Why Black Women Are Rejecting Hospitals in Search of Better Births (Published 2021) (2022)

Why Black Women Are Rejecting Hospitals in Search of Better Births (Published 2021) (1)

Some mothers are seeking alternatives, worried about Covid-19 and racial inequities in health care.

Jamira Eaddy-Onque, center, and her husband at the Birth Center of New Jersey in Union. Racial disparities in health care and the fear of giving birth in a hospital during a pandemic have increased interest in birthing centers.Credit...

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Photographs and Text by Alice Proujansky

Anastasia Onque was born just before midnight on a cold New Jersey evening in January. Jamira Eaddy-Onque pushed her out into the hands of a midwife, who set the baby on her mother’s chest. Ali Onque, the baby’s father, stretched a newborn hat over Anastasia’s wet hair, kissing her again and again as he lay with her and Ms. Eaddy-Onque in a wide, comfortable bed. The lights were dimmed and soft music was playing in the background.

The little family was safe and healthy. But this birth took place in a distressing context: New Jersey has the fourth highest maternal mortality rate in the United States, which as a country has the worst rates of maternal mortality in the industrialized world. Increasingly, experts are concluding that these grim rates are caused by racial inequities in America’s health care system.

Black mothers in the United States are four times as likely to die from maternity-related complications as white women. In New Jersey, it’s even more alarming: A Black woman is seven times as likely to die from pregnancy-related causes as a white one. The problem has become so dire that in January the state introduced a strategic plan to eliminate racial inequities and lower the rate of maternal mortality by 50 percent in the next five years. Gov. Phil Murphy has proposed a budget that will pay for many of the plan’s recommendations.

A growing awareness of these disparities, along with the fear of giving birth in a hospital during a pandemic, is leading some pregnant Black women to seek out other options. It’s one of the reasons Ms. Eaddy-Onque decided to use a birthing center when expecting her second child, Anastasia.

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Why Black Women Are Rejecting Hospitals in Search of Better Births (Published 2021) (2)
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Birth centers are sort of halfway points between hospital births and home births. They serve women with low-risk pregnancies and use midwives, who have medical training, and doulas, a nonmedical position focused on emotional support, physical comfort and patient advocacy.

Giving birth presents a number of risks to mother and child, and those risks are difficult to measure. A government-financed study showed that clinical outcomes for mothers using birth centers and those using hospitals were virtually identical for low-risk women.

But birth centers aren’t necessarily a safe option for everyone. “Even in a low-risk labor, there are situations that can arise where you very quickly go from a low-risk situation to a high-risk situation or emergency,” said Dr. Timothy Fisher, medical director of the Northern New England Perinatal Quality Improvement Network. Those risks can be minimized through careful assessment of patients and communication between the midwife and their client, he said, and by having a “local system of care that’s well oiled to to deal with those times when transfer and transport are necessary.”

The Birth Center of New Jersey in Union, N.J., where Ms. Eaddy-Onque gave birth to Anastasia, has been increasingly busy during the pandemic. Founded and owned by Dr. Nicola Pemberton, a Black obstetrician-gynecologist, this facility is unusual in that it is run by a medical doctor who has admitting privileges at a nearby hospital and that it primarily serves people of color.

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When Ms. Eaddy-Onque’s labor was taking longer than expected for a second-time mother, midwives used a variety of techniques to move her baby into a more optimal alignment. They squeezed her upper hips to open her pelvis and used a woven scarf to shake her hips. The team had her lie on her side, sit on a birthing ball, walk the hallways and use the shower and tub. The techniques were successful, helping her avoid a medical intervention like a cesarean section.

Cesareans are often lifesaving but not without risk and are thought to be significantly overused in the United States. Women looking to avoid them are among those increasingly seeking out-of-hospital births. Births in birth centers more than doubled from 2004 to 2017. In the United States, low-risk women overall had a rate of Cesarean of 27 percent in 2018, while women who used birth centers — who by definition are low risk — had a rate of 6 percent.

