The United States has one of the highest rates of maternal mortality among developed nations.
These rates are disproportionately higher for Black women.
Two Black women crossed state lines to give birth since they lived in places with low healthcare ratings.
When Mimi Evans, a 35-year-old doula and nursing student from Houston, found out she was pregnant with her third child in 2013, she immediately decided she would not give birth again in her home state of Texas.
After experiencing neglect and mistreatment during her first two pregnancies, Evans and her partner began researching top medical facilities in Richmond, Virginia, the city where she was raised and still has family.
Two months before her due date, Evans and her partner packed up their belongings in an RV and drove 1,300 miles from Houston to Chesterfield, a town outside Richmond.
In Texas, where Evans lives, the rate of maternal deaths more than doubled from 10.3 per 100,000 live births in 1999 to 21.9 in 2019. The United States as a whole has one of the highest rates of maternal mortality among developed nations, with 32.9 deaths per 100,000 live births reported in 2021.
For Black women, both nationally and in Texas, those rates are disproportionately higher. To avoid becoming another statistic, more and more Black women are opting for home births, doulas, midwives, and birth assistants.
Crossing state lines, however, is less common.
Crossing state lines to give birth isn't feasible for most people
"The ability to travel, whether for an abortion, the birth, or prenatal care during your pregnancy is often deeply grounded in the amount of privilege and resources you have. It's not something that is available to most people," said Dr. Jamila Perritt, an OB/GYN and president and CEO of Physicians for Reproductive Health, noting that Black women who are receiving insurance through government support cannot use their insurance across state lines.
"Everybody deserves proper care in their community, regardless of what state they live in or what their zip code is; you shouldn't have to travel to seek it," Perritt added.
Evans giving birth at VCU Medical Center meant switching health insurance plans, registering her RV in Virginia, and living in a caravan park for over two months. Her family and friends expressed concern with the process.
"People kept asking what I would do if I went into labor in the RV. I'd tell them if I have a baby in the RV unassisted, then I prefer that rather than having my baby in a Texas hospital," Evans said.
Despite having a positive birthing experience in Virginia, the process of crossing state lines was so tedious and inconvenient that Evans chose to exit the hospital system completely for her fourth pregnancy in 2022 and gave birth at home with a doula.
Perritt warned that crossing state lines, even for those who can afford it, will not address the Black maternal mortality crisis.
"What folks have to realize is that regardless of what state you're in, the place where you deliver is often part and parcel of the same system that is harming folks in our own communities," Perritt said.
"That isn't to say that some providers or some hospital systems or networks are not working diligently to rectify that, but the idea of a so-called sanctuary city for maternal health simply doesn't exist."
Crossing state lines to give birth ended up causing more trouble for one mother
In 2019, Erin Monk, a 45-year-old medical assistant, chose to travel from her new home in Charlotte, North Carolina, to Baltimore, Maryland, to give birth to her sixth child. Monk made the decision after realizing North Carolina had a lower healthcare rating than her former home state of Maryland.
"I wanted to make sure that I got the best care, so I decided to go back home," Monk said. But she said the care she ultimately received in Maryland was subpar.
Unlike Evans, Monk traveled back-and-forth for all of her prenatal visits. When a doctor at the original hospital she visited encouraged her to have a C-section, Monk switched to University of Maryland Medical Center, which she calls the worst mistake she's ever made.
Monk said she felt like her concerns were ignored. When she began losing amniotic fluid, she said hospital staff told her it was urine. During a pelvic examination, Monk said a doctor wore acrylic nails and rings on her fingers, causing Monk to feel extreme pain, which she said the doctor dismissed.
When asked for comment, a representative from the University of Maryland Medical Center said that for privacy reasons, they are unable to discuss an individual patient's care.
When Monk went into labor, she said things got worse. She was sent home from the hospital after suffering from intense contractions and amniotic fluid leakage.
"This was August, and they kept telling me my due date was September 15, but I knew they had got it wrong," Monk said, noting that she was five centimeters dilated at the time. When Monk and her partner made it back to Charlotte, her water broke.
"I had the option to call an ambulance or find the nearest hospital, but I decided to go back to University Hospital because they have all of my records, even though I was treated like crap the entire time," she said.
The 3.5-hour drive was brutal. Monk said she underwent all three stages of labor in the car, and returned to the hospital 9.5 centimeters dilated. Instead of accepting that the due date was wrong, Monk said that hospital staff asked if she was taking drugs and deemed her seven pounds and seven ounces newborn premature.
"This idea that there are red states and blue states, or there are good states and bad states to give birth is harmful — Black women are dying in every state," Perritt said. "There is no safe haven for us if we are talking about still being cared for by the same system that just happens to be in another place."
Instead of having to cross state lines to give birth, she said, the focus should be on demanding that resources are embedded, connected, and grown within communities so that all Black women have the ability to have safe birthing experiences.
"The reason why we are dying is not because we live in any particular state, but it is directly tied to our racialized experiences within the healthcare system," Perritt said. "And you cannot escape that by crossing state lines."
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