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(logo whooshes) (gentle orchestral music)

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(soft music)

(interviewees chattering indistinctly)

- The pain obviously,

and that's like my fear about giving birth

that it's gonna hurt really bad.

- The whole pain thing.

I mean, when people see documentaries about giving birth,

they see the screaming and the crying

and the sweating.

Yeah, I personally am scared of giving birth.

- I think Americans and women have really internalized

that birth needs to be medicalized

and you have to have an epidural

and you're not supposed to experience pain.

- Nine months, I hate throwing up, the morning sickness,

carrying something in your body

is terrifying to me.

- The idea of giving birth,

it just seems like all the images

I have in my head of women giving birth

are of them like screaming

and like their faces were really red and the sweating,

and then the husband faints and then they're, like,

"Oh, first time dad."

Like all those movie things that happen.

- At this point, we've internalized that ideology

over and over again.

It's now embedded in so many women

to think that birth is something that needs to be treated

rather than is an experience or is a natural thing.

(woman screaming)

- God, this hurts.

Pain! Pain!

(woman groaning)

(woman screaming)

- Sorry, I can't. - Yes you can.

- I can't. - Hey.

(woman screaming)

- I just can't do it!

- [Nurse] You'll hurt the baby right now.

- Oh, I hurt. I hurt.

(women screaming)

- Oh, oh!

(women screaming)

- No, I can't, I can't do it!

- [Husband] I need you to do it. You can do it.

(soft rhythmic music)

- [Paula] My name is Paula James-Martinez.

I'd recently moved to New York City

because a giant dotcom had asked me

to be in charge of all things fashionable.

So, like every career-minded woman,

I fell in love and moved to California.

(soft upbeat music)

And I can remember thinking,

it had never been a better time to be a woman in America.

♪ I am woman, hear me roar

- [Paula] Companies were taking real action on equal pay.

Sexual harassment was finally being taken seriously.

Beyonce had "Lemonade."

And we were about to get our first female president.

When I had a really bad feeling...

(brakes screeching)

Oh, ----.

(toilet flushes)

I was pregnant.

So, I googled like my life depended on it.

And apparently, it did.

Mothers in this country are routinely dying.

- Can it possibly be true that women giving birth

in our country are more at risk

than women in dozens of other nations around the world?

Afraid so.

- A new investigation claims the United States

is the most dangerous place to give birth

in the developed world.

Every year in the US, more than 50,000 mothers

are severely injured during or after childbirth.

- [Paula] Yet, in the wake of so many tragic stories,

I had a great birth.

That's me in labor,

and that's about as dramatic as it got.

But I couldn't help thinking,

"Why was I such a unicorn?"

What had gone right for me, I wondered.

Was it because I'd had a midwife, which is unusual,

but it seemed very normal to me.

In case you hadn't noticed yet,

although my daughter was born here in the US,

I was born in the UK,

and delivered by National Health Service midwives.

I know, you guys are thinking this.

- [Nun] Camilla Fortescue- Cholmondeley-Browne?

- Yes.

- [Paula] But a modern British midwife

does much more of this.

♪ Ah

♪ Ah, push it

♪ Ah, push it

♪ Push it good

- [Paula] In fact, in Great Britain, France, Germany,

Netherlands, Belgium, Denmark, Sweden, Norway and Finland,

over 75% of all babies are delivered by midwives.

And unlike the United States,

none of these countries

have a rising maternal mortality rate.

Birth in the UK is actually so safe that the baby's father

is statistically more likely to die

during his partner's pregnancy and birth.

And British babies are 70% more likely

to survive the experience than in the US.

So, why was it when I told many of my American friends

that I was having a midwife birth,

did they look at me like I'd suggested

some sort of witchcraft?

(gentle acoustic music)

- Our history with midwives is complicated.

In the 1930s, as hospitals were sort of

becoming more popularized and springing up

all across the country,

and obstetrics as a specialty in medicine

was starting to grow,

and hospitals became teaching hospitals

and, you know, suddenly, there was a shift away

from home births and midwives.

And it was almost like, you know,

let's create a new territory, and in order to do that,

we have to kind of get rid of the old.

And that was probably a very simplistic way of doing it,

but that's essentially what happened.

It's not in our popular culture anymore.

- You don't even know that it exists.

When I talk to people, they say like,

"Oh, people still do that?"

And I'm like, yes, you don't have

to have your birth in a hospital.

You can actually have it in your home

or in a birthing center, however you want,

and it's your choice.

Knowing that it's a choice.

Like, people don't know that they have choice

in how they birth, right?

(gentle acoustic music continues)

- I knew always that I wanted

to at least try for a natural birth.

It just made sense to me.

Why would I not try?

And I also knew enough

that when you go into a hospital,

that it's not going to necessarily,

it's going to be harder to go that way

if you're in that setting.

That just like, that's what hospitals are created for,

that's what doctors are trained to do,

is to intervene and to operate.

To me, it always felt like if I don't want that,

then I should stay away,

and I think there are more and more women

that feel that way.

(melancholy acoustic music)

♪ She's a good girl

♪ Loves her mama

♪ Loves Jesus

- [Paula] Kimberly Turbin lives just 30 miles

away from me in Reseda,

yet her birth story is a million miles away from mine.

It was one of the most disturbing stories I heard

when I was researching this project.

But not just that,

it was also one of the bravest.

♪ Living in Reseda

♪ There's a freeway running through their yard ♪

- Rape and having sex when you don't want to,

all that doesn't compare to, I think, what he did.

He basically changed my decision making

for me, my body, and my vagina for the rest of my life.

Like, now I have muscle spasms issues,

I have vulvodynia, which is just vulva pain.

♪ And all the bad boys

♪ Are standing in the shadows

♪ And the good girls are home

- I was fine until I let them know that I had PTSD

and that I had been raped in the past.

And I think that the feeling was starting to creep up on me,

so if they could give me something to calm down.

Doctor came in and it's not going fast enough.

He said, "We're going to have to do an episiotomy."

And I'm like, "No. Why?

We haven't even tried."

It was only 5:00 PM and right now it's only maybe 11 or 12.

And I'm like, "I haven't even started pushing yet.

This can't be right."

Basically, he said, you know, how dare I question him?

He's the expert here in the room and this is what I need.

And the nurse is like, "It's just going to be a little cut."

And I was like, "No, I don't want you to cut me. No."

- [Nurse] Keep going, keep going, go, go, go, go, go.

- [Kimberly] No, don't cut me.

No, why?

- [Doctor] What do you mean why? That's my reason.

- [Kimberly] Why can't we try?

I get one contraction and I'm not saying anything,

and I breathe out and he just starts cutting.

- [Nurse] Push, push, push.

Keep pushing, keep pushing, keep pushing.

Go, go, go, go, good job. Good job.

Keep pushing. Go, go, go, go, go, go, go, go.

Okay, and relax.

- I couldn't even, like, really cry

or get happy over my baby being here,

and he basically snatched that whole moment away from me.

I don't think they believe our pain.

Like, after I gave birth,

I asked Dr. Abbassi for pain medication

and he told me, "No." (scoffs)

And this is that I couldn't sit.

It was like, like someone ripped me open

and then they sewed it back up.

But you can't even go to the bathroom

after that comfortably.

I was able to catch full blown on video

how these doctors sometimes are acting towards us

and what they do to our bodies,

while we're sitting there saying, "No, don't do it."

- [Crowd] Stop the violence! Stop the rape!

- What made me take it further was after I had Rio,

everybody was like, "Well, you know, "it's normal.

Sometimes they cut.

That's what they decided to do and, you know, get over it."

But I was like, "But how?"

I can't even sit down without being in pain.