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But free-standing birth centers are uncommon: There are only 400 nationwide, including three in New Jersey and three in New York City.

Birth centers are also often unavailable to the low-income communities, partly because they usually involve high out-of-pocket costs. Though the centers’ approach is said to save the health care system money, they often face low insurance reimbursements and can lose money when caring for patients using Medicaid. These financial factors are part of the reason birthing centers tend to avoid locating in poorer areas.

For Ms. Eaddy-Onque, her experience at the birth center was a welcome contrast from her first birth, where she said a doctor behaved like he was “at an auto body shop.” She said he instructed her brusquely, “Hey, Mom, open up for me,” as he tried to check her cervix without explaining who he was or what he intended to do.

“You’re supposed to be relaxed, trying to literally bring life into the world,” Ms. Eaddy-Onque said.

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She had heard of Black women losing their babies or dying during childbirth, and she didn’t want Covid-19 protocols to dictate who could be with her during labor. “I don’t need to be further inconvenienced by a system that’s not going to listen to me,” she said.

“We’re talking about people who are at greater risk of experiencing racism, implicit bias, being marginalized in the health care setting,” said Rachel Hardeman, who researches reproductive health equity at the University of Minnesota. “There’s more of a need for people to be able to cultivate a space that feels good and feels safe for them. There are fewer opportunities to see that happen in a more traditional health care setting, and that’s problematic.”

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This also influenced Laneta Lafayette’s choice to have her first child at the Birth Center. “I wanted to feel more in control or informed,” she said, “like I could identify with my birth workers in the same way that my grandmother was born with midwives in the South. It was this community experience where everyone rallied together as a part of the culture to guide this mother through her birth.”

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Ms. Lafayette said it was important to her that women of color be part of her care. “I was just terrified of not being able to be heard and seen by my birthing team,” she said. “I liked that I was surrounded by Black women. That was the most comforting thing, like being in a womb of my own.”

Though Ms. Lafayette was eventually transferred to a hospital, she appreciated her time spent laboring in the Birth Center. While taking a shower there, she said, “I could see my reflection in the mirror. I just looked at myself and I was like: ‘Oh, my God, this is amazing. I’m beautiful, I’m giving birth.’ I think I’ll always remember that reflection of myself.”

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Ms. Lafayette had a long and challenging labor, which began on Jan. 27. Dr. Pemberton induced labor in several ways before transferring her to a hospital for more monitoring and, ultimately, a Cesarean delivery. All birth centers have relationships with hospitals for when medical interventions become necessary, but it is less common for a doctor at a birth center to have admitting privileges at those hospitals. Dr. Pemberton does, which is a tremendous benefit for Birth Center patients who need medical intervention.

Ms. Lafayette was relieved to feel Dr. Pemberton’s familiar hand on her belly and hear her voice in the operating room. She trusted that she had exhausted her options for a vaginal birth and that, given her lack of dilation and the concerning fetal heart tones, a C-section was truly necessary.

Ms. Gabriel-Caldwell was with Ms. Lafayette and her husband throughout her labor, giving her back massages and sips of apple juice, coaching her through contractions, tucking her hair back and firmly instructing her to relax. She was with her at home, in the birth center and in the hospital after her baby, Nova, was born.

“I want to change the narrative of birth,” Ms. Gabriel-Caldwell explained. “I want people to see options. It’s really important that it stay beautiful.”

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Alice Proujansky is a freelance journalist based in New York and is the recipient of a photography grant from the Magnum Foundation.

FAQs

What is the best country to give birth in? ›

Norway. Norway ranks as the best country to be a mother due to its wonderful health care and education systems. Mothers enjoy substantial maternity leave and childcare provisions. The country offers low cost day care and flexible schemes that allow mothers to return back to work while collecting maternity leave.

