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- [00:04]
A
This is in conversation from Apple News. I'm Shamita Basu. Today why America's maternal health care is failing families. A few years ago, journalist Irene Carmon was at a picnic for her child's preschool in New York City, watching her children and chatting with the other moms. When the conversation turned to her latest project, a book that she had just started researching.
- [00:37]
B
Somebody asked me what my book was about. I said, it's about how America treats you when you're pregnant. And somebody said, like a child. And somebody else said, like an animal. And Maggie said, like a child animal. And I sort of looked at everyone wondering what their stories were.
- [00:54]
A
One of the moms Maggie ended up becoming. One of the main stories told in Irene's new book. It's called Five Women and the Perils of Pregnancy in Americ. And it follows several families through their encounters with the healthcare system, navigating fertility challenges, pregnancy loss and birth. Each story is unique, but Irene says there is a common thread running through all of them.
- [01:18]
B
America, whether it was through our uncaring profit driven medical system or through a system of laws that were suddenly unleashed in full force when the Supreme Court overturned Roe v. Wade, has failed to see us as fully people, as fully human who are in possession of our full faculties and instead as a means to an end or a vessel.
- [01:44]
A
That failure, Irene says, is not just something people feel. It's reflected in the data, regardless of.
- [01:51]
B
How you measure it. If you crunch the numbers in the most conservative way, this is the most dangerous country to be pregnant among our pure nutrients and According to the CDC, 80% of maternal deaths are preventable.
- [02:06]
A
I told Irene, and I'll tell you listening now that I'm currently pregnant with my second child. I've been thinking a lot about how my first go around went and reflecting on why I've had so many similar conversations with women about how they felt they were treated by the medical establishment over the course of pregnancy and birth. So I asked Irene, why is this the case that for so many people in America, we're still struggling to get maternal health care right?
- [02:36]
B
There are deep problems with our medical system, but there is something different about pregnancy. First of all, when you become pregnant, gendered expectations are placed on you to become a perfect mother, to live a blameless life, to be spotless, to follow whatever the rules of the given moment are, even though they shift, you know. And the other thing is that pregnancy is something that can be both deeply powerful and deeply dangerous. And it can bring up somebody's deepest emotional, religious, social, cultural Familial convictions in a way that going in and having a colonoscopy simply cannot do. And it has the possibility for joy, by the way, despite the fact that people are having fewer children, according to the census, 80% of women today will give birth by the end of their reproductive lives. And pregnancy is also the most common reason that women are hospitalized in this country. So it's also the way in which many otherwise healthy people interact with the hospital system and with the medical system in an intensive way that they may not have had experience with before. In research, in surveys, when people who give birth are asked about what mattered to them, the biggest difference was not what kind of birth they had or where they were, but how they were treated and whether they were treated respectfully. And the experience of giving birth for many people is actually kind of putting people into contact with a kind of dehumanization in the medical system that others may experience. Perhaps if they're Medicaid patients, they're low income, they're queer, they live in a place that's underserved by medicine, they're black, they're undocumented. Many people, and I count myself among these who otherwise enjoy a lot of privileges in the system, might suddenly be shocked and outraged to be treated like a child animal the moment you come into contact with the system as a pregnant person.
- [04:35]
A
I was really struck by that anecdote that you shared in the book. We were with a couple of other New York moms, and it seemed immediately recognizable to the other mothers who'd had experiences with childbirth. What you're describing, recognizable to me, too, as someone who has had one child, who's almost two, and is now pregnant with my second, and thinking a lot about childbirth and the experience the first time around and what felt really difficult about it, frankly.
- [05:03]
B
And I wish you a beautiful and safe journey. And I think also one thing that I have learned is also different about pregnancy is that, you know, you may not be able to choose the medical outcomes. And I think the system puts a lot of pressure on the individual to, like, do all the research, have the perfect birth, when these are really systemic issues.
- [05:28]
A
Yeah.