Six months, I was walking slow,

I had to change my whole diet, all fiber,

I had to retrain my vagina how to work,

just to have a functioning vagina at 31.

That's a huge part of my body that I have

that somebody took my control over.

If I ever find somebody I love or want to marry

or make a life with,

I have to explain that I have these ------ issues

with my vagina and I may not ever

want to have a baby again.

(people chattering)

- I don't know how anyone could watch that video

and not be moved and appalled by this woman lying there

in the most submissive position possible,

with a doctor wielding scissors at her genitals,

and her begging not to be cut,

and him berating her and demoralizing her

and insulting her

and then proceeding to cut her punitively 12 times.

And it's all caught on tape

and it took us 80 lawyers to find one

that thought they could win.

- It's like a whole machine that works together.

They decide your fate before you even wake up that day.

And a lot of these cases is, but is the baby okay?

There's no is the mom okay?

- What stands out a lot for me is,

and it's happened a few times,

is the doctor not making eye contact with the mom.

Like, entering the room,

not going up to the mother's side,

not asking her how she's doing,

not asking her what she needs, what she wants.

Getting straight down to business

without any interaction at all.

Having women being told to be quiet

when asking for what they want.

- This one particular person,

who we're now really close friends,

I was there for both of her children

and one started out as a home birth

and we had to end up transferring.

The doctor introduces herself

and the first thing she says is,

"Oh, you're so lucky because I'm the only one

on the floor who uses forceps."

And I was like, "What kind of introduction is that?"

Like, that's how you introduce yourself?

Not "Hi, my name is so and so, this is my name."

It's, "No, hey, you're so privileged

because I'm the only one who use forceps."

And I was like, "Are you insane?"

(dramatic music)

- [Paula] Why don't we know about our choices?

And where did all the American midwives go?

We have to go back to the early 1970s.

♪ I am woman, hear me roar

♪ In numbers too big to ignore

- [Paula] It had never been a better time

to be a woman in America.

Companies were taking real action on equal pay.

Sexual harassment was finally being taken seriously.

Joni had Blue, and...

- [Pamela] At the time, the Vietnam War was happening.

(bomb exploding)

(sirens wailing)

- We were pacifists, we believed that people

could work out their differences

by talking with each other

and being compassionate with each other.

- [Paula] That's Pamela.

She'd never admit it,

but she's a bit of an American folk hero.

As a college student moved by the message

of peaceful resolution,

she set off across the country in a caravan

of pastoral buses with her husband

to spread the word of peace and love

when the country was facing a lot of hate.

- What you put your energy into, you get more of.

So, if we put our energy into peaceful resolutions,

then we get more of that.

- [Paula] Eventually, the caravan of buses

settled in rural Tennessee to found what would become

one of America's largest communes, The Farm,

where Pamela would become one of the world's

most famous midwives.

So, I set off to Tennessee to find out why midwives

are a counterculture movement in the US.

(soft rock music)

- We didn't call ourselves midwives.

We weren't midwives.

I had a major in art,

but we had a belief that birth would work.

- Mind and body are one.

How the woman's mental attitude is during the birth

is going to make a huge difference

on how it goes physically.

And that's part of spiritual midwifery,

you want to nurture these women,

these babies, these families.

You got to kind of give your heart and soul to them really.

- [Paula] Joanne is also one of the early members

of The Farm, and an OG spiritual midwife,

who, after seeing not just how the system had treated her,

but other women, knew it was time to fight for a better way.

Spiritual midwifery, in essence,

is the practice of caring

and listening to women during birth,

and also the title of one of a series of books

written by founding midwife, Ina May Gaskin.

These books have introduced an entire generation

to the possibility of peaceful, unmedicated birth.

Having sold over a million copies worldwide,

the book from a commune has something of a cult status.

But why now do generation after generation of mothers

continue to press their dog-eared copies

into each other's hands?

- [Doctor] All right. Let's do this, let's do this.

Let's do this.

Let's do this.

- In 1965, pretty much the standard of care,

when you first hit the hospital, you got a shot of Demerol.

Demerol is a pain reliever.

You got a shot of scopolamine, dries up your secretions.

You had your enema and your prep,

which included shaving your vaginal area.

- The nurses would call it pit, stick, suck and split.

Pitocin, an epidural stick,

suck the baby out with a vacuum extractor,

and bye, you know?

As quick as possible.

(baby crying)

- [Paula] Carol's story is really disturbing,

but unfortunately, not unusual for the time.

- I ended up having an allergic reaction to the Demerol.

Not only throwing up, but instead of it making me relax,

it made me tense.

At that time, when you got fully dilated,

they would bring you back to the delivery room

and they would give you more drugs, more anesthesia,

and put you to sleep.

- [Paula] And it wasn't just bad for mothers.

Studies also found behavioral and motor issues in babies

whose mothers had received anesthesia, including Demerol.

- And then, the doctor did a huge episiotomy

and took the baby with forceps.

- [Paula] Now, I'm only going to explain episiotomy once

because it makes even me feel weird.

But it's basically when a doctor

cuts you with scissors down there, to make, um,

the opening larger and get the baby out faster.

- After the birth, they put me in recovery

and just left me alone, flat on my back,

and I ended up throwing up and aspirating.

Luckily, one of the nurses came back in

as I had stopped breathing.

So, that was a horrific experience.

I really didn't know that that wasn't

what everybody went through.

You know, I wasn't educated enough to know the difference.

- [Paula] The difference was, though,

these were women looking for solutions

to stick it to the man and take back control.

There was a movement among women's groups in the '70s

developed to deinstitutionalize the dependent.

Feminists argued that childbirth was not a disease

and that childbirth did not require hospitalization

or the supervision of an OB.

- How did I get into midwifery, really?

Self-preservation. (chuckles)

I had my first baby in 1967

and the only real childbirth training I'd had,

as far as seeing a birth was "Wagon Train."

(dramatic orchestral music)

Once in a while, the Conestoga wagons on the trail

would pull over and film from the outside of the canvas.

You would hear a woman scream, a baby cry

and the wagons would roll on.

So, I thought, okay, you scream and the baby comes out.

I remembered one of the nurses saying,

"Just think about your breathing."

I said, "Well, how do you breathe?"

And she said, "Just think about your breath

going in and out."

And I tried it, pain cut in half,

and I was like wow, heavy magic, you know?

And then, it was just too strong,

I thought, "I can't do this anymore."

And it stopped. No more contractions.

And I'm sitting there going,

somehow I'm not understanding how intellectually,

how to get this baby out,

but my bod has gotten pregnant, grown this baby,

well on the way to having this baby.

I've just got to trust my body

that it's going to get me out of this.

And as soon as I thought that, they came back.

And pretty soon, I had to push.

- In those days, they bring you to an OR room,

which must have been about 45 degrees.

Everybody has layers of clothes,

and they're all yelling at me,

"Don't push because the doctor's not there."

Right after I'd made this deal with myself

to listen to my body.

So, I'm going, "Ah, okay, I'll be a good girl."

I don't push.

He finally shows up about 15 minutes later,

cuts a huge mediolateral episiotomy

for a 6 pound, 14 ounce little girl

I should've had 15 minutes ago with the nurses.

I couldn't sit down for a month.

I had to take a pillow with me everywhere.

I thought there has to be a better way than this, you know?

So, when I got pregnant with my second,

first midwife I ever met was a guy named Bob. (laughs)

And he asked how my other birth had gone,

and he said, "Oh, you can do it at home."

And I said, "Well, don't you need to cut an episiotomy?"

And he said, "No, no, just don't push hard."

On 4th of July, we were going over to Sutro Park

to sleep for the night.

