What I've learned from a year of reporting on maternal health

After interviewing doulas, midwives and health professionals, it's clear there's work to be done.

By Rachel Ryan

What...is a doula? That’s what was running through my mind a year ago when I started a reporting project with independent journalist Ashley Nguyen.

Like many people, I had no idea what the term “doula” meant. I would later come to find out that doulas are health professionals that provide vital emotional, physical and informational support to a birthing individual throughout their birth journey. Even later, I would recognize the essential role doulas could play in reducing the United States' high maternal mortality rates.

After a year of reporting on maternal health, here are my biggest takeaways:

1. The healthcare system has made little progress in racism.

While this is an intuitive fact, it was only further emphasized through my research and interviews. A recent panel discussion on this enduring problem touched me in unimaginable ways. The women on the panel shared their experiences of racism in healthcare. Some mentioned how they had to constantly prove their intelligence to providers, performing against engrained stereotypes to be heard and listened to. Others talked about how doctors simply left them alone in their medical rooms without saying anything. Black women are three-to-four times more likely to face pregnancy complications than their White counterparts. Doulas and midwives can be a part of the solution, serving as another voice for their clients and providing culturally competent care. But, they experience racism too. They’ve had doors slammed in their faces, their credibility questioned and so much more. The list goes on and on.

2. Home birth is not as scary as some make it out to be.

Home birth has a stigma in the U.S. It’s largely seen as unsafe — and it is for high-risk individuals, but for those at low risk, it can be beneficial and less costly. The medical culture in the U.S. promotes the idea that birth has to happen at the hospital or that birthing individuals need to be cared for by obstetricians. However, some countries outside of the U.S. use midwives as their primary care providers, whether for hospital or in-home births. The Netherlands still has one of the highest home birth rates in the Western world. In the U.S. and the Netherlands, those who were at low risk and planning a home birth were less likely to experience interventions such as a C-section than those with planned hospital births. They were also less likely to experience tears, infections or hemorrhages.

3. Doulas and midwives are essential.

Despite not knowing what doulas were before starting this project, I can confidently say that I want one when I have children someday. Midwives and doulas are trained to provide culturally competent care, which differs from training typical doctors and nurses receive; they understand what their clients are going through because they have similar experiences. Simply put, doulas and midwives can be more vigilant and personal with their clients due to their training background. Most of the time, they are of and from the community of the birthing individuals they serve. Their impact is shown in the data too. Similar to home birth, people who are supported by doulas and midwives are less likely to have C-sections. They also have lower preterm birth rates.

4. The U.S. has a long way to go for maternal health.

After talking to a large number of doulas, midwives, birthing individuals, researchers and maternal health advocates, I can confidently say their value is unquestionable. However, the current system does not prioritize their care and on a larger level, maternal health. Current reimbursement rates for doulas and midwives through the states are so low or completely nonexistent that it prevents them from providing life-saving care. It is a barrier to serving the populations that need them the most. The U.S. has one of the highest rates of maternal mortality despite being a developed country — and this number continues to rise. More legislation, training and education will be required to address the issue.

As a woman, I am baffled by the lack of attention maternal health has received on all fronts. I would be lying if I said I wasn’t concerned. However, I’m also hopeful. For the recent Black maternal health week, Vice President Harris hosted a roundtable to discuss experiences and solutions. Rep. Lauren Underwood (D-Ill.) and Rep. Alma Adams (D-NC), and Sen. Cory Booker (D-NJ) also reintroduced the Black Maternal Health Momnibus Act, an act aimed at combatting maternal health disparities. Although these steps are just the beginning, they are a step forward.

Throughout this year of reporting, one thing remains clear: we’ve got lots of work to do.

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About the experience:

I spent a year working with journalist Ashley Nguyen through the O'Brien Fellowship in Public Service Journalism at Marquette University, a program that pairs journalists with Marquette students for year-long reporting projects. Throughout the project, we got to the root of the U.S. maternal health crisis by investigating legislation, doula and midwifery care, COVID-19 implications and more.

Read the reporting >>