What is now the most common place to give birth in the United States? ›

Hospitals. Hospitals are the most common place of birth in the United States, with 98.4 percent of births taking place in a hospital in 2017 (MacDorman and Declercq, 2019).

When did hospital births become common in the US? ›

In the United States there was a large shift towards hospital births beginning around 1900, when close to 100% of births were at home. Rates of home births fell to 50% in 1938 and to fewer than 1% in 1955.

How can I give birth naturally? ›

What Happens During Natural Childbirth?
  1. hypnosis (also called "hypnobirthing")
  2. yoga.
  3. meditation.
  4. walking.
  5. massage or counterpressure.
  6. changing position (walking around, showering, rocking, or leaning on birthing balls)
  7. taking a bath or shower.
  8. immersion in warm water or a jacuzzi.

What country is it free to give birth? ›

It's 'almost free' to have a baby in Finland—and feels like 'the whole country is providing for a child'

Which country gives free citizenship by birth? ›

Antigua and Barbuda, Argentina, Barbados, Belize, Brazil, Canada, Chad, Chile, Cuba, Dominica, Ecuador, El Salvador, Fiji, Grenada, Guatemala, Guyana, Honduras, Jamaica, Lesotho, Mexico, Pakistan, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Uruguay and Venezuela.

What is the cheapest state to have a baby in? ›

On the opposite end of the list, the study shows that Arkansas is the least expensive state to have a baby in with a total cost of $20,637. The state has an average cost of health insurance sitting at around $4,832, an average cost of child care at $6,184 and childbirth at $9,621.

What is the safest country to give birth? ›

The 10 countries with the lowest newborn mortality rates in 2016, according to the report, were:
  • Japan.
  • Iceland.
  • Singapore.
  • Finland.
  • Slovenia.
  • Estonia.
  • Cyprus.
  • Republic of Korea, or South Korea.
20 Feb 2018

What is the best state to have a baby in? ›

Massachusetts topped the report's list of the best states to have a baby, receiving high marks for its quality of healthcare and family-friendliness. Following the Bay State were Vermont, Rhode Island, Minnesota and New Hampshire.

Who was the first baby born on earth? ›

The fact of her birth is known because John White, Virginia's grandfather and the governor of the colony, returned to England in 1587 to seek fresh supplies.
...
Virginia Dare
BornVirginia Dare August 18, 1587 Roanoke Colony (present-day North Carolina)
Known forfirst English child born in the New World
2 more rows

What is the most common year to be born? ›

1991 is the most common birth year in the US — Quartz.

Can you be put to sleep while giving birth? ›

General anesthesia is used for emergencies during the birthing process. General anesthesia induces sleep and must be given by an anesthesiologist. Although safe, general anesthesia prevents you from seeing your child immediately after birth.

What is more painful C-section or natural birth? ›

However, recovery from a cesarean delivery is generally more painful. “[It] is a lot more painful, longer, and often more difficult than recovery from a vaginal birth because it is a major abdominal surgery,” Teen explains.

Is induced labor more painful than natural? ›

Induced labour is usually more painful than labour that starts on its own, and you may want to ask for an epidural. Your pain relief options during labour are not restricted by being induced. You should have access to all the pain relief options usually available in the maternity unit.

How much pain does a woman feel during childbirth? ›

The most common description of the level of pain experienced was extreme menstrual cramps (45 percent), while 16 percent said it was like bad back pain and 15 percent compared it to a broken bone.

What country is the most expensive to have a baby? ›

South Korea tops the list of most expensive places to raise a child from birth to age 18, measured as a percentage of per capita gross domestic product, according to research from Jefferies (JEF) which used data from Yuwa Population Research. GDP is the broadest measure of a nation's economic activity.

What country pays you to have kids? ›

Sweden pays parents for having kids — and it reaps huge benefits.