Started having contractions,

called the Good Earth Commune.

One of the ladies came over with her baby and was,

what you would call nowadays, my doula.

And got me in a tub, talked me through some contractions,

and then I pushed him out and she said,

"He popped out."

All the fireworks in San Francisco went off.

(fireworks exploding)

It was the most empowering thing

that ever happened in my life.

It was so different from my first birth.

I just felt like I could do anything.

(gentle music)

- [Paula] So, that was it.

Women could do anything.

We were free.

Free to choose the birth we wanted to try for.

Free to push when we wanted to.

Free to say no to drugs or yes.

Free to give birth at home or not.

Free to be heard.

Free from dangerous procedures we didn't need.

Free to take back control.

Okay, maybe not.

I might have got a little carried away there.

The conflict over home birth proved one of the most bitter

between the medical establishment and the women's movement.

And while no state forbade home birth,

ACOG actively discouraged it.

Doctors have participated in home births

by offering backup in an emergency

were threatened with loss of hospital privileges

and even losing their medical license.

- Our Tennessee law had been on the books since 1898

and it was one little sentence in the Medical Practice Act

that said, "Midwifery is not the practice of medicine."

And that let midwives practice openly in Tennessee.

Not all states were like that.

- [Paula] In fact, very few states were like that.

- The midwives in the South were keeping midwifery alive.

They were keeping home birth alive.

These home birth midwives knew what they were doing.

- Midwives, especially in the Southern region,

have been the champions of our community

and there was a very intentional break.

Midwives were holding a lot of power in our communities,

and these were Black women,

and granny midwives as we call them in the South.

- [Paula] Grannies were healers

and valued by slave owners,

as more healthy babies meant, well,

more people to enslave.

But as slavery was abolished...

- [Joanne] They made it illegal

or retired them and then made it

illegal in Alabama and Mississippi and Florida. (chuckles)

- [Pamela] What it looked like to me

is the Alabama medical system

didn't want those babies to be borne by midwives.

They wrote a law and they put

all those midwives out of work.

And Alabama still has very backwards

in their thought about midwifery.

- Midwives are being attacked.

Being told that we're not safe,

but yet majority of the unsafe births

are happening in hospitals.

- [Paula] And even though the work of Black midwives

in America has been whitewashed

out of most of our cultural understanding of birth,

there's a growing number of midwives of color,

like Barbara, who are putting their lives on hold

to become qualified, often against the odds,

to provide holistic care within their community

and transform our perceptions

about what midwife care really is.

- Culturally, in African culture or Caribbean culture,

a midwife wasn't just a person that caught babies.

They were the medicine woman, they were the counselor,

they were the, you know,

they were everything centered around the community.

They uphold the family.

- [Carol] Historically, if you look back,

midwives have been a threat

and midwives have been the healers,

the people who deliver the babies

and the women who empower the women to give birth.

And there is no reason

that there shouldn't be midwives everywhere.

- [Paula] And because American tales

are often wild and winding,

the biggest community these progressive hippies served

as midwives were, well, the Amish?

- Now, the Amish are interesting

because they don't really educate

their women about childbirth,

but the girls grow up seeing their mother

having baby after baby after baby.

And so, somewhere back there,

they know that that's normal.

- So, those women are in our statistics,

you know, grand multips.

We've delivered a lady's 19th baby at 49 years old,

and that's not low risk.

- I don't think that the hospitals can brag about that.

I think that the hospitals are having a hard time

because they're doing so many interventions.

- [Paula] But interventions are also lifesaving,

which is why it's vital that midwives

are able to be supported by doctors if needed,

a model known as integrated care

in most developed countries.

- We made those connections in 1971.

Lovely doctors who are very willing to work with us

and have helped us a lot.

(birds chirping)

- For seven years, I was a backup for six wonderful,

dynamic lady midwives.

At one point, they even told me I was an honorary midwife.

I just happened to be there.

I was a midwife who could do

a ceasarean delivery if I needed to.

I was always the last person they wanted to see

because if I showed up,

it meant that something hadn't gone the way

they wanted it to.

- If there is an emergency, okay, yo,

let's go to the hospital.

If there's a C-section that is necessary and needed,

as long as that keeps baby and mommy safe and whole,

let's go do it.

(gentle acoustic music)

- [Paula] Washington has some

of the most integrated care in the US,

and the best survival rates for both mothers and babies.

In Jen's case, modern medicine saved three lives.

- I was 24 weeks pregnant

when I thought I was just having Braxton Hicks contractions.

Called my doctor,

I had mentioned that the contractions hurt

and they said, "Oh, actually, they shouldn't hurt.

You should come in."

It got serious really fast.

I hardly had time to fully understand what was happening.

(machine beeping)

When I woke up in recovery,

I knew I wasn't pregnant.

I knew they were born, I knew they were tiny,

but I didn't really understand what that meant.

It really wasn't until I was allowed

to see them the next day that, kind of,

that severity of the situation really hit me.

It was three months

and we were talking about tracheostomies.

It was six months and we were talking about more surgery

and lifelong therapy needs.

We saw what was coming with the medical repercussions

while the boys were literally

fighting for their life in the NICUs.

(gentle acoustic music continues)

- [Paula] Yet even with the incredible care

Jen's family received,

there was one very stark difference

between her story and those of mothers

in all other developed nations.

- The boys went in for heart surgery at six weeks old

and I know that bill came in at around $260,000,

which honestly, we just kind of laughed. (laughs)

Put it in a drawer.

We don't have that.

There were so much that was really expensive.

Being in the NICU, just the room itself is $10,000 a day,

plus I had two kids, so that was doubled.

That didn't include the doctors, the nurses,

the therapists, the treatments, the medications.

There were a lot of things that weren't covered,

but we we didn't start to realize some of that

until several months, even several years down the road.

I was very naive at the beginning

in that I just assumed that since we had

comprehensive medical care

and I paid my insurance bills every month

and I had an employer that sponsored this plan,

that it would be okay.

My biggest mistake was actually trying to pay everything.

We did everything we could to pay our bills

and to stay current.

So, we liquidated our 401ks, we sold our house,

we sold our cars, we sold our furniture.

We ended up declaring bankruptcy

to write off about $400,000 worth

of personal medical debt.

But even after that, their medical bills were still so high

that we just couldn't keep up.

This is America.

I had no idea we could fall into a gap like this.

(melancholy music)

- [Paula] Does the insurance system affect outcomes?

- People in the United States

no longer even know what the cost of medical care is

because it's so hidden in these copays

and you're being charged X only because they know

they're only going to get Y from the insurance repayment.

But if you're paying for it directly,

all of a sudden, there's a new price of B

that was never even part of the conversation.

So, I think that we don't live with real numbers

and that's all a part of the capitalistic system

that sort of supports

the medical industry and establishment.

It wasn't about safety

or what the women wanted or anything.

It was all about profit.

- Here, it's a business.

You become a commodity, your child becomes a commodity.

How can I thereby make money off of that?

I don't have time for you to be in labor for 72 hours.

No.

The capitalist structure of this nation

is based on the industrialization of motherhood.

- The people in charge now

seem to want to make it into shift work.

They have employed laborists, they call them,

who are watching,

actually more ladies than ACOG says

a doctor should be watching in active labor.

But they are watching numerous ladies in labor

and just intervening whenever somebody crosses

whatever arbitrary line has been created.

- Obstetrics is getting better at this in recent years

but there was a period of time where inductions

were really done for any old, almost no reason at all.

A convenience of scheduling.

- Well, I'm sorry, but our bodies

don't work like that as women.

We're not on a schedule.

We're not on a schedule.

Try to put a woman on a schedule.

