I was pregnant with my second child when I was 39 weeks pregnant. However, until I was within a few hours, I even suspected that the discomfort I was experiencing was childbirth. It may seem odd, but since my first child was delivered by emergency C-section, I had never experienced labor pains before.
When I called my doctor—a solo doctor who has been practicing for 30 years—to let him know I thought I was in labor, he shot back, “I checked you out yesterday. You can’t be in labor.” ( It’s true. I went to check it out the day before and he shared a few things with me on that date. First, based on a quick look at how I carry it – despite all the evidence suggesting I’m an ideal VBAC ( Vaginal birth after cesarean) candidate – another cesarean is almost certain. Second, delivery is not imminent.). During our brief call, he didn’t seem to care about the pain I was going through and didn’t offer an alternate explanation for why I was sad.
However, about an hour later, as the contractions became more intense and regular, I called him again. I told him I knew he didn’t believe I was in labor, but I was feeling bad and I needed to see someone for whatever reason. It was almost dinner time on Saturday night and he blew me away again. “Do what you’re supposed to do, Alan. But I’m not going to the hospital tonight.” Confused about the doctor and the pain, I turned to my husband and said, “Let’s go now. If we’re lucky, someone else will deliver the baby. .”
A few hours later, my lovely baby Lyle was born via VBAC. My doctor never showed up.
I saw that doctor again during my six-week postpartum checkup. Neither of us ever called before the birth or mentioned the fact that he didn’t have a baby. When the inspection was over, I ignored his instructions and stopped at the front desk to arrange the year. Instead, I sped past the reception and headed straight home, determined to never see him again. I didn’t re-engage OBGYN until I was pregnant with my third child.
I often think of this experience when I hear the plethora of statistics about poor maternal outcomes in our country. Most of us know that the U.S. has the highest maternal mortality rate in the industrialized world. We also realize that the situation is even more dire for black mothers, who are 2.5 times more likely to die from fertility-related causes than white mothers. Our poor performance has worsened since the pandemic, with maternal mortality surging nearly 20% between 2019 and 2020. Evidence suggests that these statistics do not reflect medical failure, but rather the system’s inability to listen to women.
This trend of firing women or medical gaslights in clinical settings isn’t new, but we’re getting better at documenting it. We now know that women are more likely to be misdiagnosed than their male peers for a variety of conditions and diseases, including stroke.
When it comes to maternity, gaslighting is especially dangerous because a level of teamwork and trust must be established between patient and provider to achieve desired outcomes. A courteous, open relationship between you and your doctor has a time limit. Ultimately, you work together in the trenches and sometimes make different decisions. As a patient, you are completely exposed. Both your lives and your children’s lives are at stake. A successful outcome depends on functional give and take between you and your provider – knowing that each of you will do your best to fulfill your respective roles.
Despite this collaborative dynamic, obstetric care, like most other service lines, is physician-centred. We met the doctor on his turf and he did something to us and told us to do more while we were away. If we don’t understand what he’s asking us to do or why it’s important, that’s our failure and we’ll suffer the consequences.
The reimbursement structure further exacerbated things. Maternity leave is a one-time payment with a low reimbursement rate, meaning providers get the same cheap pay whether a patient sees him 12 or 30 times during pregnancy. The typical health system either loses money or just breaks even when it comes to labor & delivery services. As a result, there is little incentive or budget to invest in innovating or improving the experience around it.
However, despite poor economic conditions, the health system has consistently placed women’s health as a top strategic priority. Some have an abundance of neonatal units that can offset fertility losses. Others cite the fact that women make 80 percent of household health care decisions and see childbirth as a key opportunity to include women and their families in the system.
So, in general, we have a perfect mess: a strategically — but financially — line of service, and poor outcomes shamefully defined by racial divisions.
If there’s any good news in this mess, it’s that there are real options for improvement, net-net, that won’t cost more. In fact, if implemented properly, they can reduce the total cost of care.
First, it is time to seriously discuss increasing the number and role of midwives. For most pregnancies, the midwife is a fully qualified clinical partner, if not a better one. Midwifery includes everything from fetal heartbeat detection to delivery. In addition, midwives are trained in a person-centred approach to care that is overly focused on listening to the patient, understanding her situation and concerns, and capturing barriers to success—whether social or otherwise—while physician training simply does not emphasize these obstacles.
Second, we need to assess the ways in which digital products empower women. This could mean exploring the ways remote patient monitoring (RPM) can be used to manage and notify patients and providers between appointments. Not only does RPM enable earlier detection of serious conditions like preeclampsia, but many women say it provides them with a sense of agency and increases their overall level of trust in providers. Beyond RPM, we need to consider other ways to use digital capabilities to expand access, improve quality and empower women. Examples include, but are not limited to, telefeeding, teletherapy, providing high-quality maternity, postpartum, and family content, and promoting social connections among moms and with community-based organizations. These forms of digital support are either relatively inexpensive or result in a reduction in the cost of care that far exceeds its cost.
At the end of the day, the future of women’s health lies not in a deeper understanding of our body science, but in our willingness to advance talent and create an environment where we can be seen and heard.
Photo: damircudic, Getty Images
