Maternity mortality in the United States in the year 2019
Welcome to SBH Bronx Health Talk produced by SBH health system and broadcast from the beautiful studios at st. Barnabas Hospital in the Bronx I’m Steven Clark.
According to a recent report in USA Today the United States is in the midst of a maternal mortality crisis death rates for new mothers has nearly doubled over the past two decades about 700 new mothers die every year and 50,000 other women are severely injured during childbirth my guest today is Yael Offer a midwife at SBH health system. Welcome Yael.
Thank you for having me.
So how is it that new mothers in the united states the world’s wealthiest country are suddenly at risk?
It is a shocking statistic when you hear it and very surprising there are a number of factors that contribute to the increasing death of mothers some of them are systemic and institutionalized including access to care especially in more rural areas but we also know that systemic racism is a cause of this hence we see the huge disparities between white women and black women and women of color in the United States and in New York City.
Now we’ve spoken about this before how african-american women have been disproportionately affected three times more likely to die from pregnancy or birth complications than white women and I know it’s not simply socio-economic because you hear stories like Serena Williams the tennis star who was close to death when she gave birth to her daughter a year or so ago so why is this?
So it’s actually 12 times higher in New York City and we know that the disparities get larger as the as women go up on the socio-economic ladder so that maybe white woman who is upper-middle class will get better care but her black counterpart will not so we see that the way women are treated the way women are responded to in you know crisis during the pregnancy and also not during crisis these really affects the quality of care they get and really hinders them and we see that statistically.
Studies regularly show that midwives are an effective way to keep new mothers safe I know Governor Cuomo impaneled the task force on this issue that included incentivizing midwifery training and recognition of the important role midwives play how so?
Midwives are crucial first of all most deliveries in Europe and Canada are in the hands of trained midwives unfortunately midwifery in the U.S. is still a very disenfranchised profession with only about 10,000 midwives across the United States. there just has not been funding and support for midwifery training although we are hoping to change up because we do see over and over that women have better outcomes with midwives and we are trained specifically for low-risk women although we do co-manage for higher risk women and we are experts in normal birth we are experts in identifying when things go wrong and we very much base our care on relationships and trust and believing women.
Now again a lot of people I think have the misconception of midwives you know in the plantation fields you know 150-200 years ago but tell us the kind of training that goes into becoming a mid-wife today.
Right, in the U.S. you have to be a nurse first and foremost and I’m very proud of my nursing degree but then you go on to get a masters in midwifery and that can be a 2 or 3 year education process so we are trained professionals. We do have all the necessary means to ensure a safe and successful pregnancy and labor for a woman and most of us work in hospitals although I do have history working at a birthing center and home births but most of the midwives work in hospitals.
What is the role of the midwife in relation to the obstetrician?
So especially when we have a woman who is high-risk you know so she’s either developing complications associated with blood pressure or sugar issues so the doctor has the necessary means to really help with that medical issue so we’ll co-manage at St. Barnabas. The midwives do most of the deliveries if we feel like there’s for any reason something that is an emergency that we cannot handle the doctor is called in although many emergencies that women face midwives are trained to assess and handle independently. So the doctors and midwives we both have really important different roles but we all have the goal of ensuring you know good outcomes for our mothers and babies.
Well when you decide to deliver in a hospital like at St. Barnabas Hospital do you get matched with the Midwife?
We have about seven wonderful midwives right now they are in our clinics and a lot of times you will see the midwives for prenatal care if you become high-risk a lot of times you do continue with a midwife being co-managed with a doctor but if for whatever mean or whatever reason you need to see solely a doctor you’ll continue with the doctor but most of our women here are cared for by midwives and delivered by midwives.
Do you think in the Bronx pregnant women are aware of the role midwives play?
