Chapter 1: What is the main topic discussed in this episode?
This is In Conversation from Apple News. I'm Shamita Basu.
Chapter 2: Why is America's maternal health care system failing families?
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.
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.
Chapter 3: What common experiences do women face during pregnancy in the U.S.?
And Maggie said, like a child animal. And I sort of looked at everyone wondering what their stories were.
One of the moms, Maggie, ended up becoming one of the main stories told in Irene's new book. It's called Unbearable, Five Women and the Perils of Pregnancy in America. And it follows several families through their encounters with the health care 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.
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.
That failure, Irene says, is not just something people feel. It's reflected in the data.
Regardless of 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 peer nations. And according to the CDC, 80% of maternal deaths are preventable.
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.
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?
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Chapter 4: How does the history of maternal health care impact current practices?
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, that black patient was more likely to have a C-section. C-sections, while often lifesaving 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 everywhere. 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.
The forces shaping modern pregnancy care in America first took root well over a century ago. In her book, Irian 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.
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, Anarka, Betsy, and Lucy. And they were the mothers of gynecology.
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Chapter 5: What statistics highlight the dangers of pregnancy in America?
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 fiancƩ, I should say, Jose, 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. Mm.
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.
Oh, my God.
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. 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. 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 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?
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Chapter 6: What are the systemic issues contributing to maternal mortality?
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 doctors' 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, spend hours 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 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 apartā 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.
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.
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