- [05:29]
B
You know, there's shocking research into maternal mortality and the unforgivable gap between white women and black women in America. One of the factors that makes a black woman more likely to die is the hospital that she goes to. So if a black woman goes to a hospital in which the majority of the patients are black, she is likelier to have a fatal outcome in her birth. So what is that telling us about the disinvestment in hospitals that are disproportionately serving people of color. There's also a shocking very, very large study out of New Jersey that shows that doctor convenience and profit contributes to choosing whether a patient who does not have an emergency indication has a C section, but that those choices are made more often with black patients than white patients. They found that when the same doctor was faced with a low risk white patient and a low risk black patient and there was a room available in the hospital, the black patient was more likely to have a C section. C sections, while often life saving and necessary, can also lead to more maternal complications, including hemorrhage, which is one of the leading causes of maternal death. So I think that there are so many interlocking reasons for this unforgivable gap in maternal mortality. And they also have to do with the structural elements of healthcare, even before someone becomes pregnant, how much access they have for healthcare. 35% of American counties are characterized as maternal healthcare. Deserts do not have any kind of provider of maternal healthcare. So people are having to travel. People are in many cases only getting insurance once they have a confirmed pregnancy test, but they're only qualifying for Medicaid once they have a doctor's pregnancy test. But how do they go in and get that doctor's appointment if they don't have insurance? So there are enormous barriers to even receiving the kind of care that might prevent the maternal mortality and morbidity rates from being so high.
- [07:33]
A
The forces shaping modern pregnancy care in America first took root well over a century ago. In her book, Irene highlights one of the key figures in this history. J. Marion Sims, a mid 19th century doctor from Alabama, a state that today has one of the highest maternal mortality rates in the country.
- [07:52]
B
He was drummed out of his hometown because he was a very bad doctor who stumbled upon the cases of some young women. They were enslaved women with obstetric fistula, meaning that they had damage from giving birth. And the plantation owners who enslaved them were very interested in them being able to give birth again to provide more forced labor. And J. Marion Sims was given the opportunity to experiment upon them with no anesthesia, with great pain for years. And this was the birth of modern gynecology, Was the suffering of countless women, three of whose names we know. Anarcha, Betsy and Lucy. And they were the mothers of gynecology.
- [08:37]
A
Once Sims experimental procedures were deemed safe enough to perform on white women, more and more of his colleagues saw the opportunity to build new businesses centered on their practices. And that meant Pushing out their competition, the midwives who traditionally did the work of maternal care.
- [08:54]
B
He was part of a process of forcing out the traditional midwives who had been attending birth and also helping women end their pregnancies through what means they had at the time when white male American doctors took over reproductive health care and promised that it would be cleaner, more respectable, more painless for their own profit and control. We enshrined that hierarchy into the practice of medicine.
- [09:26]
A
That hierarchy is visible at Woodhull Hospital in Brooklyn, New York. It's a public hospital that primarily serves a neighborhood with a high poverty rate. Woodhull's midwifery program draws many patients looking for that type of care. But if birthing mothers need emergency intervention, they might find themselves in the more traditional. And as is typical under resourced hospital setting, three women have died in childbirth there since 2020. Woodhull Hospital hasn't commented publicly on the circumstances of these deaths, citing privacy laws. But families have spoken out to reporters. And Maggie, the mom that Erin met at the preschool picnic, told Erin about a harrowing experience she had.
- [10:09]
B
Maggie's from Canada, and at first she did not understand the American healthcare system. And the more she learned about it, the more horrified she was. She wanted to have a healthcare practitioner who treated her like a human being. And it was not happening at the hospitals that she went to. So they drove pretty far from their house to Brooklyn Birth center, which has midwifery care. But when Maggie went into labor, after about two or three days of stalled labor, it became clear that this baby was not, and they transferred her to Woodhull Hospital. It was determined that Maggie needed a C section. And after the birth, her husband noticed her looking faint, not being herself. She almost dropped the baby, and he started calling for help without even checking her vitals. The doctor insisted that everything was fine. This is just what happened. She just had a baby, and he's going down the hallway screaming for help. People come running, they call a code blue. And it is later determined that Maggie's C section incision was not properly closed and she was bleeding out internally. And only her husband's screams being heated saved her life because she needed a full body blood transfusion and had lasting hormonal damage. And I was so deeply horrified by this story, and I was trying to understand how it fit into the broader story of American pregnancy care. She had come to Woodhull through a pathway of seeking midwifery care, which is evidence based to provide better outcomes, but that when she needed a different kind of care, she found herself with the same old crappy public hospital, underpaid doctors, understaffed nurses. This stress of being in an area with a lot of people who need a lot of help. And two months after I heard Maggie's story, a woman named Christine Fields died at Woodhull Hospital in an utterly preventable death.
- [12:09]
A
Yeah. Tell me about Christine's story.
