In a developed and resourceful country like the United States, it’s difficult to imagine that we are experiencing a maternal health crisis. However, that is the reality we face, with maternal mortality rates not just rising but reaching alarming levels. What’s even more concerning is that women of color and those in rural or underserved areas are disproportionately bearing the brunt of this crisis. For many women in America, pregnancy isn’t just about bringing a new life into the world; it’s also about navigating a healthcare system that often feels broken, unkind, and even dangerous.
As someone who has supported hundreds of women as they welcomed their babies into the world, this crisis is not just a statistic for me—it’s personal. Women deserve better, and we must demand it. So, what is going wrong, and how can we make it right?
A Grim Reality
Maternal mortality is the death of a woman during pregnancy or within a year after the pregnancy from complications related to pregnancy or childbirth. In the United States, the maternal mortality rate was 23.8 deaths per 100,000 live births in 2020. This is alarming when compared to countries like the U.K. and Canada, where the numbers are much lower. What’s even more shocking is that Black women in the U.S. are nearly three times more likely to die from pregnancy-related causes than white women. This statistic alone highlights that the U.S. healthcare system is failing our most vulnerable mothers.
The tragedy is that most of these deaths are preventable. It’s not just about a lack of medical technology or resources; it’s about a lack of empathy, equitable care, and timely intervention. Women are being silenced, dismissed, or ignored when they express concerns during pregnancy and labor. For Black and Indigenous women, this often means not receiving life-saving treatments in time, if at all.
Why Is This Happening?
There is no simple explanation for the rise in maternal deaths in the U.S. The causes are as complex as the women affected, revolving around three central issues: systemic racism, healthcare access, and social determinants of health.
1. Systemic Racism in Healthcare
The current crisis is largely influenced by racism, which leads to Black and Indigenous women being overlooked or disregarded when expressing concerns during pregnancy or childbirth. Studies have shown that these women receive less pain relief, inadequate follow-up care, and are more likely to have their symptoms dismissed. The statistics are alarming, but the real stories behind them—mothers who sought help but were ignored—are even more heartbreaking. It’s difficult to imagine entering a hospital with trust, only to be dismissed because of the color of your skin.
The healthcare system was not designed with marginalized communities in mind. It’s time to acknowledge this as a significant issue and address the systemic biases that result in these tragic outcomes. While training medical professionals to recognize and challenge their own biases is a step in the right direction, real change will only occur with a complete transformation in how care is provided to all women.
2. Access to Care
Geography significantly impacts the options available to pregnant women in the U.S. For those residing in rural areas, access to obstetric care is often severely limited. Shockingly, over half of U.S. counties do not have a hospital equipped with a maternity ward. As a result, women in these areas may face long drives, missed work, and increased costs in order to obtain prenatal care, if they are able to access it at all. These “maternity care deserts” put women at a higher risk of complications during pregnancy and childbirth simply because they cannot access the necessary care.
The alarming closure of rural hospitals has left pregnant women with few alternatives. The lack of access is not only about distance but also about quality. When hospitals lack specialists such as obstetricians or maternal-fetal medicine doctors, pregnant women may have to rely on general practitioners who may lack the experience or resources to handle complex pregnancies.
3. Social Determinants of Health
It’s important to acknowledge the impact of social factors on maternal health. Issues such as poverty, food insecurity, lack of transportation, and inadequate housing all contribute to negative outcomes for pregnant women. These challenges are further intensified by the chronic stress of living in poverty or under systemic oppression. Stress isn’t just an emotional state—it has measurable effects on the body, increasing the risk of conditions like preeclampsia and gestational diabetes, both of which can be life-threatening if left untreated.
The high cost of healthcare in the U.S. worsens the situation. Even for many low-income women with Medicaid, the out-of-pocket expenses for prenatal visits, medications, and hospital stays can be overwhelming. Additionally, the cost of taking time off work, finding childcare for existing children, and traveling to distant medical appointments further compounds the challenges, contributing to why so many women are unable to access the care they need.
The Growing Mental Health Crisis for Pregnant Women
Another important aspect of this issue is mental health. Anxiety, depression, and postpartum mood disorders are more common than we acknowledge, and they are often overlooked in discussions about maternal health. A leading cause of death in postpartum women is suicide, and we need to improve the screening for these conditions and provide support long after the baby is born. Pregnancy involves not only a physical journey but also a mental one, and too many women are facing it alone.
