内容摘要：Some of Commonsense Childbirth’s patients with complications are referred to specialists, and most choose to give birth at a local hospital, where Joseph has forged strong ties, instead of in Commonsense’s on-site birthing rooms. They then return to a midwife for postpartum care.

Some of Commonsense Childbirth’s patients with complications are referred to specialists, and most choose to give birth at a local hospital, where Joseph has forged strong ties, instead of in Commonsense’s on-site birthing rooms. They then return to a midwife for postpartum care.

“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.

One of the most important things is making sure everyone can get regular prenatal checkups, which requires having enough health care providers.“In some cases, the small hospitals are losing more money on private insurance than they are on Medicaid, which is really kind of remarkable,” he said, “but that’s how little they get paid ... by the private insurance plans.”

Low Medicaid reimbursements play a role in, along with worker shortages and declining birth rates. More than half of rural hospitals have stopped offering labor and delivery services, another recent analysis from the Center for Healthcare Quality and Payment Reform showed. That can lead to longer travel times and a

when she was pregnant with her second child. There is no labor and delivery unit at the hospital in Rocky Mount, Virginia, and a hospital about 40 minutes away closed in 2022. Ratliff, who is Black, instead went to Salem — more than an hour away — for every prenatal visit. She ran through all of her paid time off, and had no paid maternity leave.She did, however, have a doula. The doula is Black and her services were covered by Medicaid — a benefit Virginia started offering in 2022.