The conditions of the United States’ maternal health landscape call for solutions. Not only are birthing people dying at exceptionally high rates, but many of those who survive are often left to heal psychological, and in many cases, physical, wounds. 45% of new birthing parents experience birth trauma, with effects often continuing long after the event of childbirth itself. Diminishing this number requires an effort to redesign current structures of care as they stand. Amy Romano, Dr. Andrea Jones, and Amy Clark, who are among the thought leaders catalyzing this work on the ground, joined Mama Glow Founder Latham Thomas at the Doula Expo, where they discussed the pillars of respectful maternity care in a conversation presented by CVS Health.
Among the pillars is the implementation of intersectional approaches. In other words, key players must work to acknowledge the maternal health crisis in its full scope, among all people affected.
“The conversations that we’re having are not about just one particular type of person,” said Thomas. “We’re also not talking about an issue that affects one particular population. When we think about birth, we’re thinking about maternal health, and the impact that we need to make, we’re talking about all of us. This is a space where we can talk about how we affirm and lift up respectful, helpful, equitable, affordable, and dignified maternal health care.”
In addition to the unique manifestations of the maternal health crisis among different populations of birthing people, Thomas urges the acknowledgement of the various identities. Not all birthing people identify as women, and panelists were sure to honor this by incorporating inclusive language.
Amy Romano, Founder and CEO of Primary Maternity Care, cites the antiquity of the prenatal care model as the root of the biomedical model’s current distance from optimal maternity care. With the current model, visits are progressively getting shorter and shorter, despite the importance of continuous, comprehensive support. Romano’s midwifery background gives her glimpses into what equity-centered approaches to maternity care could look like. “I have taken care of pregnant people. If I think of it as my job to help the person be as healthy as possible and have the healthiest baby, I should be thinking about her as a whole person, and this family as a whole family and everything that touches them and their well-being. That, of course, is everything I can do as far as testing and monitoring at the prenatal visits, but it’s also all the wrap-around stuff.”
The “wrap-around stuff” Romano emphasizes was referenced from a previous talk by Dr. Amanda Williams, Medical Director at Mahmee. The two believe that addressing social needs is about both creating additional structures of support and wrapping around existing ones—like the hospital setting.
Once we design environments conducive to respect and empowerment for birthing people, said Romano, pregnant people will walk out of prenatal visits with a sense of confidence about knowledge of what is happening to them and their baby.
Practicing obstetrician and gynecologist Dr. Andrea Jones, who also is the Medical Director of Medical Policy and Operations at CVS Health, evaluated the clinical aspects of the birth experience. “I think we focus so much on the clinical aspect [of childbirth]. And then we forget what a joyous experience it is supposed to be. The baby’s birth date is actually the one day that you get to celebrate. The rest are anniversaries. So, let’s make this happen.” In other words, fixating on the clinical aspects divests the experience of joy—which all the panelists agree is every birthing person’s birthright.
Jones also delved into the limitations of structuring care within a fixed time frame. “What I want to get away from is the nine-month window. Yes, pregnancy is on average, nine months. But we shouldn’t be focused on just getting that birthing person to the end of that nine months. It should be more holistic.” With prenatal visits comes the opportunity to improve lives long after pregnancy and childbirth. “We now know that when you get certain conditions during pregnancy, like gestational diabetes, hypertensive disorders, that that makes your risk of getting those conditions chronically more long-term. I see the pregnancy, especially because some birthing people come to the doctor for the first time for prenatal care, as an opportunity to prevent some of the more chronic, long-term issues.”
Equally as important is the understanding that doctors are a part of a collaborative effort, regardless of intent. The care for birthing people starts at the desks that birthing people must get past to see their physicians, and extends to the nurses, physician assistants, midwives, doulas, and other hospital staff.
Amy Clark, Lead Director of Community Impact and Philanthropic Partnerships at CVS Heath, touched on the unique contributions of community partners to optimal models of care for birthing people. Community partners are key in re-establishing a sense of trust between vulnerable populations and systems.
“We work with healthcare systems and community non-profits because we know that change happens at the speed of trust. And that means that we need trusted partners to work with us, because if there is no trust, we won’t get very far. “There’s centuries of mistrust between birthing persons and the people who deliver care for them. We know that, fundamentally, there’s a lot of instances where there is broken trust due to bias, discrimination, and racism. That’s the first thing that we would need to be aware of. If we don’t address that, we can change policies and develop the most advanced practices, but we are not going to get very far.”
Designing a system that prioritizes respectful maternity care is not an easy feat, but it is absolutely necessary. The Doula Expo by Mama Glow is about working towards these realities in the present. “We’re not just going to sit back and wait for policy change, and wait for legislation to catch up. We’re going to design our own solutions. We need stakeholders like these and community to help us get there.”