Postpartum depression (PPD) affects up to 1 in 7 women, yet many remain undiagnosed or untreated. Women of color face even greater barriers to mental health care due to cultural stigma and a lack of access to mental health providers who understand their unique challenges. It’s time to start considering mental health as a fundamental part of maternal health, not an afterthought.
The silence surrounding postpartum depression is perilous. It reinforces the misconception that new motherhood is solely joyful, while in reality, the physical and emotional toll can be overwhelming. Many women may not even realize they are suffering from postpartum depression because society tells them they should be happy. We need to create more safe spaces for women to discuss these struggles and access the mental health care they need, free from judgment or stigma.
Efforts to Combat the Crisis
The government has taken some steps to address the maternal health crisis with initiatives like the White House Blueprint for Addressing the Maternal Health Crisis. However, these efforts seem inadequate. Both political parties have failed to prioritize maternal health and take substantial action to prevent unnecessary deaths. While the blueprint does emphasize reducing racial disparities in healthcare and improving access to care in rural areas, we have yet to see the comprehensive changes needed to save lives. Extending Medicaid coverage from 60 days to a full year for postpartum care is a positive move, but it’s just a temporary solution for a broken system where complications often arise long after delivery, leaving many women without the necessary support.
Policies aimed at improving maternal health have consistently fallen short, whether due to lack of funding, political disagreements, or a lack of genuine commitment to women’s health. We are still waiting for the U.S. government to take meaningful action. Maternity care should not be a low-priority issue that is only raised during election seasons and then forgotten. The lives of women depend on consistent and targeted policies that address the underlying causes of maternal mortality.
On a positive note, grassroots organizations are making important strides. The Black Mamas Matter Alliance (BMMA) has been a leading advocate for better care for Black women, altering the discourse and advocating for real policy changes that prioritize community-based, culturally competent care. SisterSong focuses on reproductive justice for women of color, emphasizing the intersection of race, class, and gender in maternal health. Every Mother Counts works to ensure safe pregnancy and childbirth for all mothers through advocacy, education, and community-based programs. Lastly, The National Birth Equity Collaborative (NBEC) promotes solutions that address racial disparities in maternal care by amplifying Black voices and ensuring respectful, equitable healthcare. These organizations demonstrate that when we prioritize the voices and needs of the most marginalized, everyone benefits.
U.S. Hospitals: Cold, Corporate, and Impersonal
In the US, hospitals are often thought of as the safest place to give birth, but this overlooks the impersonal nature of many hospital environments. Hospitals, as large corporate entities, often treat patients like numbers rather than individuals, especially in overcrowded maternity wards. Many women feel that their concerns are overlooked in favor of medical protocols designed for efficiency, rather than personalized care, leaving them feeling like cogs in a machine.
Midwives, particularly those working in midwife-run birth centers or providing home birth care, offer a contrasting experience. Midwives spend more time with their clients, focusing on building a relationship and understanding their specific needs, desires, and concerns. They listen in a way that can feel rare in hospital settings, and this personalized, compassionate approach makes a difference. They are not restricted by the fast-paced, assembly-line model common in hospitals, allowing them to truly listen to their clients, creating an environment where mothers feel heard, respected, and supported.
It’s not just about making birth feel more supportive; it’s about improving outcomes too. By ensuring that women are heard and respected throughout their pregnancy and delivery, midwives are in a better position to spot potential issues early, which could be crucial in addressing the maternal mortality crisis. Birth should be an empowering experience, not a rushed one, and the personalized care midwives provide can play a critical role in ensuring that more women survive and thrive in the process.
Community and Midwifery: A Path Forward
I have personally witnessed the impact of personalized and compassionate care as a midwife. There is a crucial need for the inclusion of midwifery and doula services in mainstream maternal care. Midwives offer comprehensive, continuous care throughout pregnancy, childbirth, and the postpartum period. They form strong connections with their clients and provide personalized support that is often lacking in traditional obstetric care. Doulas also play a vital role, offering essential emotional and physical sup
port and advocating for women during and after delivery.
It’s time to view midwives and doulas as essential components of the maternal care team, particularly for women in high-risk groups, rather than mere alternatives. Research demonstrates that access to midwifery and doula care leads to better outcomes, including fewer cesarean deliveries, decreased complications, and more positive birth experiences. This is not a luxury, but a necessity.
Countries like the Netherlands, with well-established midwifery systems, consistently report superior maternal health outcomes. Midwives prioritize the overall well-being of women – their physical, emotional, and mental health – throughout and beyond pregnancy. This personalized, continuous care approach is especially effective for women at higher risk, including those from marginalized communities.
