--:-- Shamita Basu: This is In Conversation from Apple News. I'm Shamita Basu. Today, why America's maternal health care is failing families.
--:-- Shamita Basu: A few years ago, journalist Irin 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: One of the moms, Maggie, ended up becoming one of the main stories told in my 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.
--:-- Irin Carmon: Each story is unique, but I say 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.
--:-- Shamita Basu: That failure, Irin 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.
--:-- Irin Carmon: And according to the CDC, 80% of maternal deaths are preventable.
--:-- Shamita Basu: I told Irin, 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.
--:-- Shamita Basu: So I asked Irin, why is this the case, that for so many people in America, we're still struggling to get maternal health care right?
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Shamita Basu: 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.
--:-- Irin Carmon: In research, in surveys, when people who give birth are asked about what mattered to them, the biggest difference was not, you know, what kind of birth they had or where they were, but how they were treated and whether they were treated respectfully.
--:-- Irin Carmon: And the experience of giving birth for many people is actually kind of putting people into contact with the 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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?
--:-- Irin Carmon: There 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.
--:-- Irin Carmon: But 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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 health care, even before someone becomes pregnant, how much access they have for health care.
--:-- Irin Carmon: 35% of American counties are characterized as maternal health care deserts, do not have any kind of provider of maternal health care. 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.
--:-- Shamita Basu: But how do they go in and get that doctor's appointment if they don't have insurance?
--:-- Irin Carmon: 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.
--:-- Irin Carmon: The forces shaping modern pregnancy care in America first took root well over a century ago. In my book, I highlight 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: And Maggie, the mom that I met at the preschool picnic, told me about a harrowing experience she had there. Maggie's from Canada, and at first she did not understand the American health care system.
--:-- Irin Carmon: And the more she learned about it, the more horrified she was. She wanted to have a health care practitioner who treated her like a human being, and it was not happening at the hospitals that she went to.
--:-- Irin Carmon: 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 coming out, and they transferred her to Woodhull Hospital.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: 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, the stress of being in an area with a lot of people who need a lot of help.
--:-- Shamita Basu: And two months after I heard Maggie's story, a woman named Christine Fields died at Woodhull Hospital in an utterly preventable death.
--:-- Irin Carmon: Yeah. Tell me about Christine's story.
--:-- Irin Carmon: Christine was born at Woodhull Hospital. She was raised a few blocks away in Bed Brooklyn throughout her childhood lived in 31 different foster homes.
--:-- Irin Carmon: 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 with, and they were planning on getting married.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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 fiancé, I should say, Jose, in the operating room for the C-section, which is very unusual from what my reporting suggests.
--:-- Irin Carmon: And when he protested and advocated on her behalf because she was having an anxiety attack, they called security on him.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: He's actually trained as a doula, and he's training medical students to prevent anything like this from happening again.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: And I said, I'm also going to ask you about Asia 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.
--:-- Irin Carmon: And I made repeated attempts to reach out to them, and they were not responsive.
--:-- Shamita Basu: Jose is in the process of litigation against Woodhull on behalf of his children. And Maggie and her husband also considered whether they wanted to go the route of litigation.
--:-- Irin Carmon: And Maggie describes this in my reporting in the book, like, do I really want to spend my time? Like, I have a newborn now. What am I going to spend all my time pursuing litigation against this hospital?
--:-- Irin Carmon: 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.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Shamita Basu: And so even if you do go through this process where you have to tell your story over and over again, re yourself spend hours where you could be taking care of your kids or yourself, it may not lead to very much.
--:-- Irin Carmon: What happened at Woodhull is that a few months after Christine died they finally fired that doctor.
--:-- Shamita Basu: 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?
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Shamita Basu: In these stories that you're telling, I'm struck by the actions of these women's partners in all of this.
--:-- Shamita Basu: 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.
--:-- Shamita Basu: And what a difficult and stressful ask that is of the partners. It is traumatic for them in a way, in its own way.
--:-- Irin Carmon: So there's research that shows that you are likelier to be mistreated depending on the race of your partner.
--:-- Irin Carmon: So women of any race were in these surveys, these very large surveys that were conducted about mistreatment in birth, women of any race were likelier to be mistreated if they had a Black partner.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: So it's a very tricky position to be 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?
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: The research that shows that having a doula leads to dramatically better outcomes in maternal morbidity and mortality.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: And so what does that say about the strain on our systems at this time of deep vulnerability?
--:-- Irin Carmon: 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.
--:-- Irin Carmon: But I think not having that trust built up from the beginning, and there are certain communities who have historic reasons to mistrust the medical system.
--:-- Irin Carmon: 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?
--:-- Shamita Basu: Mm hmm.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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?
--:-- Irin Carmon: So the stories in my book are deeply challenging, but there are also moments, I think, of beauty and of hope.
--:-- Irin Carmon: I'm really inspired by Jose trying to make births safer. I'm inspired by Dr. Yoshika 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: And I think pregnancy is also all of us operating in a web of needing each other.
--:-- Irin Carmon: 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.
--:-- Irin Carmon: 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.
--:-- Shamita Basu: Irin, thank you so much for your time for talking about this with me.
--:-- Irin Carmon: Thank you.
--:-- Shamita Basu: And I am sending you all the good vibes.
--:-- Shamita Basu: You can find Irin Carmon's book Unbearable on Apple Books. We'll link to it on our show notes page.
--:-- Shamita Basu: 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. Thank you.
