Anywhere else in the Western world, mothers are given a degree of respect and support evident from their treatment in the hospital, the workplace and the home.
Not so in the United States. New mothers are treated more as profit centers for hospitals and burdens for employers than as the linchpin of a healthy society. Instead the U.S. has become fertile ground for those who seek to control not only a woman’s reproductive rights but also her rights as a mother, from the moment of conception until her child becomes an adult.
An industry that fails women
The problem starts with the astronomical cost of maternity care in the U.S. As reported last year by The New York Times, an in-hospital birth can cost as much as $45,000 without insurance. Mothers don’t, however, get their money’s worth. Despite spending more than $98 billion annually on birth, the U.S. has relatively high maternal mortality rates, ranking 50th worldwide.
Interventionism is a primary culprit. In the U.S., 53 percent of women giving birth receive Pitocin, a medication that augments their contractions, and more than 63 percent receive an epidural for pain relief. The C-section rate is the second highest in the world, about 34 percent. More interventions lead to more complications and higher rates of maternal and neonatal mortality. This drives up the average cost of a birth, which can deter low-income women, particularly women of color, from seeking the necessary prenatal treatment for a healthy pregnancy.
Prenatal and childbirth costs can be prohibitively steep even with insurance. “I was kicked out of my regular GYN’s care because I could not pay for prenatal care up front — even with insurance. I was refused care and went to the pregnancy clinic instead,” said Jennifer Cumby, a writer from Virginia. “I had just had a miscarriage. I was very vulnerable and scared. I cried for about a week.”
Highly medicated and controlled hospital births have become such a successful business venture for insurance companies and medical institutions — with 98.6 percent of U.S. births occurring in a hospital — that other childbirth options widely encouraged in European countries for healthy pregnancies are discouraged. This has led to a generation of OB-GYNs who have rarely witnessed unmedicated, natural vaginal deliveries. Most women who have avoided interventions in a hospital setting have had to fight very hard for that right.
I’ve experienced the fight firsthand. I gave birth to my son at home in December 2013. Because I documented each step of the process on social media, I became the poster girl for the home birth movement in the United States. My son’s birth was a difficult, painful and unmedicated labor during which the midwife expertly performed the Gaskin maneuver to get him out when his shoulders got stuck. I lost too much blood and was transferred to a hospital for a blood transfusion afterward. My birth experience perfectly demonstrates how midwives can help healthy pregnant women deliver their babies naturally and how medical centers can provide specialized treatment when and if complications arise.
After my son’s birth went viral, I was accused of endangering my baby’s health just to have the birth I wanted. The most vicious critics were medical-intervention advocates who thought the only way women should give birth is in hospitals, preferably sliced open in the operating room. The hostility I faced for choosing an at-home birth reveals the tiresome animosity in the U.S. between the for-profit medical insurance industry and midwifery, an affordable practice that has been successfully integrated into the medical systems of most European countries. Women too often face criticism for articulating the birth they want, particularly if it is low cost and unmedicated — and does not involve a $2,000-a-night hospital stay. The fear surrounding childbirth has been boosted by a medical industry that is arguably more concerned with liability and getting paid than allowing women safe and affordable options.
After childbirth, the deluge
After negotiating the stresses and costs of birth, a new mother is met with little support at home or in the workplace, never mind from the state or federal government. Mothers are often given only weeks to recover from the huge physical, emotional and financial upheaval of birth before they are expected to be back in a work environment, where they will face prejudice for being mothers and risk consequences if they bring that role into their employment.
After facing huge physical, financial and emotional struggles in the process of giving birth, women re-entering the workforce suffer a second round of inequalities.
If women choose to stay at home and raise their baby, they tend to face a major pay cut. Neeshi, a social worker, told me that she quit her job — removing one income from the family budget — after she realized she spent only an hour a day with her 10-month-old baby. Unsurprisingly, the U.S ranks third to last (PDF) among Organization for Economic Cooperation and Development countries on public spending, despite research that shows paid family leave increases women’s job tenure and employment rates and improves child health and development.
New parents receive inadequate support even from the most welcoming states. California’s paid family leave program, which provides partial pay to mothers and family members supporting a new child for up to six weeks after birth, is still far behind the U.K.’s 90 percent pay for six weeks, then government support for six months and your job held for you for up to one year.
The experience of Laura Stokes, an adjunct professor in Virginia, is sadly the norm rather than the exception. “I had zero maternity leave. I had to get up two weeks after a C-section to go teach a class,” she told me. “I was barely able to function, but I’m an adjunct, so I have zero benefits. I would have been fired had I not gone back right away.”
The pressure to return quickly to work can have severe consequences, particularly for low-income, single women. Poor mothers, Randy Albelda wrote for The Nation, “are caught between a rock and hard place,” with child care costs swallowing nearly half a single mother’s salary. “Without another reliable adult around, it is a herculean task to find enough time and money to survive.”
That uphill battle has its roots in President Richard Nixon’s decision to veto a comprehensive universal child care bill passed by Congress in 1971. Since then, mothers have only fallen further behind: Low-income mothers are unable to find and sustain decent employment because of child care difficulties, and middle-income women futilely hold on to jobs that usually end up just covering child care costs.
Women already face huge physical, financial and emotional struggles in the process of giving birth. That mothers re-entering the workforce then suffer a second round of inequalities — lower than average wages, preschool that costs the same as the median wage in the U.S. and child care that costs more than the median rent in some states — only underscores how far behind European countries we are.
The mommy wars — the conflicts between working and stay-at-home mothers on everything from diapers to preschool — are a product of a society that punishes mothers with a systemic lack of support and infrastructure. It’s paramount that we give new mothers the means to have affordable births and child care.
Key to this shift is expanding the discussion early on — for one, around more compassionate, holistic pre- and postpartum care. Stepping into the gaping hole left by a medical industry that often discharges new parents without even a follow-up phone call are birth and postpartum doulas, including those who work on a volunteer basis with low-income mothers and try to find them sliding scale services they can afford. But many women don’t know doulas exist or how to locate an affordable one.
The U.S. could take lessons from the U.K., where National Health Service midwives and family doctors follow a rigorous schedule of mandatory home visits and check-ins with new mothers, keen to spot the first signs of postpartum depression and ease women into their new roles.
On the child care front, early childhood education programs such as universal pre-K have been proved to significantly improve long-term educational, health and economic outcomes, especially for low-income children. But we need to push for more free education programs nationwide.
By making life so difficult for mothers — whether they are social workers, adjunct professors or teens — the U.S. undermines the role of feminism when women are at their most vulnerable and are most unable to articulate their demands and their complaints. The schism between the childless woman and the mother is a fabricated one. It’s time to put aside fractured politics and form a united front that demands better support for us and for our children.