Taking Big Strides Towards Improved Maternal Health
Allyson Felix wanted a natural birth, and she had no reason to think it wouldn’t happen. A champion sprinter with 11 Olympic gold medals to her name, Felix was in peak physical condition. Yet, unexpectedly, a life-threatening complication—severe preeclampsia—necessitated an emergency C-section eight weeks before she was due to give birth. While she was grateful for the care that saved her life and her baby’s, Felix was left feeling blindsided.
Felix’s birthing story—and her decision to advocate for improved birthing experiences and outcomes—is front and center in a new feature-length documentary film, She Runs the World, co-directed by Perri Peltz, MPH ’84, DrPH ’23, a member of the Columbia Mailman Board of Advisors, with collaborator Matthew O’Neill. On June 5, the day of the film’s premiere at the Tribeca Festival, Peltz led a discussion with Felix and an expert panel at SiriusXM studios in midtown Manhattan. The conversation explored the maternal health crisis in the United States and how midwives can contribute to the solution.
The expert panel of maternal health advocates—as seen left to right in the header image above—comprised Elaine Welteroth, founder of birthFUND, a non-profit organization that provides need-based grants to families for midwifery care and holistic perinatal support; Avenel Joseph, vice president of policy at the Robert Wood Johnson Foundation; and Tonya Lewis Lee, executive producer of She Runs the World and Peabody-award-winning director of the film Aftershock.
Peltz is an Emmy-winning documentary filmmaker, journalist, and public health advocate whose previous documentaries have focused on opioid addiction and the mental health risks of youth social media use, among other issues. Maternal health was a natural choice for her next project. Columbia Mailman, where she earned master’s and doctoral degrees, is a leader in the area. For decades, the School’s researchers have examined topics such as mistreatment during childbirth, and drug use and maternal mental health during and after pregnancy—as well as extensive studies on the links between prenatal environmental exposures and child neurodevelopment.
The Maternal Mortality Crisis
Rates of maternal mortality in the United States—when a mother loses her life because of complications tied to having a baby—are ten times higher than in any other high-income country, and Black women are dying at three to four times the rate of White women during and after childbirth. “This is the deadliest, high-income country to give birth in, especially if you are Black,” Peltz noted at the taping. “And here’s a staggering fact: according to the CDC, up to 80 percent of these deaths are preventable,” she added.
One factor fueling the crisis is the lack of attention pregnant people get from medical providers. Prenatal appointments often don’t last longer than 15 minutes, which means that mothers like Felix are not given the chance to learn about their risk for complications. Preeclampsia, which is characterized by high blood pressure, disproportionately affects Black women. After mothers go home from hospital, they often don’t see a doctor again for six weeks—a critical period during which many complications and deaths happen.
Welteroth said midwives offer “a more compassionate model of care.” They also save lives. When you give birth with the help of a midwife, you usually see them the next day. When she experienced blood clots in her leg days after giving birth, Welteroth’s midwife told her to go straight to the ER. Among many misconceptions about midwives is the false notion that they won’t encourage medical interventions when they’re needed.
Another driver of the maternal mortality is the reality that many employers don’t support pregnant people. Felix hid her pregnancy from her sponsor, fearing disclosure would lead to reduced compensation. A year after giving birth, she went public with her story in a New York Times op-ed, writing, “Working women all over the U.S. deserve protection when they have children.” Lack of support means mothers can’t “bond [with their baby and] heal for themselves,” Joseph explained. The U.S. is the only wealthy country without paid parental leave.
The U.S. is also the only wealthy country where midwives aren’t part of women’s health care. Most health insurance won’t cover birth by a midwife—despite evidence that midwives produce better outcomes. Even if you arrange payment for a midwife, many doctors will refuse to see you if you tell them you are working with a midwife, Welteroth explained. “There should be room for midwives, doctors, and doulas to coexist,” she said. In an audience Q&A, Mary Lake Polan, professor of obstetrics at Yale and a member of the Columbia Mailman Board, concurred, saying, “Everybody has to work together.” Midwives are welcome in her clinic, Polan said, adding that academic health centers could serve as a model to integrate midwifery everywhere.
“A Culture Shift”
On a fundamental level, Americans need to rethink childbirth, Lee asserted. Even when it comes to something as simple as the language we use when discussing it. “Doctors don’t deliver babies; women birth babies,” she said. “I think what we need is a culture shift.”
For her part, Felix said the trauma of her birthing experience forced her out of her comfort zone. “This was one issue that I couldn’t stay quiet on,” she said. In 2024, her efforts were bolstered by a $20 million grant from Melinda Gates—part of which she passed along to birthFUND, which, since its founding last year, has already supported close to 100 families and 10 birth centers across the country. When it came time to give birth again, Felix did things differently. “I was blessed to have a Black doctor, a midwife, and a doula all in the same room,” she noted.
Recent months have seen severe cuts to public health and the social safety net, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which provides nutrition counseling, parenting advice, breastfeeding support, and food assistance to millions of Americans. Welteroth pointed to a ray of light in Midwives for MOMS, a bipartisan bill that would inform people about the option of a midwife. “Just letting women and families know that they have agency and choice is huge,” she said.