- [12:11]
B
Christine was born at Woodhull Hospital. She was raised a few blocks away in Bed Stuy, Brooklyn, throughout her childhood, lived in 31 different foster homes. And at the time before she gave birth, things were really looking up in Christine's life. She was attending college. She was about to graduate. She was raising her two kids. She had met somebody, Jose Perez, who. She had a beautiful relationship, and they were planning on getting married. She had won the housing lottery, the subsidized housing lottery, and moved into a beautiful high rise in Long Island City, away from some of the bad memories of her childhood. But she wanted to come back to Woodhull to give birth when she got pregnant again because she'd had beautiful care from a midwife, and unfortunately, that's not what she got. She repeatedly told them that she thought that something was wrong. She was dismissed. She became upset, left the hospital, checked herself out, came back later, repeatedly saw that a white patient was being treated with great care while she was being ignored and dismissed and wound up having a C section in a way that felt like a complete emergency. And she very much did not want a C section. And instead of calmly explaining to her her options, the hospital was screaming at her. They were pushing her husband away. They did not allow her husband, her fiance, I should say, Joseph, in the operating room for the C section, which is very unusual from what my reporting suggests. And when he protested and advocated on her behalf because she was having an anxiety attack, they called security on him. And when she emerged from the operating room, the baby went to the nicu. And Jose followed the baby. Her mother went to Christine. And by a completely inexplicable series of events, Christine was left alone by nurses, so that when Jose returned to her, her lips were gray and she was unresponsive. It turned out that she had been disoriented and ripped out her IVs, and nobody had noticed.
- [14:20]
A
Oh, my God.
- [14:21]
B
It turned out that Christine had the same injury, the same botched C section that Maggie had. And I learned in my reporting that four years apart, they had the same doctor.
- [14:33]
A
Oh.
- [14:33]
B
And by the time doctors finally realized what was happening with Christine, it was too late to save her life. Not only in the aftermath Was the family not given answers as they were protesting outside on a weekly basis? But Jose had to fight to bring home his son. He was locked out of their family home, even though it was also in their children's names for over a year. And he has become a maternal health advocate. He's actually trained as a doula, and he's training medical students to prevent anything like this from happening again. Wow.
- [15:09]
A
Wow. I mean, it's. What a story. And you really describe Jose as such a fierce advocate for Christine and what she needed in those moments. And the incredible frustration of being feeling like you're being blocked out and definitely not heard in both of these cases. For both of these stories, I'm sure that you sought reaction or statement from Woodhull Hospital. What has Woodhull said about these instances?
- [15:41]
B
So I initially reached out to Woodhull and they were responsive to me coming in for an interview until I said, this is when Christine was alive. They told me I could come in and interview midwives and doctors. And I said, I am also going to ask you about Shaasia Semple, who died in June 2020 at the hands of an anesthesiologist at Woodhull. And they canceled the interview, and no one ever called me back again. And I made repeated attempts to reach out to them, and they were not responsive. Jose is in the process of litigation against Woodhull on behalf of his children.
- [16:19]
A
It does sound like Maggie and her husband also considered whether they wanted to go the route of litigation. And Maggie describes this in your reporting in the book. Like, do I really want to spend my. Like, I have a newborn now. What am I going to spend all my time pursuing litigation against this hospital? And not only that, it sounds like by the time they learned the severity of some of the long lasting medical issues that she was left with, they were timed out of taking legal action against the hospital. Right.
- [16:51]
B
So it's a very American way of doing things that when you are harmed this way by a system that is so much bigger than just one bad doctor, it also falls on the person who's been victimized to go through a grueling, expensive, sometimes traumatizing, dehumanizing legal process. The way our system is set up, it's on you to sue. And suing a public hospital in New York City is a very narrow time window of the statute of limitations. But also the potential settlement in these cases is very limited. Jose has been advocating for the Grieving Families act because currently, the way that damages are calculated does not include emotional distress. It only includes lost earnings. And so somebody like Christine, who was in college, who had just completed her degree, who worked at a supermarket and a dollar store while putting herself through college, would be valued very little because emotional distress would not be taken into account. And it's only through the power of insurance companies and doctor's associations that that has not become law in New York State to take into account damages because it's passed the legislature numerous times and it's been vetoed by Kathy Hochul because she said it would cost too much for hospitals. And so even if you do go through this process where you have to tell your story over and over again, re traumatize yourself spe where you could be taking care of your kids or yourself, it may not lead to very much. And what happens, what happened at Woodhull is that a few months after Christine died, they finally fired that doctor. But did they fix the underlying problems that would lead Christine to be left alone, to bleed to death when there were obvious signs of distress, when she. Her IV was not hooked up, when nobody checked on her, even though she had had major surgery? So I think one of the aspects of the problem that I explore in the book is that although it deeply shocked me that Maggie and Christine had the same doctor making the same mistake four years apart, it's so much bigger than just one quote, unquote, bad doctor. It's also a level of disinvestment that we've tolerated that surfaces at moments like this that some hospitals can't pay their doctors as much, are afraid to fire the bad doctors because they might not be able to hire another one. They rely on Medicaid. We are experiencing a crisis in cuts to Medicaid that we haven't even yet felt the full impact of in this country.