Where is the cheapest place to give birth in the world? ›

Color-coded by the least to the most expensive places to give birth, a quick look at the map reveals that the U.S. and Japan are the priciest places to pop out babies, while Canada, Russia, South America, and South Africa are the least expensive.

What is the easiest citizenship to get? ›

An Antigua and Barbuda passport offers you visa-free travel in 151 nations across the world. Antigua and Barbuda is one of the easiest countries to get citizenship by investment.

Which country gives fastest citizenship? ›

The fastest way of getting a second passport is participating in the St Kitts and Nevis or Vanuatu citizenship by investment program. The obtaining period is 2 months. In Vanuatu, it's easier to pass the Due Diligence check, but a St Kitts and Nevis passport provides more benefits.

What is the most powerful passport? ›

The world's most powerful passports

Japanese citizens now hold the most passport power, as they are able to enter 193 nations visa free, or with visa-on-arrival. South Korea and Singapore hold joint second place, with both countries' passports enabling their citizens to access 192 nations without restrictions.

Which U.S. state is the cheapest to live? ›

1. Mississippi. Coming in as the cheapest state to live in in the United States is Mississippi with a cost of living index score of 83.3. It also has the lowest average housing costs in the nation at 33.7% below the national average.

Where is the cheapest place to have a baby? ›

According to Magnify Money, the 10 cheapest states to raise a baby, and the total monthly costs are:
  • Arkansas: $723.
  • Mississippi: $759.
  • West Virginia: $814.
  • Tennessee: $830.
  • Louisiana: $835.
  • Alabama: $837.
  • Utah: $850.
  • South Carolina: $850.
28 Nov 2018

What are the benefits of having a baby in the USA? ›

The benefits to your baby of being born in America include the following:
  • American citizenship and a Social Security number.
  • Visa-free entry to 169 different countries.
  • Grants while enrolling in major U.S. educational institutions.
  • Access to multiple credit resources after age 21.

Do Japanese co sleep with babies? ›

In Japan, infants and mothers co-sleep as part of common practice since ancient times, and mothers and infants usually sleep in the face-to-face position. As of 2008-2009, at least 70% of infants in Japan reportedly co-sleep with their parents (Shimizu et al. 2014).

What happens if an American gives birth in Japan? ›

The child can stay in Japan for up to 60 days after birth without the need to apply, but if the child will continue to stay in Japan for more than 60 days after its birth, then an application is required to be submitted within 30 days of the child's birth.

What country has the healthiest babies? ›

Overall, the report found that the top 10 rankings on the child flourishing index were the countries of: Norway, ranked first overall.

What is the rarest state to be born in? ›

Nevada. Nevada wins the gold for the states with the fewest residents remaining. It is heavily dependent on gaming and tourism, and just over a quarter of its residents can say they were born there.

What's the best state to live in 2022? ›

Massachusetts topped 2022's list, touting a score of 62.65 out of 100. New Jersey came in second, dropping from the top spot last year. New York, Idaho and Virginia fill out the rest of the top five states to live in, in that order.

How much does it cost to deliver baby in USA? ›

A new study by the Kaiser Family Foundation found that the average cost of childbirth in the US is $18,865 under large insurance plans. Though most of that is often picked up by insurance, out-of-pocket payments clock in at an average of $2,854.

Has a baby been born in space? ›

Can Babies Be Born In Space? No, babies cannot be born in space. Since November 2011, there has been an uninterrupted presence of humans in space. There has always been at least one human in space, although since Yuri Gagarin (the first human to be launched into space), only about 500 people have gone up into the void.

Who was the first woman to ever get pregnant? ›

Lina Marcela Medina de Jurado (Spanish pronunciation: [ˈlina meˈðina]; born 23 September 1933) is a Peruvian woman who became the youngest confirmed mother in history when she gave birth on 14 May 1939, aged five years, seven months, and 21 days.
...
Lina Medina
Children2
3 more rows

What are July born called? ›

If your baby is born between July 23rd and 31st then he or she is a Leo.

