“Listen to women” and #MeToo became part of the headlines and hashtags from 2018, crafting a new narrative from U.S. Supreme Court hearings to workplace dialogues — bridging tears, trauma, and tools for reparations. Listening to women is also getting traction in New Jersey’s collective effort to improve maternal health, as reported by NJ Spotlight. As we listen to women in all of their life experiences, maternity care continues to be a significant life event with long-term consequences. One time, I gave a speech and gave the definition of “obstetrical violence” used by Venezuela (an umbrella term including coercion, bullying, discrimination, forced procedures, and lack of consent) and asked the audience of New Jersey nurses, healthcare providers, doulas, and parents to raise their hands if they had had ever witnessed the five indicators of obstetrical violence. Every hand was raised.
New Jersey has the opportunity to engage the momentum for real change in maternity care by putting respectful maternity care (RMC) in the focus and priority area. More than just a nice phrase, respectful maternity care is an indicator of quality.
RMC acknowledges the meaningful experiences of childbirth by women as an essential element of quality healthcare, which involves recognizing their self-worth, feelings, choices, and preferences. It is globally recognized as a universal human right for every childbearing woman admitted in any health facility. With both clinical and community tools, RMC can help New Jersey families. More than 40 percent of births in New Jersey occur to foreign-born parents (ACNJ Babies Count 2018); incorporating the RMC quality indicator would be a transformative tool. This month, Dr. Neel Shah, an obstetrician from Harvard, spoke a symposium in New Jersey, declaring, “Women deserve safety. Women also deserve dignity.”
Paying attention to consumers of maternity care
When we listen to what families experience as consumers of maternity care, we need to hear the ongoing impact of implicit bias and racism in the delivery of healthcare. Listening to Mothers is the name of a four-time seminal research series into the experience of childbearing women in the United States. Most recently, it was completed in California, where the experiences of women of color reflected their experience in maternity-care health systems. The survey results of Listening to Mothers in California have national implications for better serving pregnant and parenting black women across the country. The conclusion: “Black women are not receiving the healt care or the nonmedical support they need to thrive before, during, and after childbirth.” The survey found that many black women reported not receiving the high-quality, culturally relevant, unbiased care that all women need. The study also profiled what women of all races know about cesarean births. Six in 10 women did not walk around at all during labor after being admitted to the hospital. That number needs to be explored in New Jersey, where we are learning from California’s terrific toolkits. We can also survey the experience of new parents and see if they had access to evidence-based care practices for a safe and healthy birth, including movement in labor.
How do we ask maternity care to begin with the inherent dignity and worth of every human being? Other states are making sure early childcare and education are at the table for maternal health transformation, using the brain science that early experiences matter and posting adverse childhood experiences so that pregnancy and early parenting can have protective factors. The neurobiology of love and attachment reminds us that it deeply matters how women, families, and communities are cared for, invested in, and impacted by social determinants of health. And neurobiology reminds us that the first 1,000 days are posited by politicians and media outlets, moving health, early learning, and community development out of silos and into integrated sustainable systems with an emphasis on equity. Early experiences matter, in particular the relationship of the infant-parent dyad. We also know that how we treat a woman in pregnancy can assist her in nurturing and parenting, supporting not only the clinical needs, but also the social and emotional transition through caring family, friends, and doulas.
But none of that can occur if we lose mothers or infants. But we are losing mothers and infants, having too many near misses and too many families feeling traumatized after experiencing birth. I am eagerly anticipating the next #123ForMOMS, which designates each January 23 as the day for New Jersey maternal health. Last year, a free toolkit and resources for families and providers were available to help families formulate questions and assist providers to hear about symptoms so needed in assessment.
Tearing down the statue
When we listen to women, we know we will hear trauma. This past summer in Central Park, a statue of J. Marion Sims, “the father of modern gynecology” was taken down. As NPR explained, “some of the tools he developed are still used in exam rooms today. But his breakthroughs came at the expense of enslaved black women upon whom he performed dozens of intrusive and painful experiments without anesthesia” or consent.
We birth seven generations forward, explained an elder midwife, speaking about legacy and generational trauma. The stakes are too high to not listen to women in labor and in life. As our country begins to talk about consent, power, and privilege, we can also listen to women to change the world for children and communities in New Jersey.