(soft dramatic music)

- As society advances and medical care in general advances,

there's probably an underlying belief

that every technology that gets developed

is going to improve childbirth

and the care of pregnant women.

I think that's just a value

and something that's not necessarily proven scientifically.

- We are a country that likes to sue

whenever there's an outcome that is not optimal.

And so, we have a reactionary healthcare field

where we tend to not push the envelope,

allow somebody to do something

that's outside the normal standard of care

because we're really concerned about a lawsuit.

It is absolutely driving decision-making

in healthcare right now.

But it's also helping drive the maternal mortality crisis

because we tend to intervene out of concern

that we might be heading down a path

where we might see an adverse outcome

if we're not listening to people,

if we're not hearing what they're saying,

if we're missing important clues,

not just during their pregnancy and birth,

but in their postpartum period, we see adverse outcomes.

- If I had a wish,

it would be that we would have a birthing system

that was set up for and by women,

and that women were in control of the birthing process.

Because I think that there are things

that the largely male administration of most hospitals

and the boards of directors of insurance companies

just don't get about birth.

In an ideal world, I would love for all OBs

to have midwifery training

so they could understand the process of normal birth

as opposed to the medicalization of birth.

- [Paula] One of the most vulnerable moments

of my life was during labor,

and I can't imagine doing it without support,

particularly that of my doula.

If I'm honest, I don't really remember

anyone else being there,

but my husband assures me he was.

You might be wondering what a doula is.

No, a doula is not a handbag,

a weird deer or a part of your brain.

It's not exactly what Ali Wong suggests either.

- I'm very, very scared of childbirth.

That's why I'm going to hire a doula.

You know what that is?

You know what a doula is?

That's a white hippie witch (audience laughs)

that blows quinoa into your pussy

to Keyser Soze all the pain away.

- The doula is for physical and emotional support.

So it's what we used to do centuries ago.

Back in the day, our sisters, our mothers,

our grandmothers, our cousins, our aunts,

all the women before us who had babies helped us birth.

They were there, they were rubbing our back,

they were talking to us, they were singing to us,

they were doing all of these things

that helped us through childbirth,

and we just don't do that for women anymore.

And so, I think the doula fills that spot now.

- So, I think that doulas are extremely important

and I may be a little biased in that because I am a doula,

but I understand how important it is

for women to have support,

for us to be able to take care of each other

during this journey to motherhood.

♪ But I need a place to command ♪

♪ Somewhere quiet and somewhere warm ♪

- [Paula] And as much as you might think

doulas are in the same category as kale facials

or jade vagina eggs,

it's statistically proven

they can have huge benefits for mothers.

In fact, a large scale study of over 15,000 women

from 17 countries found that compared to birthing people

with no labor support,

those with a labor companion such as a doula

were more likely to have a shorter labor,

less likely to need drugs to speed up labor,

less likely to use any pain medication while giving birth

and less likely to have their babies admitted

to a special care nursery.

- Having come from a long line of teen parents,

I had always really been drawn

and had a heart for teens, pregnant teens.

You know, thinking of all these girls,

well, first thinking of my family, my mom, who with me,

took a bus to the hospital to get induced

and then took a taxi home at 18-years-old.

All my aunts who gave birth at 15, 16, 17.

I thought about them and what that experience

must have been like for them

and how different it was from my experience.

That is what made me go and do my doula training,

because I wanted to serve them

and other, you know, underserved women.

There's rarely a girl that says no to a free doula.

Do you want someone who's going to be there

and help educate you leading up to your birth

and then she'll join you during your birth

and she'll help massage you and comfort you

and give you all the information you need?

Do you want this person?

Yes.

Yeah, of course. And who wouldn't?

And a lot of them don't even know

that they have these choices and that they can speak up

and that they can walk into a hospital and have a plan.

Most of the doctors who they work with

and nurses do not expect them to walk in

knowing what they know.

And they would prefer that they didn't ask

and that they would prefer

that they didn't know these things.

- Our work becomes more in the realm of advocacy

in really trying to advocate

for this person's basic human rights.

Just the human right to just be who you are

and to have bodily autonomy over yourself

until you birth your babies in a way

that is affirming to you.

(gentle music)

- Doulas have been proven to improve outcomes

and the system is starting to recognize that.

It's a Band-Aid on a broken system

when what we should be doing

is spending all of that money and time fixing that system.

- What care ideally should look like

is that the woman who comes in to have her baby

is asked questions around what is important to her

and what those things are that she's really looking for

along the journey of her birth.

Where we're respectful,

if somebody's having a contraction

to stop talking and to support her through that

rather than being focused in our computer systems.

Where we are high touch and low tech,

where every woman's birth has a goal

of being as low intervention as possible

and not as managed.

And culture change is where hospitals

can make the greatest impact.

But society has just as great a role in how we portray birth

before somebody ever comes into that system.

- I stopped doing obstetrics last December,

which still is sad for me.

I came to that decision

because I just couldn't any longer

practice in a place where women's goals were so dismissed.

The chairman of our department

actually said that they were going to have protocols

and all ladies would get the same care no matter what.

And so the chance to individualize care for a given patient

went out the window.

And I couldn't, in good conscience,

take patients, who, over the years,

had entrusted me to be their advocate

and to make medical decisions for them, knowing them,

to have to give up not so much my autonomy,

but their autonomy was too heartbreaking.

It wasn't what I went to medical school to do.

- When you get a medical education,

you are apprenticed in some of the basics

and presumably, over the course of your career,

you're going to keep learning and advancing

and as the field changes, you keep along with it.

You get trained to practice in a certain way

and you get a certain familiarity

with clinical scenarios that are common.

And you basically learn this is how I treat scenario A

and this is how I treat scenario B.

To practice in a way that is different

in the way that you are trained

or different in a way that you are familiar with

becomes very uncomfortable

because you're not necessarily used to

or familiar with what's going to happen

if I don't do these things.

And our position as obstetricians is going to be

well, that's too bad.

You're just going to have to figure out a way

to survive it and get through it.

This is the only thing that we can offer you.

I just came to feel that we had taken

a wrong turn somewhere,

and how did our specialty get to a place

where the experts in childbirth cannot deliver a baby?

and how did our specialty get to a (soft dr)

- [Paula] How do the rest of us learn about childbirth?

(baby crying)

(people chattering indistinctly)

- All right.

Well, I'm going to set up a quick sonogram

and see if we can find out about the baby.

It looks like we will be having a happy, healthy baby.

First thing I'm going to do

is I'm going to give mother cabbage

a large dose of imagicillin.

Now this does not hurt nor harm her,

just loosens her leaves and helps for an easier delivery.

And the next thing I'm going to do

is I'm going to check to make sure

she's exactly 10 leaves apart.

She's going to need your help

with a quick breathing exercise

to help her relax a little,

so I'm gonna need you all to breathe in.

(people inhaling)

And out. (people exhaling)

And in. (people inhaling)

And out. (people exhaling)

All right.

Now she is ready to push,

but she's going to need your help one more time.

So, on the count of three,

can I get you all to push as loud as you can.

One, two, three.

- [All] Push!

- [Instructor] All right.

One more time, just a little bit louder.

One, two, three.

- [All] Push!

- [Child] Oh, he's so cute.

- [Instructor] Here's our lilele boy.

- [Audience Member] Yay.

- [Instructor] So, I'm just going to wrap him up,

and tell you a couple of things about him.

- [Child] So cute.

(soft eerie music)

(insects buzzing)

- [Pamela] When your body goes into labor,

you have a hormone, oxytocin.

In labor, it rises and rises and rises.

And at the time you have the baby,

you have the most amount of oxytocin

going through your system of any other time in your life.