I think there’s confusion and I don’t think it’s only in the Bronx I think it’s in the United States. Doulas and midwives get confused very often. Doulas are extremely valuable and important, however different, they are more like coaches that provide maybe some emotional and physical support but they are not medically trained. They train, they don’t supervise the pregnancy although very important and I think there is confusion between midwives and doctors because we work so closely together and our health system doesn’t really support midwives a lot of times. It’s confusing if you are getting care from a midwife and as we get more and more independence as a profession and respect also midwifery care will be able to be given rather than obstetric care given through midwives but rather midwifery care through midwives.
I read that only about 8% of the U.S. births are attended by midwives I guess in other countries it’s much higher than that?
Yes if I’m not mistaken I think it’s almost 80 to 90 percent in Europe and Canada and that eight percent is not quite accurate because in some states women are midwives rather are not autonomous rather they are supervised by doctors for example in California. so in California if a midwife delivers the baby the doctor will sign off on it so no one ever knew that a midwife was part of that delivery. In New York midwives are autonomous we do not need supervision by ob/gyn so we are counted for when we are in a delivery.
So let’s talk about the relationship again a woman comes into a hospital like st. Barnabas Hospital and they’re paired with a midwife how does that relationship continue over the course of her pregnancy?
Right so most of my clients as I like to call them because I do believe they are choosing me. Most of my clients or patients I see throughout their entire pregnancy. So we develop a relationship over nine-ten months where they trust me and I trust them and I listen to them and I give them information and I trust that they with all the information can make the best choices for themselves and we know also again from studies done that a trusting relationship between providers across all fields leads to better outcomes so it’s important that relationship and it’s a crucial part of midwifery.
I’ve also read that there’s also bottom line benefits not only as far as safety goes that we talked about earlier but associated with lower rates of c-sections and other interventions that can be often costly risky and disruptive to the birthing process
Correct, care by midwives shows lower what we call low birth weights preterm deliveries, lower c-section rates, healthier pregnancies which is obviously you know important because we want our women and our babies to be healthy but also if we look kind of economically
it’s also beneficial for the hospitals so midwifery care makes sense on all levels health care wise as well as economically for our communities.
Now Medicaid covers all midwifery services right?
Correct, I think there are some limitations in our reimbursement rates. I think it’s only eighty percent compared to doctors obstetricians who receive a hundred percent and for trained midwives like myself if I was to do a home birth which is a woman’s right I do not quite know the specifics but we are not fully reimbursed by Medicaid and every insurance company is different whether they will cover that right that a woman has to choose where she delivers if she qualifies for an out- of-hospital birth.
Does that ever happen that a woman comes here for prenatal care and then says you know what I’d like to get birth at home?
We do not really see that, especially because none of our midwives here have home birth practices although there are plenty of amazing midwives one that I have worked with here in New York City that do home deliveries at you know in for the five boroughs and actually one of those midwives who’s been a midwife for 30 years used to work at St. Barnabas and now has a home birth practice.
How did you get involved in this in midwifery?
Midwifery I always deeply deeply cared about women’s health and women’s rights and I felt you know as a woman growing up that I could see that sometimes there were disparities and I you know remember having really bad cramps myself when I was younger and felt like you know I wasn’t being listened to and I felt like also you know everything in my body is one whole associated with how I’m feeling mentally physically emotionally and I encountered midwifery. Actually when I was studying abroad and there was a French professor and leader of the largest maternity ward in Paris who wrote a book about out of hospital nonviolent maternity care and that’s when I started really thinking about what maternity care could be and what it should be.
Okay to get more information about midwifery at St. Barnabas Hospital or to make an appointment is there a phone number people can call?
Yeah, well there’s the website that you can always go to www.SBHny.org. You can also call to make an appointment 718-960-1669 that is the OBGYN extension line for appointments there’s also the general St. Barnabas number 718-960-9000.
Okay well thank you Yael.
Thank you for having me and looking forward to supporting midwifery care throughout the United States.
Great, again for more information on maternity or other services available at SBH health system as Yael mentioned, visit www.SBHny.org. Thank you for joining us!
Thank you for having me!