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Obstetric Supremacy vs Respectful Maternity Care


Americans who read The Unequal Distribution of Health in the Smithsonian Magazine may be shocked to learn that US women today are 50% more likely to die in childbirth than their mothers, and that our death rate is 3 to 5 times higher than European countries. They may have thought this was a tragedy only in the Black community and not a problem with obstetrical practice in the US. Most Americans also do not realize that we are the only country where 90% of births are attended by physicians instead of midwives.

To a retired Black Obstetrician, and a student of the history of Obstetrics and Midwifery, what is almost as concerning as the racism in obstetrics is the lack of attention to the failure of Obstetricians to critique their own management of maternity care. There is a lack of awareness of what has transpired since the pathologizing of pregnancy and birth, and the virtual elimination of midwifery practice in the US one hundred years ago. Yes, Black women are mistreated more than whites when accessing healthcare and we need culturally congruent and community-based care, but all women are at risk for mistreatment and harm, and the majority of those who die or suffer complications of pregnancy are white women. If doctors were faced with the clear connection between their interventions, patriarchy, and racism, and the rising maternal death rates of all mothers in the US, might they begin to employ the solutions advised by Black Midwives and Birth Justice Activists who are leading the charge to transform hospital based obstetrics to respectful maternity care?

Let us spotlight the flawed obstetrical experiment of medicalization of what is for 85% of birthing people a natural, powerful, joyful, and nonmedical life experience. Let us shine a light on rising c-section rates, labor inductions, traumatic births, and postpartum depression. Let us publicize the surveys of women which report verbal and physical abuse (known as obstetric violence) when giving birth in the hospital, especially when they try to assert their rights to bodily autonomy. This is an American problem, a lack of accountability and oversight of our medical and maternity care industry.

When we only focus on the racism in medicine and call it a problem for Black people, we allow doctors and hospitals to deny their complicity in perpetuating our dismal maternal mortality and severe morbidity statistics. That’s because most white Americans in the medical professions are in denial about their own bias, and they still believe that Black people are to blame for poor health outcomes. Doctors believe they are the best trained and educated to care for women, and midwives and out of hospital birth are the lesser options. Our statistics and studies of Midwifery care show otherwise. The American College of Obstetricians and Gynecologists (ACOG) has recently begun to change their guidelines to lessen obstetric intervention in order to reduce c-section rates, but they have no means to change the long held belief of Obstetricians in Active Management of Labor. ACOG also has a strategic plan to address racism, but it can not change the power differential which doctors cling to and the biases they deny.

Let’s call attention to Doctors’ and Hospitals’ controlling policies and procedures, along with the patriarchy and racism embedded therein. We can shift the narrative and revisit the safer and more supportive option for low-risk mothers – the traditional midwifery model of care which has served human beings for millennia. We can reduce the obstacles faced by people of color to a career in midwifery and establishment of birthing centers. Midwifery works for the rest of the world so why not the US? Let’s end Obstetric Supremacy.