And that oxytocin is a pain killer.

- [Paula] It's not just a better understanding of birth

for those having babies that's needed.

Partners are also a vital part of the process, too.

(child crying)

- [Charles] Let me see.

Which one? Which one is it?

- [Child] This one.

- [Charles] Which one is it? This one?

- [Child] Yes.

- [Charles] Let me see. You need a new finger?

- [Child] Yes.

- [Charles] All right. Let me check my pocket.

What's tonight, guys?

- Taco. - Taco what?

(child mumbles)

- [Charles] Taco Tuesday.

- [Friend] You want some tomatoes?

- [Child] Oh.

We had this with... (mumbles)

- [Friend] You did. Do you want the tomatoes?

- [Charles] This is a table I had.

This is actually, before we met,

this is like the table that Kira and I had.

- Yes. - In the place here, so...

For weeks, we moved in, and so she'd walk in,

I'd be sitting at this table, like eating,

like, a grown man who's like, all the time, like...

- That's amazing.

- Langston is in, what I call the toaster,

the little incubator, just taking a nap.

Kira is resting in her bed.

As I look down, I begin to see the catheter

at Kira's bedside begin to fill with blood.

And I was, I was alarmed, frankly,

and I brought it to the attention

of the staff and the nurses.

And they came in, they assessed Kira.

They ordered a series of tests,

including blood work and an ultrasound

and also very importantly,

a CT scan they were supposed to perform stat.

I'm concerned, but I'm thinking,

"You know what?

My wife is healthy.

My baby's healthy, and we're at Cedars-Sinai."

The blood work comes back, it's abnormal.

It's showing that all of her blood levels are dropping.

When they do the ultrasound,

they can see that her abdomen

is beginning to fill with fluid.

So, keep in mind, this is shortly after 4:00.

The doctor comes in, he looks at her,

feels around her stomach.

She's in intense pain, and he says,

"We'll just see what happens."

Right? And walks back out of the room.

And I'm asking, "Well, where's the CT scan?"

They're telling me, "It's coming, it's coming, it's coming."

7:00 comes. By this time, Kira's shivering uncontrollably.

She's beginning to become very pale.

They do another ultrasound,

they see that there's even more blood in her abdomen,

and I'm asking still, "Where is the CT scan?"

And at which point a staff member tells me,

"Sir, your wife just isn't a priority right now.

Your wife just isn't a priority right now."

9:00 comes, 10:00 comes.

No CT scan. Kira's condition is continuing to deteriorate.

And they said, "So, we need to give her a blood transfusion

so that we can keep her stable."

And I'm saying, "Keep her stable?"

Just a couple of minutes ago,

somebody tol tme that she wasn't a priority.

What are you talking about, "Keep her stable?"

Hours continued to go by.

10:00 comes, 11:00 comes.

It wasn't until after midnight

that they finally took Kira back to surgery.

I'm angry, I'm frustrated, but I'm thinking,

"Finally, they're going to do something.

They're going to do something.

They're going to fix it."

(machine beeping)

On the way to the operating room, I'm holding her hand,

and she's saying, "Baby, I'm scared."

And if you know Kira, there was not a lot that scared Kira.

We're talking about a woman that raced cars,

who ran marathons, who was an avid skydiver.

But she's holding my hand, she's saying, "Baby, I'm scared."

And the doctor says, "It's no big deal."

He says, "I'm going to go back in through the same incision

that I made earlier when I did the ceasarean.

I'm going to find out what's going on

and I'm going to fix it."

He told me that she would be back in 15 minutes.

(melancholy music)

After they took Kira back to the operating room,

they took me out to a waiting room,

the same waiting room we had entered that hospital in

at 1:30 that afternoon.

And at 1:30 in the afternoon,

that room was full of life.

It was full of mothers and balloons

and families that were excited

to welcome these precious gifts and these new babies.

And they put me in that waiting room and it was empty.

All I could hear was the janitor's vacuum.

My eyes are fixed on this set of double doors

because I know when somebody comes to give me some news,

they're going to come through that set of double doors.

Finally, those doors open,

a set of residents walk towards me

and they say, "Mr. Johnson, we need you to have a seat."

So, I sit down and they tell me,

"Mr. Johnson, we couldn't be back there any longer

without letting you know what's going on.

When he made the incision to open her up,

there was a lot of blood and Kira coded."

And I'm saying, "What?"

She coded, but her situation is critical

and they're continuing to work on her.

There was hope. They were working on her.

And in my mind, I honestly, at that point,

I thought that she was gonna be okay, right?

Because you're working on her.

And this is Kira, right? She's...

She's amazing.

That set of doors open again and those same two residents,

along with a doctor that I'd never seen before, came.

They told us that Kira had died

and there was nothing that they could do to save her.

♪ My darling time to shut your eyes ♪

♪ And leave the day behind and slumber ♪

♪ Tomorrow waits for you rise

♪ So rest your weary head and dream of wonder ♪

♪ It's not goodbye, it's just good night ♪

(gentle music)

♪ I'll meet you on the other side ♪

- [Charles] When they took Kira back into surgery,

and that doctor opened her up,

there were 3.5 liters of blood in her abdomen

and her heart stopped immediately.

♪ So much to tell you

♪ So much I want to show you

♪ I'll always be right here beside you to hold you ♪

♪ It's not goodbye, it's just goodnight ♪

♪ It's not goodbye, it's just goodnight ♪

- Yay, give me hugs.

Oh, I love you, sweetness. You're my baby.

Mwah.

I love you. Mwah.

- A woman like Kira,

a woman that's perfectly healthy,

having access to care, who has a healthy child,

who didn't have a high-risk pregnancy,

walking into a hospital like Cedars-Sinai Medical Center,

and not walking out to raise her precious sons,

I thought that she was an anomaly.

(singer vocalizing) (birds chirping)

(birds chirping)

- [Paula] I wondered if those in power

were starting to hear the voices

of those who felt so powerless.

- I'm here first and foremost

as not just a man and a husband,

but a dad to a beautiful, healthy

little five-and-a-half- year-old girl

that is missing the most important thing in the world

for every little girl, and that's a mom.

My wife took her life 41 days after my daughter was born.

No where on that death certificate

was a box checked that he had given birth to a baby.

There's two words: hanged and hanged herself.

My daughter has to look at that death certificate.

I'm running out of stories to tell her about what happened.

The reality of the matter is I'm scared to death

she's gonna blame herself.

But it's not her fault and it wasn't her mother's fault.

It's the system's fault.

It's healthcare's fault.

My wife did not suffer in silence.

She was extremely vocal about what was going to happen.

We went to seven different hospitals

and different facilities in the last 13 days of her life,

each one turning her away for one reason or another.

All the doctors she talked to,

the answer every time was the same and never changed.

"You're fine.

You're not crazy.

You don't belong with them.

Just go home and be with your friends and family.

This will pass."

Postpartum depression is twice as common as breast cancer.

Now, imagine that.

Imagine you just get diagnosed with breast cancer,

you walk into a hospital and they say,

"I'm sorry.

We don't offer services for that.

Just go home. You'll be fine."

It's too late for my wife,

but it's not too late for my daughter.

We have an opportunity

to make sure that my daughter's generation,

that women after my wife,

get the care they need, the care they deserve.

And I always emphasize all the time,

it is not a women's health issue,

it is a family health issue.

If mom is not okay, everybody suffers.

(melancholy music)

- [Paula] Postpartum depression is not a small problem,

yet far too many suffer in silence.

Not only are mothers not being heard,

but also there's this guilt

if you say you're struggling, that you're a bad mom.