What is the rarest birthday month? ›

Ultimately, it can take up to a year for a healthy fertile couple to get pregnant, so you could start out with plans for a spring baby and end up joining the baby boom in the fall.” According to the CDC, February is the least common birth month.

What is the rarest birthday in the world? ›

It may come as a surprise, but December 25 is on the top of the rarest birthdays.

Is painless birth possible? ›

Painless, normal delivery is possible by providing the mother with epidural anesthesia during labor. This is regional anesthesia that reduces pain in a certain part of the body.

Can a woman give birth without pushing? ›

What is the fetal ejection reflex? The fetal ejection reflex, also known as the Ferguson reflex, is when the body “expels” a baby involuntarily — that is, without forced pushing on your part.

Does labor still hurt with an epidural? ›

With an epidural, you might be able to feel contractions — they just won't hurt — and you'll be able to push effectively. There is some evidence that epidurals can speed the first stage of labor by allowing the mother to relax.

Why do they tie your arms down during C-section? ›

Next, something that completely surprised me: Some hospitals may strap your arms to the operating table (others leave them free)—done to prevent you from inadvertently knocking a member of the medical team while they are wielding a scalpel.

Why do they keep you awake during C-section? ›

With epidural and spinal regional anesthesia, the anesthetic is injected near the spine, which numbs the abdomen and legs to allow the surgery to be pain-free while allowing the mother to be awake.

Which delivery is painless? ›

Painless normal delivery or delivery with labor analgesia (Epidural) is a technique where very specific concentration of drug is used. Although the drug reduces the pain, it maintains the ability to push your baby out through the birth canal.

Is it better to go naturally or be induced? ›

Nature typically prepares the cervix for delivery in the most efficient, comfortable way. However, when there's concern about mother's or baby's health or the pregnancy continues two weeks past the due date, inducing labor might be the best option.

Does it hurt to have your water broken? ›

Does it hurt when my waters break? No, it shouldn't hurt when your waters break or when they are broken for you. The amniotic sac, which is the part that 'breaks' doesn't have pain receptors, which are the things that cause you to feel pain.

What happens if I say no to induction? ›

What Your Care Provider Might Say. If you decide to hold your ground and not go along with the induction, there's no hospital police that will come to your house and arrest you. Ultimately you hold the power to accept or decline treatment, whether it's an induction or any other procedure.

What is more painful than giving birth? ›

While both have elements of pain, some may last longer depending on the type of surgery, the location of the incision or surgery, and the health of the individual. Needless to say, recovery from surgery can be more painful than childbirth.

Who has higher pain tolerance male or female? ›

Acute Pain Tolerance Is More Consistent Over Time in Women Than Men, According to New Research. Many researchers exclude women from pain studies because they assume that hormonal changes in women lead to more variability over time and less reliability in ratings of pain.

Do babies feel pain during birth? ›

The results confirm that yes, babies do indeed feel pain, and that they process it similarly to adults. Until as recently as the 1980s, researchers assumed newborns did not have fully developed pain receptors, and believed that any responses babies had to pokes or pricks were merely muscular reactions.

What is the safest country to give birth? ›

The 10 countries with the lowest newborn mortality rates in 2016, according to the report, were:
  • Japan.
  • Iceland.
  • Singapore.
  • Finland.
  • Slovenia.
  • Estonia.
  • Cyprus.
  • Republic of Korea, or South Korea.
20 Feb 2018

Where is the cheapest place to give birth in the world? ›

Color-coded by the least to the most expensive places to give birth, a quick look at the map reveals that the U.S. and Japan are the priciest places to pop out babies, while Canada, Russia, South America, and South Africa are the least expensive.

