Improvement in Maternity Care

Bintou Diarra, A.B | Medical Anthropology, Brown University | August 30, 2023

Lawmakers, advocates, and other key stakeholders often cite doula care as essential in combating America’s maternal health crisis. When people suggest the incorporation of doulas into the care of our nation’s birthing people, they often fixate on bringing birthing people to an empowering birthing experience. While this is essential, recent research suggests the importance of treating survival as a baseline. A New York Times article cites the postpartum period as maternity’s most dangerous time—a finding that underscores the significance of managing risks after the birth of the baby. This calls for changes in the nature of maternal care in the United States.

It also calls for the exploration of the source. Unfortunately, the fixation on the birthing experience suggests that, latent within current efforts to combat the maternal health crisis is the desire to protect the infant alone. This unconscious belief, when coupled with the United States’ lack of a national standard for paid maternity leave, highlights a casual disregard for birthing people once they are no longer attached to the child. Birthing people cannot keep up with routine checkups when they must worry about clocking into work to put food on the table for themselves and their growing infant. This is most likely to impact birthing people who are already marginalized—like those belonging to low-income families. 

The factors outlined in the piece leave additional hints about which members of the population are the most vulnerable during this period. According to the piece, those who start pregnancy with chronic medical conditions are more likely to deal with complications after childbirth. Statistics on the racial disparities present for conditions like diabetes and hypertension, unfortunately, paint a bleak picture. Black birthing people are undoubtedly among the people of highest risk, which necessitates further study and care into the postpartum period.

Luckily, solutions are ever-present. With growing conversations about coverage for doula care, we should consider the unique contributions of postpartum doulas to maternal health and wellness so that Medicaid coverage, which key stakeholders are fighting to secure for birth workers, is not limited to perinatal care alone. The number one factor that heightens the health and safety of a birthing person during a time of great vulnerability is continuous care. Acting on this knowledge is key if we wish to touch on all the factors contributing to the United States’ worsening maternal mortality crisis. 

Postpartum doulas work to provide families with useful information for the period following childbirth. This includes information about infant feeding, physical and emotional recovery from childbirth, soothing measures for infants, and coping skills for parents adjusting to the arrival of their baby. This all falls under the umbrella of social support, which is said to be a significant predictor of the development of postpartum depression. In a nation that often siloes dimensions of community and leaves birthing people isolated within their personal spheres, having a postpartum doula is invaluable. It means that, at that very least, there exists a safe space for parents to express their feelings, concerns, and fears. It also means that there is one space where they are met with empathy, reassurance, and non-judgmental listening.

It is well known among birth workers that the fourth trimester, or the first twelve weeks after childbirth, is critical for setting the foundation for long-term health. This discovery is a product of the restructuring of research efforts, and so the goals they inform must follow suit. What this means is that bringing mothers and birthing people to a safe delivery is the bare minimum and not the ultimate goal, in the fight against maternal mortality.

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