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Film Premiere: American Delivery

Film poster

On Monday the 10th of March I joined the premiere of the documentary ‘American Delivery - Solving the Maternal Mortality Crisis in the US Healthcare’ by filmmaker Carolyn Jones. She tells stories of nurses and (nurse)midwives in the United States (US) who provide alternatives and more personalized care for women during their pregnancy and in the post-natal period.

 I was sitting next to a woman who worked as a nurse and researcher, who was personally invited to attend this premiere at the Church Center for the United Nations during the CSW. She travelled for a few hours to New York only to attend this premiere, she did not have a UN pass and did not attend other sessions. She knew many other women in the audience, who also worked in the field of nursing. They looked happy and proud to be there as they are aware of the valuable work of nurses in maternity care in the US.

Complex Maternity Care System in the US

Nurses and (nurse)midwives are working on changing their role in the US healthcare system, which has complex preconditions. It is especially complex for women and families when making choices in order to be able to receive the type of maternal care they want and need. This complexity is not only shown in terms of the different types of healthcare insurances and payments related to receiving care, but also whether you have access to care, and even the type of training your (nurse)midwife has received. The authority of (nurse)midwives can even change per state. As a medical anthropologist I was curious to hear more about the current situation of maternal care and maternal mortality in the US.

The medicalization of childbirth in the US has many negative side effects, leading to unnecessary interventions and in effect complications. For example, cesarean sections rates are higher than necessary (32.1% of all births in 2022) according to the World Health Organization (WHO), who recommends not to exceed 10-15%. Unnecessary cesarean sections can be dangerous or lead to unnecessary complications. From a human rights perspective (over)medicalization undermines laboring women’s autonomy and bodily integrity, which has been a pressing issue for years. This issue has also been raised in many different documentaries for over 20 years. So, what are new trends in maternity care and are things improving in the US?

High maternal mortality rates

The documentary is made in a context of high rates of maternal mortality in the US, in many cases including deaths that could have been prevented (for example due to hemorrhages). The statistics of the situation in the US is compared to other Western countries, when comparing this to the Netherlands maternal mortality is 10 times higher in the US. These numbers are shocking and it is necessary that the way the maternal healthcare system is designed, changes.

The documentary also highlights another shocking reality relating to the higher rates of maternal deaths (including prenatal and postpartum deaths): black women in the US are four to five times more likely to die. These deaths can also be related to, for example, postpartum depressions. There are ‘medical desert’ areas in the US. These are areas where women cannot easily access critical health centers or even whole food markets. Nurses are one of the healthcare providers that find their way to women who need care, and for example create postpartum group sessions to discuss breastfeeding. A lot of these issues require the right type of care at the right time, therefore systemic change and accessibility is necessary.

Hope

The documentary shows examples of hope. It starts with a woman who receives house visits by her nurse during her pregnancy. Nurse-family partnership (NFP) is presented as one of the ways in which nurses provide more personalized care. NFP is designed for pregnant women with low-incomes and focuses on first-time parents. In the movie you can see how the nurse and the mother build a bond, care is personalized and the mother has time to ask questions and receive support where needed. Another hopeful example from the documentary is maternity care provided in a birth center in Brooklyn. At this center they provide holistic care with a focus on the physiology of birth. This contrasts to a more medicalized birth provided in most hospitals. In addition, we can see female nurses having leadership roles within the hospital setting, and nurses who include women in group sessions to interact and share experiences. The documentary focused on the role of the nurses.

You cannot Separate Reproductive Care from Maternal- and Infant Care

The discussion was short, but highlighted a few important points. A Canadian woman addressed that she heard young women in the US talking about having children with fear, because of the risks during birth. This means that these young women are aware of the current situation of maternity care in the US, and it is influencing their future choices in life.

At the end, one of the speakers concluded with an important message: you cannot separate reproductive care from maternal- and infant care. These are connected and therefore (multiprofessional) collaboration is needed to change policies, training and schooling, and provide more person-centered healthcare, such as by doing house visits and bringing women together in their communities.

By Britt Myren, Atria

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