What country has the best paid maternity leave? ›

Top 10 Countries with the Longest Minimum Maternity Leaves (in weeks):
  • Bulgaria — 58.6 weeks.
  • Greece — 43 weeks.
  • United Kingdom — 39 weeks.
  • Slovakia — 34 weeks.
  • Croatia — 30 weeks.
  • Chile — 30 weeks.
  • Czech Republic — 28 weeks.
  • Ireland — 26 weeks.

Can Tourists give birth in USA? ›

United States immigration laws regard pregnancy in the same way as other medical conditions. This means that if you enter the U.S. on a B-2 visa, you must have private health insurance or sufficient funds to pay for any medical care you might need. Giving birth in the United States can be costly.

Do Japanese co sleep with babies? ›

In Japan, infants and mothers co-sleep as part of common practice since ancient times, and mothers and infants usually sleep in the face-to-face position. As of 2008-2009, at least 70% of infants in Japan reportedly co-sleep with their parents (Shimizu et al. 2014).

What country pays you to have kids? ›

Sweden pays parents for having kids — and it reaps huge benefits.

What happens if an American gives birth in Japan? ›

The child can stay in Japan for up to 60 days after birth without the need to apply, but if the child will continue to stay in Japan for more than 60 days after its birth, then an application is required to be submitted within 30 days of the child's birth.

Is childbirth free in USA? ›

In the U.S., the average cost of a vaginal birth is $13,024, including standard predelivery and postdelivery expenses such as facility fees and doctor fees. A cesarean section (C-section) is much more expensive, costing an average of $22,646 including standard predelivery and postdelivery expenses.

What happens if a pregnant woman gives birth in another country? ›

If you are a U.S. citizen (or non-citizen national) and have a child overseas, you should report their birth at the nearest U.S. embassy or consulate as soon as possible so that a Consular Report of Birth Abroad (CRBA) can be issued as an official record of the child's claim to U.S. citizenship or nationality.

Do you have to pay to have a baby in America? ›

The cost of having a baby isn't cheap — in the United States, at least. The average cost to have a baby in the US, without complications during delivery, is $10,808 — which can increase to $30,000 when factoring in care provided before and after pregnancy.

What country has the shortest maternity leave? ›

Using OECD figures, here is a snapshot of paid leave for mothers around the world.
  • Iceland – 18 weeks FRE (26 weeks total)
  • United Kingdom – 12 weeks FRE (39 weeks total)
  • Mexico – 12 weeks FRE (12 weeks total)
  • Australia – 8 weeks FRE (18 weeks total)
  • United States – 0 weeks FRE (0 weeks total)
27 Jan 2020

What country has the longest paid paternity leave? ›

The country that offers the longest duration of paid paternity leave is South Korea, where a duration of 52.6 weeks offered.
...
Countries With The Longest Paid Paternity Leaves.
RankCountryWeeks Of Paid Leave For Fathers
1South Korea52.6
2Japan52.0
3France28.0
4Luxembourg26.4
6 more rows

Does China have paid maternity leave? ›

Female employees receive a maternity allowance during their maternity leave. This allowance is calculated from their insurance policy, which is based on their salary. The most common allowance mechanism in China is operated through insurance. In this case, the female employee is paid by the Social Security Bureau.

What happens if a child is born in America to foreign parents? ›

Anyone born in the United States or its territories acquires automatic US citizenship, according to the 14th Amendment to the Constitution. Even children born in the US to non-resident foreigners on vacation acquire US citizenship by birth, even if they are also citizens of their parents' home country.

What is the cheapest state to give birth in? ›

North Dakota was named the most affordable state to deliver a baby—a notable ranking, considering that the average conventional delivery in the U.S. costs over $10,000. And those birthing costs can vary significantly from state to state, given the wide disparities in cost of living.

What happens if a Canadian has a baby in the US? ›

How to get Canadian citizenship for U.S.-born children Canadians can pass on citizenship to their children who were born in the U.S. by applying for a “Proof of Citizenship.” U.S.-born children of Canadians can automatically get Canadian citizenship.

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