How Do We Fix Maternal Health?

I have the immense privilege of spending the majority of my days speaking with birth workers all over the world. Doulas, midwives, nurses, traditional birth attendants, educators, advocates. Women and people who are deeply committed to improving maternal health outcomes in their respective communities. And what I can tell you is this: we are all working toward the same goal. What I have learned, from witnessing so many different models of care, from community-based systems to hospitals that truly prioritize support, is that so many of the solutions are actually quite simple. But our systems, and our narrative, are not designed to support those solutions.

All over the world, birth is becoming more and more medicalized. And let me be clear, medical advancement is incredible. It saves lives. It is essential. We need it. But birth and motherhood become infinitely more powerful, more beautiful, and more empowering when they are held by community. Birth should not happen in isolation.

So I want to invite you to imagine something with me: a world where every single community has an abundance of midwives, where midwifery care is accessible, respected, and woven into the fabric of society. A world where home birth, when appropriate, is the norm, and when complications arise, because of course they do, hospital transfer is smooth, seamless, and without shame. Where the midwife remains present, even if the role shifts, where care is continuous, and where the system works together instead of fragmenting the experience.

Right now, there seems to be this unnecessary war between the medical system and the non-medical system, and we are wasting so much energy fighting each other when that energy could be used to actually improve the system. Maternal health is a global crisis. In the United States, maternal mortality rates are rising. In many parts of the world, cesarean rates are climbing to 50%, 70%, even 90%. More women are experiencing postpartum mood disorders, and more families are navigating early parenthood in isolation, without support, without community. So can we please, collectively, change this narrative? Because this is not just a medical issue. This is cultural. This is structural. This is about how we value mothers, babies, and the act of bringing life into the world.

If we are going to shift this, we have to take a multi-faceted approach, and one of the most important pieces is that we have to rebrand midwifery. Midwifery care needs to be sexy. It needs to be something that when children are asked what they want to be when they grow up, they say a midwife. It needs to be visible at career fairs, accessible in universities, and feel like a viable, respected, and exciting path. Because right now, it is not. Even in a country like the United States, where there are pathways, the system is fragmented. There is the CNM pathway, rooted in nursing and the medical system, and there is the CPM pathway, focused on out-of-hospital birth, and yet CPMs are not even recognized in all 50 states. So we have trained, skilled providers who cannot legally practice depending on where they live. Insurance companies are often incredibly difficult when it comes to covering home birth midwifery care, with inconsistent reimbursement and limited access, pushing an evidence-based, cost-effective, deeply supportive model of care to the margins.

And then we zoom out globally, and in so many parts of the world, there is no pathway at all. In countries like India, where there is one of the highest birth rates in the world, there is literally no formal pathway to becoming a midwife. In Tanzania, nursing students receive a short period of midwifery education and are then expected to work in labor and delivery wards, but there is no role dedicated solely to supporting physiological, unmedicated vaginal birth in the way humans have been giving birth since the beginning of time. And yet, in these same places, there are traditional and Indigenous midwives, women who have learned through decades of lived experience, through apprenticeship, through community. They are holding so much knowledge and responsibility while often practicing without recognition, without protection, and without integration into the system.

So what happens when we do not invest in midwifery, when we do not create pathways, when we do not build systems that allow birth to unfold physiologically when it can? We get over-medicalization. We get systems that rely on intervention not always out of necessity, but out of structure. We get cesarean rates that continue to rise, and again, I have to ask, why the f has that happened? Because we have created systems that do not have the time, the staffing, or the design to support birth as it naturally unfolds. Because we have allowed fear to dominate the narrative.

And we cannot let fear be the driving force behind birth. Not in hospitals, not in homes, not anywhere. Because fear changes physiology, fear disconnects us from our bodies, fear creates urgency where there may not need to be urgency. What if instead we centered a different narrative? Power. Magic. Because that is the truth I have witnessed. There is no greater moment in my human experience than being present for a birth where a woman is supported, where she feels safe, where she is surrounded by care. Watching a couple fall more deeply in love, hearing that first cry, feeling the flood of relief, of oxytocin, of awe that fills the room. Birth is not just a medical event, it is a human event, a relational event, a transformative event, and when we strip it down to something purely clinical, purely controlled, we lose something essential.

So yes, this will take time. This will not happen overnight. It requires policy change, educational reform, insurance reform, cultural shifts, and global collaboration.

But let’s aim high. Let’s build toward a world where there are so many midwives, so deeply woven into every community, that we are no longer asking how to fix maternal health, but instead asking what to do with the abundance of care. Let that be our problem. I would love for that to be the issue we are trying to solve.

And it starts with changing the story.