- I think you're starting to see men step up

and talk about it, and we have to.

I cannot imagine going through that period

with a new addition to our family without my wife there.

I can't imagine it for me.

Obviously, your entire life would be upended.

I can't imagine it for our three-year-old little daughter

or our one-year little boy.

I can't imagine the stories that I have heard

from husbands and dads that have told their own stories.

What compels me to try to speak up about this

is to know that we can do something about it.

- [Paula] But is anyone in Congress doing anything?

- We're 47th in the developed world for maternal mortality

and it's getting worse.

So, then, the next question is why?

Like, why are we the 47th and why is it getting worse?

And why are some states even worse than others?

You know, if you're an African American woman in New Jersey,

I admit almost, to them, where it's like,

should we try and let them have birth elsewhere?

It's mind blowing, in 21st century America

that that's happening.

So, these groups started saying,

"Well, we can't answer the question fully.

"We need maternal mortality review committees

in every state.

We have to investigate every death."

- [Paula] In a moment when it feels like

we're unable to agree on anything as a country,

two mothers from either side of the aisle said, "Enough."

- [Jaime] We pushed and pushed and pushed

many different angles.

The coalition, Charles was willing to tell his story.

- I just started lobbying for it.

I sttearted writing letters.

I started making phone calls.

I started making visits to Washington, D.C.

Taking meetings with anybody that would meet with me.

Trying to tell Kira's story,

trying to get people's attention.

I'm not asking at this point.

I stopped asking a long time ago.

When I go into these offices,

I'm respectfully demanding their support.

I'm respectfully demanding that this bill

go to the floor for a vote.

Because there's two types of people in our country,

either you are a mama or you have one.

Poured my heart out to Congress.

People on both sides of the aisle are in tears.

For those that choose to stand in opposition to this bill,

you don't owe me an explanation,

you owe an explanation to my boys.

You owe Tara Hanson's son an explanation.

(melancholy music)

It passed with flying colors,

unanimous support in the House.

It passed to the Senate.

And so H.R.1318 is a law.

- Because I've been at the table doing policy

while I've gone through challenging pregnancies

or typical pregnancies,

or now, we're doing this with a midwife, right,

so get a little bit of everything.

I think it adds to my perspective when I'm making policy.

So, I bring that to the table, and we need it.

I guess part of the problem

is maybe there haven't been as many people,

I don't know, giving birth while in Congress?

- [Paula] Well, it's certainly an issue

that some of our lawmakers are less shy about discussing.

Lawmakers like Tammy Duckworth,

a senator, a veteran who lost both her legs

while deployed in Iraq and a working mom of two.

- And exerting even more control over women's bodies.

It's sexist, regressive and flat out dangerous.

But even while this administration's agenda is a travesty,

it's not an anomaly.

Rather, it's just the latest step

in the far right's long march to strip away women's rights.

And I'm tired of it.

Sick of them trying to shame women

when they are the ones who should be ashamed.

So, enough with hypocrisy, with the misogyny,

with some men in hallowed halls in D.C.

arguing that they know better than moms in Illinois,

or Arizona or Missouri.

We can and we must do better.

That means fighting for everything from equal pay

to better parental leave.

It means proving that we care about women

every day of the year, not just on one Sunday in May.

That's the least that our mothers

and daughters and sisters deserve.

Thank you.

The rising maternal mortality rate in the United States

is really an issue of disparity.

And it becomes an issue of disparity of resources.

And I think that the push to go after organizations

like Planned Parenthood, the abortion debate,

the choice debate has really allowed those folks

who are very extreme on the far right

to stop the funding stream that goes

to a lot of these healthcare practices

that really serve underprivileged and lower income women,

and that's really causing the rates to spike.

- [Paula] It's reported that nearly a quarter

of rural hospitals are on the brink of closure.

Being 90 miles from your nearest ER

can't be good for anyone's health.

- [Reporter] Data used by the LeapFrog group

ranked the Lehigh Regional Medical Center at the bottom,

an F for patient safety.

- [Reporter] Georgia mothers are dying.

Our state ranks last when it comes to maternal mortality.

- [Paula] And even if your hospital stays open,

unfortunately, the lower your neighborhood income,

the less likely your hospital is

to have a good safety grade,

as resources are strained and staff are overworked

and under supported.

- I've had a long journey to motherhood.

It took me 10 years of infertility

to try to have my children.

I know how precious they are to me.

And so it really is something

that I can't imagine a child growing up without her mother

because her mom died in childbirth.

I can't imagine that we, as the richest,

most powerful nation on the Earth, can't solve this problem.

I can't imagine that continue to take back control?e

The more I connected grassroots workers in maternal health,

the more I saw how hard it was for them to be heard

beyond those who already knew we have a problem.

In answer to this is Mom Congress,

a group of mothers, fathers and birth workers

who came from every state in the nation

to collectively take a series of bills

to their representatives.

- I think that's really all of our goals.

And if we want to highlight specific disparities

and things like that, we can absolutely do that.

- [Speaker] I think we have to.

Because the majority of, you know,

when we have 78.3, 78% of, you know,

people of color, then that's the issue.

- [Paula] Well, it's all the symptom of the same thing.

They aren't listening to women.

And they're deaf to Black women.

- When it comes to women in general,

we're just not being listened to,

we're not being heard.

Our children are not being heard

and not being taught about themselves, about their bodies,

and we're not being educated.

So, then, you grow up to be an adult

who then becomes pregnant,

and we don't think about pregnancy until then.

- [Speaker] Right.

- All right, so let's bounce,

let's get through security, and let's get this done.

(group members chattering)

- [Group Member 1] Some of us,

some of the moms are not here.

- Too many moms, right? - Three moms are not here.

- [Group Member 1] And that's why

we're here today.

(group members chattering)

(people chattering indistinctly)

- [Paula] Imagine if, and just hear me out here,

two men died every day in America

as a result of reproduction.

If their contributions to the birthing process

were a game of Russian roulette,

would we stop having sex without medical help?

Would we tell them, "Well, you know it's a risk

if you choose to become a daddy?"

Would we brush these stories under the rug

and chalk them up to the original sin?

Well, if the industry that created Viagra

was anything to go by,

I'd say that's a probable no.

(crowd chanting indistinctly)

And what about feminism?

Why is that a complicated word?

- [Interviewer] How do you make sure that younger people

feel like they can embrace the word feminist?

- Send them to the dictionary because, if-

(people laughing)

No, seriously, because it has been demonized

by Rush Limbaugh and company into feminazi and man hating.

There are synonyms.

We don't have to all use the same word.

There's mujerista, womanism,

women's liberation, girrrls with two or three Rs,

which I love, I think that's great.

- [Paula] Mother?

I wonder why I'm not seeing my feminist allies

show up for the maternal health crisis.

- I think that motherhood

is the most extreme expression of femininity,

and so it is challenged.

When we talk about motherhood,

we're talking about both I think of a relationship

that a parent has with a child

and the act of birthing children.

But really, we're talking about how women

are symbolized in society

or rather that women have value when it's based

upon the life of someone else.

- [Speaker] Sex and race, because they are easy,

visible differences have been the primary ways

of organizing human beings into superior

and inferior groups

and into the cheap labor on which this system still depends.

We are talking about a society

in which there will be no roles

other than those chosen or those earned.

We are really talking about humanism.

- [Paula] And if you're shocked to discover

that women don't have equal rights under the Constitution,

you're not alone.

(singer vocalizing)

- [Paula] When I first heard about the work

of National Advocates for Pregnant Women,

I was like, "How are these cases even real?"

But on talking to their founder, Lynn Paltrow,

I discovered the need for legal support

for pregnant women was terrifyingly important.

