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Childbirth can be one of the most profound experiences of someone’s life. It’s also sometimes dangerous, especially in America.
The U.S. is arguably the most deadly high-income country in which to give birth. According to a recent report by the Commonwealth Fund, the American maternal mortality rate is more than twice as high as those in Canada, France and Korea, and at least four times the rates of the United Kingdom, Australia and Japan. Norway has virtually no maternal deaths.
Complex factors drive this disparity, including racial inequities that put Black patients at the greatest risk of death, but a 2022 analysis from the CDC argued that 80% of maternal deaths are preventable.
One way to address this problem is to increase access to quality maternity care before, during and after birth. To do so, the Health Resources and Services Administration says the U.S. needs to bolster the maternal medicine workforce.
This guide, which draws on interviews with members of that workforce, overviews their various skills and the support they provide.
Obstetrician: a doctor who specializes in delivering babies and caring for people during and after pregnancy. Most obstetricians are also gynecologists, which treat the female reproductive system. An obstetrician-gynecologist is commonly referred to as an OB-GYN.
There’s a growing shortage of OB-GYNS, a trend the Health Resources and Services Administration projects will intensify through the end of the decade. This threatens to further degrade the quality of maternity care in the U.S.
At the same time, OB-GYNs are facing new challenges. Compared to a few decades ago, pregnant patients seem more prone to chronic diseases like diabetes and hypertension, said physician Keith Williams.
Williams, who serves as the division chief of obstetrics and gynecology at Geisinger Medical Center’s flagship hospital in Danville, said that higher rates of obesity are also complicating care. And people who previously faced infertility issues due to serious health conditions are now finding they can have children.
Still, he told Spotlight PA, “Having a baby can be a wonderful experience and can be unlike anything else a patient has ever encountered.”
Anesthesiologist: a physician who prevents pain during medical procedures and surgeries.
During childbirth, the most common method of pain control is an epidural. For this procedure, a catheter is inserted in the lower back along the spine. Then a combination of a local anesthetic and an opioid, such as fentanyl, is injected to numb the lower part of the body. Only a small amount of the drug gets into the bloodstream, meaning it’s safe for both parent and child.
Richard C. Month, an obstetric anesthesiologist at Temple University’s Lewis Katz School of Medicine, told Spotlight PA that there is no “right way” to give birth, and that when speaking to patients, he emphasizes that he’s there to tailor their care to their preferences.
“If you know you want an epidural from the beginning? Great! We’ll be there for you when you’re ready. Not sure? Great! I’ll sit down with you and discuss the pros and cons as best I can,” he wrote in an email.
“Want to try without? Great! I’m here to support you however I can. Absolutely sure you don’t want one? That’s ok too! I’ll be here to help you however I can, including if you change your mind or if there’s an emergency.”
A common concern among patients is that a mistake during their epidural could result in paralysis. Month said the likelihood of this carries about the same risk as being struck by lightning.
However, an epidural might not be a good option for people with spinal or blood clotting issues. In those cases, clinicians can use IV medications or laughing gas to help alleviate pain. Nonmedical tactics, such as breathing techniques, or giving birth in water, are also alternatives.
Nurse: a licensed medical provider trained to provide fundamental care to patients. Nurses, like doctors, have many specialties and perform a wide range of tasks, but their primary mandate is to maintain the welfare of patients. This can include performing examinations, administering medications and monitoring vitals, among other duties.
Nurses who work in the birth center at UPMC Magee-Womens Hospital participate in labor and delivery, surgeries and intensive care.
Rebecca Lavezoli, the unit director of Magee’s birth center, said labor and delivery nursing epitomizes teamwork. When patients go into labor, Lavezoli said, these nurses are their go-to for answering questions, explaining delivery options and reviewing birth plans.
Most babies at Magee are delivered by physicians. But Lavezoli said sometimes labor progresses rapidly and a nurse has to step in.
Nurses who specialize in labor and delivery get exposed to a lot of emotional extremes, Lavozoli said, so “it is a true calling” to work in this area of health care.
Midwife: clinicians who deliver babies and provide reproductive health care but are not physicians. Most midwives are registered nurses who have additional training.
Midwives provide similar types of care as obstetricians, but place a greater focus on patients’ social and emotional health. While midwives attend deliveries both in and outside hospitals, only physicians can perform surgery. So midwives primarily work with low-risk pregnancies.
“Midwife care is also great for people who want to be active participants in their care and don’t want medical interventions unless they are medically necessary,” said Christine Haas, the executive director of the Midwife Center in Pittsburgh.
A report released earlier this year by March of Dimes — a nonprofit that works to improve maternal and infant health — said midwives could supplement the dwindling OB-GYN workforce and expand maternal care to communities with fewer hospitals and clinics.
Another benefit of midwifery care is the lower rates of medical interventions, including cesarean sections. A C-section is a major surgery and patients who deliver this way, compared to vaginal births, have higher rates of infection and uterine tearing, among other outcomes.
Doula: a nonmedical professional who provides emotional, physical and informational support to a patient before, during and after childbirth.
Research suggests that doulas improve birth outcomes and reduce racial disparities in maternal health.
A doula’s patient advocacy can extend beyond perinatal duties, said Gerria Coffee, president of the Pennsylvania Doula Commission. Doulas might connect clients to mental health or domestic violence services, or help them sign up for nutrition support through the state.
“Everyone deserves to have a safe, beautiful experience regardless of the outcome,” said Coffee.
Doulas do not need a certification to practice. However, recent changes to Pennsylvania’s Medicaid program allow doulas to be reimbursed for their services, provided they have a certified perinatal doula license from the state.
Correction: A previous version inaccurately described where midwives receive training.
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