- [19:28]
A
I mean, in these stories that you're telling, I'm struck by the actions of these women's partners in all of this. And it takes me back to my own birth experience, where my husband was put in the position of being this advocate for me, and really, in many scenarios, fighting with the medical providers around us, and what a difficult and stressful ask that is of the partners. It is traumatic for them in a way, in its own way.
- [19:57]
B
So there's research that shows that you are likelier to be mistreated depending on the race of your partner. So women of any race were in these surveys, these very large surveys that were conducted about mistreatment and birth. Women of any race were likelier to be mistreated if they had a black partner. There's also research that shows that the act of pushing back on your medical care during pregnancy is a kind of catch 22, because some people are penalized for complaining they're retaliated against once they are perceived as difficult. So it's a very tricky position to be in, and it does involve a lot of vicarious trauma. But it also puts you in this unfair situation where you worry, how much will this pushback come back to harm me? Yeah. And Jose said that he felt that he had been marked from the beginning when they came to the hospital as a problem because he was advocating for Christine, and he's Latino and he has a lot of tattoos. At the time, he had gold teeth. They marked him down as somebody who was a potential problem, so that every interaction that they had with him, there was security there. And so he now says, I wish I had gone to jail that night. I wish I had fought harder. It's too much to put on any individual to advocate that way. The research that shows that having a doula leads to dramatically better outcomes in maternal morbidity and mortality, what that's telling us is that just having one person advocate for you and be a set of eyes in birth can make a difference between whether you suffer major physical trauma in addition to what might be involved in your birth. And so what does that say about the strain on our systems at this time of deep vulnerability? You know, your partner, if you have a partner, is not trained in any of this. And there's understandable deference in something that really, truly can be an emergency. But I think not having that trust built up from the beginning, and there's certain communities who have historic reasons to mistrust the medical center system. If you don't have that trust built up to begin with, if you don't feel listened to, then when somebody tells you that you need a certain kind of emergency care, are you going to accept it or are you going to ask more questions?
- [22:24]
A
You recently published an essay in the New York Times, and the title was what I Tell a Younger Version of Myself about having a Baby. Knowing everything you know now and having done this work for years and spoken to so many people, what would you tell your younger self? Or what would you tell anybody right now who is considering having a baby?
- [22:46]
B
So the stories in my book are deeply challenging. But there are also moments I think of beauty and of hope. I'm really inspired by Jose trying to make births safer. I'm inspired by Dr. Yashika Robinson, a black woman born and raised in the south, provided abortions for as long as she could, now is fighting for safe births for the patients who are left behind in Alabama. And it's precisely because these moments in people's lives are so intimate and personal and can be so beautiful and so joyful that we need to expose what's wrong with them. And we can also talk about, we can open up that space to say, this can be a source of beauty, this can be a source of joy. And I think pregnancy is also all of us operating in a web of needing each other. It's your body, it's your pregnancy, it's your choice. But there's also an interdependency in the people who care for you and the people who will care alongside of you if you choose to have a child. And for me, it's been beautiful and rewarding, and I wish for safety and joy and love for anybody who wants to be pregnant and carried to term because it could be so much better than what we have right now.
- [24:03]
A
Irene, thank you so much for your time for talking about this with me.
- [24:06]
B
Thank you. And I am sending you all the good vibes.
- [24:12]
A
You can find Irene Carmon's book Unbearable on Apple Books. We'll link to it on our Show Notes page. And every weekend you can find new episodes of Apple News in conversation in the Apple News app. Just tap on the audio tab, that's the little headphones at the bottom to find it.