Maternal Mortality in America and the Crisis for Rural Women | Linda Robinson | TEDxDirigo

2008 I'm working in Congo with women traumatized by war my first delivery a young woman refused to push her baby out and I did not know why I asked the local midwives and they told me her first child died while they were running from the my my local doctors here cut women open with no anesthesia and they died she is scared this story is shocking but not uncommon with women traumatized by war and I thought then there is nothing that compares to this in my country but I was wrong it's 2014 I'm working in Maine a woman who had just moved here was pregnant with her fourth child her first birth was normal vaginal everything was fine her second was breech and she agreed to a c-section her third she wanted a VBAC a vaginal birth after cesarean but was not allowed that option so against her will she had a repeat c-section and then suffered a severe postpartum depression pregnant again she is scared she is so scared she's considering staying in a camper with her three kids to be near the only hospital that will support her decision in New Hampshire and I thought we traumatized women in my country too we just put a cleaner face on it when I tell audience is the first story they often ask me what can we do when I tell them the second silence the horrors in Congo were so great I was worried about coming back and working here I was afraid I would have no compassion at all instead I began to see some parallels some universal unfairness for what happens to women in a health your system when I left Congo I promised the women I would tell their story I felt it was the only lasting good I could do to raise awareness of what happens to women affected by war and I've done that I wrote about it and they speak about it and now I feel I have to tell a story of women right here in the United States the maternal mortality rate is rising we are one of eight countries where this is so here it has tripled since 1980 why poverty lack of access to prenatal care and disappearing services in rural areas native and African American women died at triple the rate of white women when I spoke to an audience of midwives two years ago someone asked me what was my biggest frustration with our health care system and I told him I have many but I used the example of VBAC this practice once commonplace has been banned in many hospitals and many many women are forced to have repeat c-sections they do not need we watch as women are wheeled into the operating room often against her wishes forced by our system to have major surgery which puts her and her baby at increased risk I told this audience I would no longer call this unnecessary surgery I will start calling it what it really is mutilation we are mutilating women for profit and convenience I said none of us agree with this practice but we watch it happen yet if we saw someone coming at a woman on the street with a knife we would call 9-1-1 we can argue with those in power we advocated policy meetings we cite all the data and still she gets wheeled into a room where her life is at risk for money and the last time I watched this I thought if she dies this we'll be manslaughter she was emotionally manipulated into agreeing to the surgery nobody wants their baby to die no woman goes into childbirth wanting to die so when a person in power says to her if you attempt a vaginal birth your baby could die of course she says yes the World Health Organization estimates that between 6 and 15 percent of c-sections are necessary and the rate in this country is now 34 percent and women are dying from complications from those surgeries I am calling 9-1-1 after 23 years I quit a job I loved I agonized for a long time making that decision I had a comfortable life I was working in the Women's Center I helped create with women I loved I love my patients I love my community I had it all but over the last decade I have watched as improvements made in women's health started disappearing for profit outraged I spoke out at meetings I lobbied in Washington I yelled in the hallways I realized I was working in a system whose values I no longer shared and I was angry poor women do not have the luxury of expressing anger in a system that abuses them they are labeled and judged and unwelcomed so was difficult as it made me to work with I felt it was my job to do it for them when I was a public health nurse in Peace Corps our goal was to have a maternity clinic situated so that no woman would have to walk more than five miles in labor and this would take her about an hour and a half now consider a rural woman who traveled to Bar Harbor for her pregnancy she was poor though she and her husband both worked full-time and physically difficult low-paying jobs they had unreliable transportation the hospital closest to her refused to care for her baby so she travelled almost two hours to get to this hospital where she hoped to have a vaginal birth she had had previous c-section for breach but her chances of delivering vaginally were excellent I advocated and fought for her safety and right to a vaginal birth but under pressure she agreed to a repeat c-section that then put her at increased risk for blood clots infection chronic pain and death but it was convenient and profitable surgical birth carries a higher risk than vaginal birth for mothers and babies long-term risks surgical complications are a factor in the rising maternal mortality rate in this country a woman has a three times greater chance of dying if that birth is by cesarean yet this statistic rarely if ever gets included in the information we call informed consent when the natural birth movement took hold in the 1980s hospitals got on the bandwagon because there was competition for deliveries since women are loyal to the place they deliver and they make most of the health care decisions for the family so this made economic sense but when insurance reimbursement changed maternity care became more costly for hospitals with low volume and many in rural areas eliminated those services altogether and now poor and disadvantaged women must travel sometimes over two hours to get to a facility where they can deliver safely they have no money for gas they have no one to care for their other children they go without prenatal care they have so much anxiety about getting to the hospital in time they are being scheduled for induction of labor or a c-section and their risk of dying than triples maternity care may be expensive to provide but every single study out there demonstrates that natural birth at full term results in healthiest mothers and babies and this means having services available and yes this cost money cardiac arrest cost money too but we don't eliminate those services what I want to know is why aren't hospitals asking what we can do to provide this service in a way we can afford there are solutions out there it is estimated by the World Health Organization that if we increase the number of midwives in the world by 25% we will reduce maternal mortality by 50% this is not a rare disease this is pregnancy a normal condition 80% of women will experience in her lifetime it does not matter that numbers are low in rural areas all women deserve a safe and respectful way of giving birth it is a basic human right so I hope you're all now asking what can we do you can call 9-1-1 it's time reach out there is a sister nearby who needs you start a support group take time to meet and brainstorm about how we can help each other we are better off when the poorest among us are better off drive someone to her appointment start a childcare co-op be a mentor demand to have women's health services available in your community including a midwife driving two or more hours in labor is torture and to my colleagues in health care make this a priority combined our voices will be harder to ignore thank you


  1. I had a home birth in Arizona with a private midwife. ♡ Perfect home birth. I Love my Midwife! All of my friends have had c sections, and repeated c sections in hospital. This is why I had a safe home birth with a professional midwife I trust.

  2. I'm going to Canada to give birth. I'm sure it's less expensive and I'll have a better chance of surviving

  3. I'm sorry but if your American and don't have enough money for transportation or even to hire a sitter for a day or two you should NOT be having a child. I think bringing a child into poverty should be considered abuse. At the same time, condoms and birth control should be free and accessible to avoid the abortion option or raising children in unsafe and poor conditions.

  4. It is not solely low-income, racial minority women who are being exploited and abused by opportunists in the medical profession. Well-insured white women are being told scare stories and denied safe cancer screening, to force them against their wishes to have mammograms. Then this ends up in many cases of their being subjected to unnecessary medical interventions: mutilating surgeries, "overdiagnosis," "chemotherapy," increased frequency of exposure to low dose ionizing radiation that is far from harmless, and implants that can cause a "rare" cancer.

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