literatelush

You open by discussing the alarming fact that the U.S. is the only developed country that has a climbing maternal mortality rate, which is absolutely true and as an expecting mother in America I find that especially troubling. Then you say:

We know that community care, doulas, lactation consultants, mental health support, and other services are what improve health outcomes.

How do these things relate to increasing maternal mortality? You seem to suggest that insufficient investment in these services is related to or driving the maternal mortality crisis. Are there peer-reviewed studies or resources available that shed light on that relationship, whether it’s causal or correlational? If not, what do you think is actually driving the maternal mortality crisis and how do you think it should be addressed, ideally?

On a personal note, I find that I am quite inundated with unofficial resources of the “wellness” variety that often run counter to what modern medicine says is best for my and my baby’s survival and wellbeing — for example, giving birth outside of a hospital. There’s been a growing culture of shame surrounding “non-natural” birth plans rooted in scientific and medical fact for quite some time (most prevalent on social media). This has coincided with explosions in popularity of other “wellness” trends such as essential oils, alkaline water, healing crystals, and so on — it’s a whole subcultural groundswell. This flurry of unscientific information has made it more difficult for well-meaning people, including expecting mothers, to separate fact from fiction and make choices that actually maximize their chances of a successful health outcome. Taking my earlier example, it seems like opting for a non-hospital birth plan would actually promote increased maternal mortality rather than help it. Thoughts?

Thanks for your time and best of luck with the website.

If that’s true and it’s also true that midwives/doulas improve maternal mortality outcomes in those cases, then there should be proof of that. I am asking OP for that proof.

To clarify, are you saying that obstetricians are high-risk providers compared to midwives? Do you have proof of that?

How are midwives better equipped to identify “clots, pre-eclampsia, bleeding, or other preventable health issues that could be caught by earlier intervention” than doctors?

I recently saw a published study (can’t find it now but it popped up within the last few months here on Reddit in r/science or r/psychology I believe) that showed that women lose sexual interest in their long-term partners over time spent cohabitating. The study also showed that men don’t experience this reduced interest/desire in their partner, and that the women who were exempt from that reduction were those with less education than their male counterpart.

This sounds to me like it characterizes the general tendency in long-term monogamous hetero relationships for the “passion to go away.” What are your thoughts on that result? What can be done about it, if anything? Is that an indication of strict monogamy perhaps not being a good fit, or something else? Do we just need to accept and settle for that?

I’m very happily married to a man I love deeply and who I know is physically very attractive, and he finds me very attractive. When we have sex it’s enjoyable for both of us, and we communicate very openly about what we like and want to try and are generally willing to try new things, and we do.

But I just never really want to have sex with him, and it makes me feel absolutely terrible and guilty. I can’t explain why. I have sex with him as much as possible but not because I feel desirous, I just do it for him. I do experience sexual attraction to other people occasionally but I don’t act on it. It feels like I’m in the same situation that billions of other people/women are in but haven’t figured out the solution yet. Is there an answer to this problem?

Edit: We have discussed the possibility of opening our sexual relationship to other people but neither of us feels great about that. I think we’d both enjoy having sex with someone new but would hate seeing the other person enjoy sex with someone new.

I agree. I’d guess the main driving forces in our maternal mortality crisis include (1) poor access to healthcare in the first place, so that many women forgo adequate prenatal and postnatal care, (2) differentially lower quality of care for minority women (both due to worse access and other causes), (3) obesity, (4) lack of guaranteed maternity leave, and there are undoubtedly others. It is not driven by OBs’ evil machinations and shameless profit motives.

Attempts to sow even deeper seeds of mistrust in medical professionals in the minds of uncertain women/expecting mothers doesn’t sit well with me and I agree with you that it only adds to the mortality issue because it discourages regular, adequate medical care. There are parts of this post’s discussion where OBs are straight up maligned and it’s implied that the maternal mortality rates in this country exist because they are basically killing women. It’s also mentioned that seeing a surgeon such as an OB is a drastic measure most pregnant women don’t need. I 100% disagree with that statement. Eye doctors, ear doctors, and dermatologists are all surgeons as well, and yet we routinely seek their expertise for non-surgical care. You don’t only see a surgeon when you need surgery, to say so is a meaningless deception tactic that serves to undermine medical professionals and scare women who are already hesitant and fearful.

I absolutely believe that doulas can play a supporting role in the pregnancy/childbirth process and work in conjunction with doctors and nurses to improve health outcomes. But I am deeply, extremely uncomfortably with how common it is for folks (often doulas themselves) to frame the matter as an “us vs. them” choice, because that’s dangerous and wrong. Of the seven women closest to me who have given birth (four friends, my mom, my MIL, and my aunt), FIVE of them required crash C-sections after attempting vaginal birth. All seven of them had top-quality care throughout and after pregnancy, and none of the emergency C-sections occurred because of problems that should have been caught sooner — the need simply arose suddenly and urgently. Had they been outside of the hospital setting with their deliveries supervised by anyone other than an OB, they would have died. It is not an either-or situation, but if it were, I’d choose my OB every time.

(End of brain dump!)