- We really want to ensure

that pregnant people are recognized

as having their own personhood

and are fully included in the US Constitution.

We live in a country that has a constitution

and it's been interpreted to protect the right

to bodily integrity and medical decision making.

And these are decisions that appear to be,

and apply to all people.

But the more cases we deal with,

the more apparent it becomes

that people think of pregnant women

as a separate and unequal class of persons

who really have no rights at all.

- I never thought I could be arrested

for experiencing a tragedy.

I lost my daughter and then I was prosecuted for it.

- A pregnant woman shot in the stomach,

now facing possible manslaughter charges

for the death of her fetus.

The shooter not charged in this case.

Critics calling it a cruel and dangerous new step

by the state to criminalize pregnancy.

- [Reporter] Marshae Jones' arrest came some six months

after the 28-year-old,

who was five months pregnant at the time,

was shot in the stomach.

According to the grand jury indictment,

Jones intentionally caused the death

of her unborn baby by initiating a fight

knowing she was five months pregnant,

concluding it was caused in a sudden heat of passion.

- [Paula] Yes, this is real life,

not a made- for-TV horror movie.

And even if a criminal complaint could be complex,

what about a medical one?

- A young mother of three is suing a New York hospital.

She claimed she was given

a cesarean section against her will.

- [Reporter] 35-year-old Rinat Dray

is the mother of three boys.

Her first two were delivered by cesarean section,

which involved difficult recoveries.

- Then he said, "It doesn't matter

that there's good progress.

"I don't think it's going to be natural.

I don't have the whole day for you."

I was begging all the way,

"Don't do it.

I feel my baby. Everything's fine.

Don't do it. Don't do it."

His answer was just, "Don't speak."

- She didn't say, "I refuse to have one."

If you tell me, give me any information

that my baby's really in jeopardy, I'd agree to it.

But I'm not seeing anything from anything you're telling me,

the doula isn't seeing anything

that says I need to have it right now.

Unbeknownst to Rinat, the hospital had a written policy,

not just the practice,

that authorized doctors to perform surgery

without a woman's consent.

In fact, over her explicit, clear refusal

if they believe that the fetus' life was in jeopardy.

And the next thing she knew,

Rinat Dray was wheeled in,

forced to undergo cesarean surgery,

and in the process, they damaged her bladder.

The defense of what they did,

cutting this woman open over explicit refusal,

and, I should add, that they were so confident

in their right to deny an adult woman

of her medical decision making,

that they wrote in her records...

- [Reporter] "I have decided to override her refusal

to have a C-section."

- And the hospital's claims,

their absolutely vigorous defense of what they did to her,

over and over says, well yes,

there is a Patient Bill of Rights in New York

that requires us to inform patients of all of our policies,

including the maternal refusal,

we get to cut you open without your consent policy,

but it doesn't specifically include pregnant women.

Their position was pregnant women aren't protected

by the New York State Bill of Rights.

Their position is women

aren't protected by the Constitution.

They're not protected by common law rights.

That by becoming pregnant,

a woman takes on the obligation

to do whatever is in the best interests of the fetus,

as determined by doctors, judges, anybody but her.

There are definitely many powerful people

who believe that undergoing major surgery

that is a risk to your health,

is just the burden women bear because they are pregnant.

We really have not accepted the idea

that healthcare is a human right for everyone,

including the people who can get pregnant,

and that maternal and reproductive rights

aren't separate, special rights,

but they are what half of all the human beings need

in order for their survival,

and what all human beings need

for the survival of the species.

- Most of our laws around abortion

are kind of understood through the lens of Roe v. Wade.

When you read the Supreme Court decision,

it actually is less naming women's ability

to have access to abortion,

and more saying that a woman has the right

to determine when and whether to continue a pregnancy.

So, it's as much giving women autonomy

over choosing motherhood

as it is choosing when not to be mothers.

- There are many people who are fundamentally

genuinely opposed to abortion

for religious, moral, ethical reasons,

who have not thought through what the consequences

of their position is if it becomes law.

Because if it is illegal to have an abortion,

then the woman who wants a home birth,

but somebody thinks it endangers the life of the fetus,

is committing a crime.

The woman who refuses cesarean surgery

is no better than the murdering woman

choosing to end her pregnancy early through an abortion.

The woman who chooses to continue working

so she can have healthcare

to support the children she'll have, and her prenatal care,

could be endangering the life of her unborn child.

It is about taking away every right

we associate with personhood

from the people who can get pregnant.

- In the United States, pregnancy,

the only coverage you get for pregnancy

in a workplace situation is a disability.

You become a little bit of a second class citizen.

You're not fully capable of executing things.

That's an example of a lot of the language

used around birth and parenting and pregnancy.

It's a little manipulative,

and I think it's meant to sort of keep people

in a not so much fearful state,

but in a dependent state.

A dependent state upon a medical institution

that knows what's right for women.

You also become free public domain.

I mean, any pregnant woman talks about how all of a sudden

everybody can come up and touch your belly.

People can have comments about what you're eating

and can comment on what you're drinking

and what you're doing, and you shouldn't be lifting that.

All of a sudden, your personhood is up to public scrutiny.

You think that mothers have full choice over their lives,

and they don't.

- Equal rights.

Equal rights to have a job, to have respect,

and not be viewed as a piece of meat.

- We get distracted by abortion

because we think of it as needing our support

more than mothers need our support.

But if you look at, you know, a slew of laws

that have come out in the last several decades,

they've been very subtle,

but they've essentially taken the rights of mothers

out of mothers' control.

(melancholy music)

- There are many women who are just ignored

every day in society,

and they tend to be Black women and poor women,

and we just sort of don't see their experience.

And so, I think when we talk about

the treatment of pregnant women,

we're often talking about the treatment of, sort of,

white privileged people,

and what's different is that that community of people

is used to not being scrutinized

as much as other populations.

- [Paula] Remember those closed door conversations in D.C.?

Well, one thing came up again and again.

- [Speaker 1] I think it's important to understand

where these numbers are coming from,

are really a part of systemic racism.

And if you don't admit that,

then we're never going to be able

to change any of these numbers.

We can talk about them, we can be aghast about them, but-

- [Speaker 2] You have to acknowledge-

- [Speaker 1] We have to acknowledge

the source of the problem.

(gentle music)

- [Paula] Although many communities

are marginalized in many different ways,

there's something disproportionately going wrong

for Black and Native women when it comes to childbirth.

- African American women are facing maternal mortality

in such a desperate way because racism is real.

The system of white supremacy is real,

and it permeates every sector of our lives.

And so we can't think that the medical industrial complex,

it doesn't affect that as well.

And so we have to know that when folks

are walking into their doctor's offices,

when folks are going in for care,

going in to ask questions,

going in to get what they need for themselves,

their families, that racism, unfortunately,

meets a lot of folks at the door.

- [Paula] Monica came to her place in reproductive justice

through civil rights work.

She's also a doula and uniquely placed

to talk about the intersecting needs

of Black mothers in the South.

- It is astonishing that we are not understanding

the history that is connected to this issue.

And sometimes, we see that as a side issue and it's not.

- For several weeks now,

we, the Negro citizens of Montgomery,

have been involved in a nonviolent protest

against the injustices which we have experienced

on the buses for a number of years.

- [Crowd] Black lives matter!

Black lives matter!

- Hands up! - Don't shoot!

- Hands up! - Don't shoot!

- Hands up! - Don't shoot!

- Hands up! - Don't shoot!

- [Crowd] No justice, no peace!

No justice, no peace!

No justice, no peace!

No justice, no peace!

- It's all connected.

