Centering the Woman in Maternity Care

April 12, 2022

Perspectives in Primary Care (formally the Primary Care Review) features perspectives from practitioners and students representing organizations, practices, and institutions across the country and around the world. All opinions expressed in this article are owned by the author(s).

Few human experiences match the intensity of stress, pain, exertion, and emotional turmoil as labor. The mortality risk in pregnancy is present for all, though Black women in the United States are three times more likely to die from pregnancy-related complications than white women. And yet, there also exists another tragedy—the unaddressed pregnancy-related morbidity, which affects women’s lives far into the future.


Maternal morbidity is defined as “short- or long-term health problems that result from being pregnant and giving birth.” For instance, hemorrhage, infection, blood clots, high blood pressure, and cardiovascular disease are classified as severe maternal morbidities and often garner high attention. However, morbidities like difficulty breastfeeding, challenges bonding with the newborn, perinatal mood disorders, pelvic floor dysfunction, and low self-esteem in motherhood are equally important. Already a women’s health nurse practitioner, I later trained as a doula in order to further address these morbidities from a systems perspective.


A doula is a trained professional who provides continuous physical, emotional, and informational support to pregnant persons before, during, and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible. While practicing as a doula, I’ve come to understand that our traditional model of obstetric care often doesn’t center the needs of the woman. And further, the limited focus only on pregnancy and immediate postpartum care serves as a primary risk factor for pregnancy-related morbidity. As we focus solely on the delivery of a healthy baby, we miss the importance of the maternal-fetal health continuum. Unfortunately, the health care system we must navigate was built on the disempowerment of all women, particularly women of color.


To address the needs of the woman in tandem with the baby, we must shift towards a comprehensive model of care that determines success of a pregnancy and birth as defined by the perspective of the woman. In clinical practice, this may include discussing one’s desires (and fears) for the delivery and birth, goals for nutritional, mental, and physical health, and supporting the woman in her preparation for labor and the postpartum period. We must also encourage preconception planning during primary care visits, as well as normalize having more than one postpartum visit.


The goal of these efforts is to help women feel more empowered to trust their bodies and to advocate for themselves as they navigate these highly stressful, yet transformative, times in their lives. This is even more important for Black women and other marginalized groups, as these communities often bear the heaviest burden of maternal morbidity and mortality in the United States.


Through legislative policies like the Black Maternal Health Momnibus Act of 2021, stakeholders advocate for how pregnant people receive health care in the U.S., with a sharp focus on reducing racial disparities in maternal health outcomes. And while these systems-level changes are incredibly important, there’s also room for individual action. We can all contribute to these efforts by unlearning and relearning how to provide care in pregnancy… and we must remember that collaboration is key, as the focus of our work must always remain centered on the woman.

This piece is being published during Black Maternal Health Week. You can learn more about this week here!

**Feature photo obtained with standard license on Shutterstock.


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Ketura’h Edwards-Robinson, MSN, is a Boston native, women’s health nurse practitioner, and Manager of the Maternal Child Health Program at the Dimock Center in Roxbury, Massachusetts. Ketura’h received her Master of Science in Nursing (MSN) with a concentration in women’s health from Boston College, and she holds a certificate in adult-gerontology from the University of Massachusetts Boston. She is also a trained sexual assault nurse examiner (SANE), doula, and childbirth educator. Ketura’h is passionate about providing women with comprehensive health care and empowering women in pregnancy.

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