Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa. This essay was originally published in the Des Moines Business Record’s Fearless publication.

While we see regular news coverage about challenges accessing maternal health care in Iowa and the related racial disparities, I rarely see the mention of higher cesarean rates as a relevant factor in those disparities.

April is Cesarean Awareness Month, and April 11-17 is Black Maternal Health Week. The overlap of these initiatives is relevant given the higher cesarean rate for Black people across the country and Iowa. 

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

The 2022 Iowa legislative session saw the most significant momentum in more than forty years of advocacy for the creation of a licensure of direct-entry midwives in Iowa. With the 2023 legislative session underway, I will review the pivotal moments in the 2022 legislative session and explain why the Iowa legislature and Governor Kim Reynolds should prioritize enacting a midwifery licensure bill.

While I have addressed the need to provide a licensure for Certified Professional Midwives (CPMs) in previous pieces, I will go more in-depth in providing background on why all Iowans should want and support CPMs practicing in our state.

Note: I would not benefit directly in any way if this bill passed, as I am not a birthworker (doula, midwife, physician), and I do not plan on having any more children. Through my volunteer work with the International Cesarean Awareness Network, I have learned a lot about the different types of midwives and believe Iowans have been “dealt a bad hand” by not having knowledge or access to community birth options that are more readily available in other states and other high-income countries. Iowa families deserve to have all options available for safe and quality maternal health care.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

A 2022 report from March of Dimes shows that “36% of counties nationwide — largely in the Midwest and South — constitute ‘maternity care deserts,’ meaning they have no obstetric hospitals or birth centers and no obstetric providers.” While their report does not provide state rankings, you can see whether your county classifies as being a maternity care desert here. Additionally, a report from Stacker in June 2022 ranked Iowa eleventh on a list of “states where the most people live in maternal health care deserts.”

Even if your area has maternal health care providers (OBGYNs, family physicians, midwives), finding quality care is another challenge facing pregnant and postpartum individuals in both urban and rural areas. I’ve discussed some of those problems in previous articles for this website. 

The good news is relatively low-cost, evidence-based solutions are available to make maternal health care more accessible in Iowa, which would improve outcomes. I have identified and prioritized opportunities that should be bipartisan based on successes in other states.

Note: I am not including abortion access in these recommendations, since the procedure continues to be legal in Iowa, the media regularly cover this topic, and several organizations advocate on this issue. This article from Commonwealth Fund explains how states with restrictive abortion laws have worse maternal health outcomes.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

In August, I spoke to the Broadlawns Board of Trustees for the third time in the past four years.

You can read my comments from my first time speaking during their citizen comment period in July 2018 when I was five months pregnant and looking for VBAC supportive care for the birth of my second child. Unbeknownst to me at the time, this experience launched my maternal health advocacy.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

I recently recounted how it took the Iowa Department of Public Health (IDPH) 170 days to respond to my request for information on the total births, primary cesareans, total cesareans, and vaginal births after cesareans (VBACs) at Iowa hospitals. I eventually received aggregated five-year totals (2016 through 2020) for each birthing hospital in Iowa.

The International Cesarean Awareness Network (ICAN) of Central Iowa, where I serve as a volunteer chapter leader, has made the data available on our website. You can see it in table form below as Appendix 1. 

While I would have preferred for IDPH to provide the figures for a single year, as I requested, the compiled data still tells us a lot about the overuse of cesareans at several Iowa hospitals and the lack of VBAC access across much of the state.

Rachel Bruns recounts the saga of trying to obtain records that the Iowa Department of Public Health could have provided promptly.

In an article I wrote for this website in January 2021, Provider practices in Iowa lead to more c-sections, complications, I mentioned that I had requested records from the Iowa Department of Public Health (IDPH) on the number of cesarean births and vaginal births after cesarean (VBACs) in Iowa hospitals.

A lot has happened related to my request since then. I’m summarizing my experience in case it can help other Iowans seeking what should be public information from a government entity.