And if we're not understanding that Black women

are still at the bottom of the economic scale,

if we're not understanding

that there is a deep, deep history,

especially in the southern region,

we can't be surprised that, unfortunately,

rates of maternal mortality

are gonna continue to increase,

and that we're going to see disparities continue to rise.

- When we think about the history of the United States

and people of color in the United States,

the medical model of care

was never created to treat people of color.

It wasn't.

If you think about the enslavement

of African people and the emancipation,

now you have people who are "free."

Now you have Jim Crow laws.

So, now, everything is separate.

Sometimes you didn't even have access

to get into the hospital.

This conversation now around maternal mortality,

Black people have been dying.

Black women and children have been dying since,

I mean, I started this work in 2008,

and the premise of this work was on the foundation of

wow, Black women and children are dying.

- [Lynn] In America, Black women are three to four times

more likely to die due to pregnancy- related causes

than white women.

And in New York City,

they are 12 times more likely to die.

- [Paula] Chanel runs Ancient Song,

a community doula service in Brooklyn.

She is also an educator leading the charge

on how to combat racial biases in the medical system.

And probably needs her own TV show.

- What we continue to see perpetuated

within the medical model of care is this structure

that is based on racial ideals

or perceptions of racial identity

for Black and brown people that are false concepts.

- [Reporter] The American College of Obstetricians

and Gynecologists acknowledge that,

"The racial and ethnic disparities in women's health,

including high rates of preterm birth

and maternal mortality,

cannot be reversed without addressing racial bias,

both implicit and explicit."

- [Paula] Bias by nature is complex.

But basically, explicit bias is conscious,

like thinking you're better than someone

because of the color of their skin or sex.

But implicit bias is mostly subconscious and not as obvious,

like assuming the doctor you're about to see will be a man.

There are many assumptions, both explicit and implicit,

about why people are more likely

to die in childbirth than others.

- Even after we do the adjustments for income,

for education, this is true across the board.

This is true for well-educated African American women,

for wealthy African American women,

and the best studies that I've seen

put it down to just one thing: prejudice.

- Today, a wealthy, well educated African American woman,

one with a college degree,

is still more likely to die during childbirth

or to have her baby die,

than a poor white woman

who does not have a high school diploma.

And you can't explain that by location,

you can't explain that by education,

you can't explain that by income,

you can't explain that by wealth.

You can't explain that other than by acknowledging

the fact that there are still vast

and deep racial disparities in our healthcare system

and across our country.

- Doctors, or people in general,

just don't believe that Black people suffer,

or we're strong enough to take the pain.

- [Reporter] Several studies,

including from the University of Pennsylvania

and in The New England Journal of Medicine,

found that Black patients

with the same symptoms as white ones

receive less pain medication

and are referred to specialists less often.

In a national survey of over 2,000 women,

21% of Black mothers reported poor treatment

from hospital staff,

which they attributed to race, ethnicity,

cultural background or language.

Just 8% of white mothers reported similar poor treatment.

- My wife was not here to raise her sons

because of the color of her skin.

One of the things that I struggle with all the time is,

what else could I have done?

What could I have done differently?

What could I have done more of?

Maybe if I had grabbed the doctor by his collar,

maybe if I had gotten irate,

maybe if I had turned over a table,

maybe if I had made a scene,

maybe they would have taken Kira more seriously,

maybe they would have moved with more urgency.

But in the moment, I was thinking,

"I'm a Black man at this hospital

and I have to stay under control

because I don't want to be seen as a threat."

Because if I'm seen as a threat,

and I get removed from the hospital,

then who's advocating for my wife?"

- Interesting thing about white supremacy and capitalism,

it's not this one answer, right?

It's so intricate.

It's so deeply thought out in detail.

Put the light skin against the dark skin.

Put the old against the young.

Put the men against the women.

- You know, I have two sons, I have four daughters,

and I have to consistently worry

about how the world sees them

and their perception of a young Black man

or their perception of young Black women.

You know, when you become pregnant,

you shouldn't have to think about that.

Your choice shouldn't have to be based on

do I want to have a child and think about,

well, you know, right now, they're cute,

and you see them as cute 'cause they're a baby.

But when they're 10-years-old, they're a threat.

And I'm tired of just living in a mode of survival.

Like we now are at a point of, no,

we need to thrive, you know?

And that is only going to come with,

with people, with allies,

with individuals purposely stepping aside

or either stepping up and saying

we need to open these doors.

We need to change these frameworks.

We need to deconstruct these ideals

and our perceptions of one another based on,

you know, these socialized ideals

to see one person above the other.

Because at the end of the day, we all bleed the same.

At the end of the day, we all live and we all die.

And all people ever really want to do is just,

you want to know that you can live in a place

where you feel free.

(soft dramatic orchestral music)

- [Paula] Given that things are continuing to get worse,

I felt like we just couldn't sit back and do nothing.

So, I wondered if we could fight the system

of a lack of education and fear by changing the conversation

the American way: with advertising.

So, I approached Ad Age's 2019 Agency of the Year,

Mother, to ask them why they thought birth

was so badly branded in a country

where it was a commercial enterprise.

As non-mothers, we feel like they know a lot about the word.

What do you think about that?

(all laughing)

- When I was pregnant, my mom said, I quote,

"They cut me from hole to hole."

- [Chanel] What?

- So, that was, like, made me so excited about giving birth.

- I don't know if I want to have kids or not,

but I was like, there's no way

I would survive a birth like that.

And I didn't have that recently.

I had that thought when I was younger.

I don't know where that came from,

but I was like, "There's no way.

That looks crazy."

- How do we change that conversation,

that every time you speak about it,

doesn't mean I'm about to become pregnant,

or something disgusting is going to happen,

or men don't, suddenly, they just like shrink, you know?

I'm like how do we change that?

How can we have a normal dialogue about it as mothers,

non-mothers, as human beings in society?

It's really hard to advocate for mothers.

You know, it's hard to get brands onboard for it

because it's not exciting.

It doesn't feel contemporary.

They're like, "Mothers, you guys have been around a while."

You know? (all laughing)

You're not a new thing.

- [Chanel] They're gonna go out of style.

- So, that's also the big challenge,

how do we make this feel fresh for people

and something that they should be revisiting?

- Women should be entitled

to have whatever type of birth they want,

but it's harder to kind of know what those resources are

from the industry standpoint,

but also when the cultural ecosystem

and narrative ecosystem is so narrow minded

and scary for women.

And when you create that cultural fear,

you're more likely to just relinquish control.

You walk into the hospital, you're like,

"Put me under.

Give me the epidural.

I don't care what you do,

I just want this to be over."

Which, like, is not how anyone, I don't know,

that's not what birth should be.

Birth is an amazing thing.

- We just put big bold billboards of

"We have hope,"

and people are like, "Is this a cult?"

(all laughing)

Like, "No. Pregnancy."

You have to have hope for your children,

you have to have hope for yourself.

You know, it's an act of hope in itself,

to bring another person into the world.

- And to want to see them...

You know, I know for me, doing this work,

I want to see my children be able to live in a world

where they are seen and they can have hope, too.

They can have some kind of foundation that,

yeah, sees the humanity.

Where we see the humanity in each other, right?

And it just resonates in such a way where,

I don't know, maybe I'm being idealistic and utopic,

but, you know, that just can bring pure joy

to someone's life on a consistent basis.

Because when you look in children's eyes

and you see the level of just purity that comes across,

it's like why wouldn't you treat the vessel

that produced that with the same level of,

of sanctity that it deserves?

If you can see how joyful children are,

and it's that sheer, like, pure, unconditional love,

why wouldn't you want the person

that is going to be carrying that to have that same thing?

(gentle orchestral music)