Volume 111

Disasters Lying in Wait: Over-Medicalization of the Birthing Process and the Lifesaving Practice of Midwifery

by Fulton Wald

A midwife looks at a pregnant woman and sees a beautiful, normal, physiological, wonderful event about to happen …. An obstetrician looks at a pregnant woman and sees a disaster lying in wait for them. If you’ve got these two health care professionals working together as a team and meeting in the middle, what you end up with is really good health care. 

— Sally Collins, Associate Professor of Obstetrics, University of Oxford Footnote #1 content: Kate Womersley, Why Giving Birth Is Safer in Britain Than in the U.S., PROPUBLICA (Aug. 31, 2017, 8:00 AM), https://www.propublica.org/article/why-giving-birth-is-safer-in-britain-than-in-the-u-s [https://perma.cc/E74H-FNC5]. 

In the United States, physicians preside over 90% of births, yet the country paradoxically has the worst maternal and infant mortality rates of any wealthy nation, with risks up to three times higher for Black and Indigenous American women. Footnote #2 content: See Sandi Doughton, The Case for Midwives: Washington State Leads the Nation in Midwifery Care, SEATTLE TIMES (Mar. 15, 2020, 7:00 AM), https://www.seattletimes.com/pacific-nw-magazine/ the-case-for-midwives-washington-leads-the-nation-in-midwifery-care-giving-women-another-childbirth- option/ (“[There are] rising levels of complications and premature birth; C-section rates more than twice the recommended level; a looming shortage of obstetricians; and sky-high spending.”); see also Christopher Ingraham, Our Infant Mortality Rate is a National Embarrassment, WASH. POST (Sept. 29, 2014, 10:38 AM), https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate- is-a-national-embarrassment/ (citing a Centers for Disease Control report finding that the United States has a “higher infant mortality rate than any of the other 27 wealthy countries”). This Note acknowledges that not all pregnant people are women, nor are all people who are able to become pregnant women. By referring broadly to “healthcare” and “patients” wherever possible, we remember that many people encounter the obstetric and midwifery care systems discussed in this Note. However, in line with the Trans Journalists Association’s guidelines, this Note retains gender-specific language (e.g. “pregnant women”) if discussing a study that only includes cisgender women. It also retains “maternal mortality” as a term of art. See Statement, Trans Journalists Ass’n, TJA Best Practices  This problem has only worsened over time—maternal mortality rates in the United States have almost doubled in the last twenty years, with 60% of these deaths estimated to be preventable. Footnote #3 content: See Sofia Jeremias, The Rise of Midwives in Rural America, DESERET NEWS (Sept. 2, 2021, 12:00 AM), https://www.deseret.com/2021/9/1/22650628/the-rise-of-midwives-in-rural-america-nurse- midwifery-maternal-death-rate-medicine [https://perma.cc/84Y2-MBX7].  A myriad of issues contribute to these mortality rates. The U.S. for-profit healthcare system creates high financial barriers to access and wealth inequality gaps are at an all-time high; people of color in the United States are disproportionately impacted by poverty, and this results in people of color disproportionately dying in childbirth due to structural barriers inhibiting their access to prenatal or postnatal care. These mortality rates are indicative of the nation’s long history of reproductive violence against people of color, particularly Black women. From its legacy of slavery to forced sterilizations and the overturning of Roe v. Wade, Footnote #4 content: See Dobbs v. Jackson Women’s Health Org., 142 S. Ct. 2228, 2242 (2022).  U.S. institutions continue to harm people of color. While many different tactics on various institutional levels are needed to combat these issues, this Note highlights midwifery as an essential part of the solution to high U.S. maternal and infant mortality rates. Footnote #5 content: This Note does not pretend to address all aspects of U.S. maternal and infant mortality rate disparities. Rather, this Note centers the specific crisis of Black women’s birth outcomes in Southern states. Additionally, while a focus on Southern Black women of course includes Southern Black disabled women, trans people, and other intersecting identities, this Note does not intend to address the unique challenges these Americans face in accessing pregnancy care—instead, the author invites future research and scholarship in the area. 

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Wald Note, Disasters Lying in Wait