内容摘要：AP Medical Writer Lauran Neergaard contributed to this story

AP Medical Writer Lauran Neergaard contributed to this story

Jennie Joseph, back left, lead midwife and clinic director at the Commonsense Childbirth clinic talks with client Regine Baramore as husband Scott holds six-week-old daughter, Yahareice. (AP Photo/John Raoux)“We have these four tenets that go with my model: access, connection, knowledge and empowerment,” she said. Some patients “cry because they’ve never had that kind of care or respect.”

All of this, Joseph said, contributes to better outcomes. With thousands of patients over about 26 years, she and her colleagues have never had a maternal death.— which refers to the death of a woman from pregnancy or childbirth complications during or within 42 days of a pregnancy — generally has been rising in the U.S. About 700 women die each year, with another 60,000 suffering related injuries or severe complications.A controversial study recently attributed the increase to a change in how they’re recorded: a “pregnancy checkbox” on death certificates recommended by the National Center for Health Statistics partly to fix an undercount. But the U.S. Centers for Disease Control and Prevention and many doctors pushed back against

, which suggested the rate is about 10 in 100,000 live births. Some say the true rate may be somewhere in between — meaning it’s still higher than other wealthy nations.Midwife Stephanie Wood examines Courtney Knight during a pregnancy checkup. Midwives at Commonsense Childbirth are striving to provide good, accessible care. (AP Photo/Laura Ungar)

Midwife Stephanie Wood examines Courtney Knight during a pregnancy checkup. Midwives at Commonsense Childbirth are striving to provide good, accessible care. (AP Photo/Laura Ungar)

U.S. rates remain high despite proven ways to prevent maternal deaths and injuries, experts say — things like ensuring quality medical care at delivery; getting to know patients; addressing issues like addiction or poor nutrition; and providing care and support after the baby is born.who lack permanent legal status after their work hours; and in California, where

, who often work on farms or at meatpacking plants.“We’ve learned that we have to go to people, we have to go to where they’re at, they’re not going to come to us,” said Mandip Kaur, the health director of the nonprofit Jakara Movement.

More than one-third of the nation’s rural hospitals — about 700 — are at risk of closing because of “serious financial problems,” according to a July analysis from the Center for Healthcare Quality and Payment Reform. Harold Miller, the center’s president and CEO, said one hospital closure can ripple through a rural community.“If the hospital didn’t exist, there wouldn’t be any physicians there,” Miller said. “There is no place to go and get a lab test except for that hospital. There may be no nursing home or place to get rehab or long-term care other than these hospitals.”