Why we must support MOMS
700: the number of women in the United States who die every year during pregnancy, birth, or in the first few weeks after birth. In the wealthiest country in the world, in a country that spends more on healthcare than all other wealthy republics in the world, 700 women die annually, and for every one woman who dies in pregnancy or childbirth, another 70 come very close to death because of a life-threatening pregnancy complication. Among our peer developed nations, the US has the highest maternal mortality rate (maternal mortality refers to deaths due to complications of pregnancy or childbirth). While many US citizens believe that the maternity care in this country is of the highest caliber and quality, consider that we rank 56th in the world as far as maternal mortality (tying with Romania, Moldova, Latvia, and Ukraine), meaning 56 other countries have better outcomes, yet we are the top spender on healthcare. Hard to believe right? How can this be? Allow me to enlighten you if you are hearing these statistics for the first time.
The disparity in maternal health, particularly among underrepresented minority women, is a main contributor to the grim statistics. Black women die at a rate three times higher than their non-Hispanic white and Hispanic counterparts. Women over age 40 die at a rate of nearly eight times that of women under the age of 25. Native American women have twice the risk of dying from pregnancy-related causes. Not only are women of color affected by higher mortality rates, but preterm birth rates are significantly higher among Black, Hispanic, and American Indian/Alaska Native women. Black women bear the greatest burden of preterm birth, with a preterm birth rate 50% higher than that of all women combined. And the most alarming fact about all of this: approximately 60% of those 700 annual deaths are preventable.
Another major contributor to the high maternal mortality in the US is the lack of access to quality maternity care. Women who live in any of the 35% of U.S. counties lacking any maternity care services, in addition to another 11% who have very limited access to quality services, face real danger in pregnancy and childbirth. Lastly, a major contributor to the rise in maternal morbidity and mortality rates is the increase in, and widespread use of, unnecessary intervention, which includes cesarean section. As compared to our developed country peers, we have one of the highest cesarean birth rates in the world at 32.2%. Lest higher cesarean rates are equated with “safer” birth, consider also the high maternal mortality rates in the US – a high cesarean rate does not equate to safer birth. Norway for example, a country with one of the lowest maternal mortality rates, has a very low cesarean section rate of 6.6%.
The outlook is also not good for the future availability of maternity care providers and services; the US is heading straight towards a critical shortage of providers, which includes midwives, family practice physicians who provide maternity care, and obstetrician-gynecologists. While the national birth rate is predicted to grow, the number of providers available to provide care for them is declining in proportion.
Enter good reason to support the Midwives for Maximizing Optimal Maternity Services (MOMS) Act, introduced in Congress on May 19, 2021, by Representative Lucille Roybal-Allard (D0C) and Jamie Herrera Beutler (R-WA). Midwives have a proven track record of providing quality care – both in the US and globally. Numerous studies have demonstrated excellent care, resulting in improved pregnancy outcomes, among populations of women cared for by midwives. A 2018 study demonstrated that the US states with the highest proportion of midwives, and thus a higher percentage of midwife-attended births, also had the highest rates of best maternity outcomes, measured by higher vaginal birth rates, lower cesarean birth rates, lower numbers of newborn deaths, and premature births. Not only does the care provided by midwives result in superior outcomes, but it is also economical, particularly compared to the current cost model in the US.
The MOMS act provides for two new funding paths specifically for the establishment and expansion of accredited midwifery programs, with the result of educating more midwives, and increasing the U.S midwifery workforce, particularly within Historically Black Colleges and Universities. Pregnant individuals deserve to be cared for by providers with whom they can identify, who look like them. Numerous studies have shown improved outcomes when providers and patients are racially concordant.
We cannot afford to take a “wait and see” stance on this issue; Congress must commit to a solution that serves women and families; 700 mommas who will never see their babies grow up is too high a price to pay. Take the time to contact your legislators to urge their support of H.R. 3352/S. 1697 now and help make pregnancy safer for U.S. women.
About the author
Michelle Collins, Ph.D., CNM, RNC-EFM, FACNM, FAAN, FNAP is also the Dean and Professor of College of Nursing and Health Loyola University New Orleans