Women Deserve to Be Heard
The most critical aspect of addressing this crisis is to empower women to advocate for themselves. Many women are not taken seriously or are dismissed when they voice concerns about their pregnancies or childbirth. We need to create a culture where women feel confident to speak up, ask questions, and demand better care.
Childbirth should be an empowering and positive experience for women, not one that leaves them traumatized. It is essential to listen to women and honor their choices in maternal care. Healthcare providers need to prioritize women’s needs by offering personalized care options, respecting birth plans, and honoring preferences.
The focus of the conversation around childbirth needs to shift from solely the baby’s health to equally valuing the mother’s health, safety, and well-being. Ultimately, a healthy baby is a result of a healthy mother, and it’s crucial not to overlook this fact.
What You Can Do
Speak up:If you are pregnant or planning to be, make sure you are an active participant in your care. Don’t hesitate to ask questions, voice concerns, or seek a second opinion.
Get involved:Support organizations like BMMA, which advocate for policy changes to make maternal care safer for all women.
Stay informed:Keep up with the latest research and be proactive about understanding your rights and options during pregnancy and childbirth.
Conclusion
The maternal health crisis in the U.S. is a complex, multifaceted issue that goes beyond mere statistics—it’s a matter of equity, respect, and human rights. Every woman, regardless of race, income, or location, deserves the opportunity to bring her child into the world safely and with dignity. Our healthcare system, as it stands, is failing too many mothers, particularly women of color and those in rural or underserved areas.
We need to rethink how we approach maternal care. Hospitals, while often seen as the safest option, can feel cold, corporate, and impersonal—treating women like numbers rather than individuals. Midwives and doulas, by contrast, offer personalized, compassionate care that focuses on listening to women and respecting their needs. This kind of care can make all the difference, especially when it comes to improving maternal outcomes and reducing preventable deaths.
The time for action is now. We must empower women to speak up, provide them with real choices in their care, and demand systemic changes that prioritize equity and respect. The lives of mothers depend on it, and there’s no more time to waste. Together, we can build a future where every birth is a story of health, empowerment, and hope.
— Stay Strong! Jaelin —
Additional Reading:
- “Racial Disparities in Maternal Mortality” – Black Mamas Matter Alliance
https://blackmamasmatter.org/ - “How the U.S. Can Address its Maternal Mortality Crisis” – The American College of Obstetricians and Gynecologists
https://www.acog.org/ - “Maternal Health in America: Racial and Ethnic Disparities” – Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-complications.html - “Improving Access to Maternal Health Care in Rural Communities” – U.S. Department of Health and Human Services (HHS)
https://www.hhs.gov/blog/2019/06/12/improving-access-to-maternal-health-care-in-rural-communities.html - “The Role of Doulas and Midwives in Ensuring Better Maternal Outcomes” – National Partnership for Women & Families
https://www.nationalpartnership.org/our-work/health/maternity/doulas-midwives.html
Let’s strive for a world where every birth story is about empowerment and health, not fear and tragedy.
Jaelin Stickels, CNM, WHNP, is a deeply passionate and highly skilled Certified Nurse Midwife, Women’s Health Nurse Practitioner, and the owner of Holistic Heritage Homebirth in Houston, Texas. With over a decade of experience, Jaelin has had the privilege of helping several hundred women welcome their babies into the world. In addition to her advanced practice licensure training, she has additional advanced training in twin and breech births, making her one of only a few with these skills in her area. Jaelin approaches every birth with expertise, compassion, and a deep respect for the birthing process. Jaelin is finishing her doctorate and looking forward to being Dr. Jaelin in early 2025.
Jaelin’s journey into midwifery began with a profound love for supporting women through the incredible experience of pregnancy, labor, and postpartum. Since 2010, she has been dedicated to walking alongside families during these transformative moments, offering guidance, support, and care tailored to each individual’s unique needs. She is a big believer in informed consent and ensures clients are given the best evidence-based information to make the best decisions for themselves and their families.
Married to her high school sweetheart Ted (aka Chef Ted) since 1984, Jaelin is the proud mother of three grown children and the delighted grandmother of one amazing granddaughter. When she’s not assisting in births, Jaelin finds joy in going to the movies with her husband, quilting, and cherishing time with her family. Known by the other midwives in her practice (Holistic Heritage Homebirth) affectionately as the “Birth Hog,” she brings an unmatched dedication and enthusiasm to her work—no one loves birth quite like she does.
