Shifting the Zeitgeist: Challenging the Status Quo in Maternity Care

According to Merriam-Webster, “zeitgeist” is the general intellectual, moral, and cultural climate of an era. It combines two German words: zeit (“time”) and geist (“spirit” or “ghost”).

When it comes to maternity care, the “spirit” of this era is characterized by some of the following:

• Most people birth in a hospital with an OB-GYN. Many people lack access to alternative options because of where they live, limitations imposed by insurance companies, and restrictive laws.
• Medical interventions are necessary and life-saving, at times, but they are frequently overused. They are also often presented as requirements for receiving care, even though the routine use is not always evidence-based.
• Compared to other high-income countries, the United States has unacceptably high levels of maternal mortality and morbidity (and it continues to rise).
• Black birthing people have the highest rates of maternal mortality and morbidity, due to systemic racism.
• Hospitals are institutions that prioritize efficiency and managing legal risk over individualized care and  bodily autonomy.
• The fall of Roe v. Wade is having a negative impact on those seeking abortion access AND those needing safe access to care for serious and sometimes life-threatening pregnancy complications.

But there is an ever-growing push for change, and birth workers are leading the effort to shift the zeitgeist.

Community-Based Midwives and Doulas of Color

Community-based midwives and doulas of color are at the forefront, improving outcomes through their leadership and efforts to fill gaps within the maternity care system. 

🔗 They are key to addressing the U.S. Maternal Health Care Crisis.

Frustratingly, they often experience resistance by the very system that is causing harm to the pregnant and birthing people in their communities. Here’s just one example:

Dr. Stephanie Mitchell, DNP, CNM, CPM is working to expand access to birthing centers in the state of Alabama, which has some of the worst maternal and infant health outcomes in the United States. Midwifery care and birth centers have been shown to approve outcomes, yet the Alabama Department of Public Health is standing directly in the way of access to these options.

Those continuing to stand in the way of community-based models of care are causing direct harm to marginalized communities. Because these innovative models do work.

Like, midwife Jennie Joseph’s The JJ Way®, which has reduced disparities in health outcomes in her community.

And there are many others. Here’s just a few:

• Uzazi Village
• Mamatoto Village
• Nikki McIver-Brown, APRN, MSN, CNM
• Asasiya Muhammad, CPM, LM
• Sabia Wade
• Birthmark Doula Collective

Others Leading This  Shift

There are many others doing important work in many different ways. Here’s my incomplete list:

• Rebecca Dekker of Evidence Based Birth 
• Cristen Pascucci of Birth Monopoly 
• Lindsay McCoy of Body Ready Method®
• Mandy Irby, the Birth Nurse
• Jen McLellan of Plus Size Birth
• Stephanie Tillman, the Feminist Midwife
• Gail Tulley of Spinning Babies
• Cheyenne Varner of The Educated Birth
• Nekisha Killings, MPH, IBCLC, founder of the Melanated Mammary Atlas®
• Kimberly Seals Allers, creator of the IRTH App
• Jen Kamel, founder of VBAC Facts®
• Jenna “JB” Brown of Love Over Fear Wellness
• Moss the Doula

There are many more. Who would you add to this list?

I wrote another blog post on Clearing the Path and ways you can work to remove some of the obstacles that could get in the way of a smoother birth journey. The people I listed above are also working to clear the path. They are working to move some of those immovable and more systemic barriers that you can’t move on your own. Because of them, you are not alone in your efforts.

Defining the Spirit of the Next Era in Birth

When I look ahead to what maternity care could look like in the future, there are three main themes that I hope will define the next era in birth: equity, autonomy, and access.

Equity

Reducing disparities in health outcomes is part of a much bigger fight against systemic racism. What if all birthing and postpartum people were truly safe and supported?

Autonomy

While we seem to be going in the wrong direction currently, bodily autonomy is critical for all people. The right to make decisions about what happens to your body is a fundamental human right. What if people were actually trusted to embody this most basic right?

Access

Right now, access to options is unnecessarily limited by a variety of factors. What is these barriers didn’t exist and people truly had freedom of choice?