The idea for the Safe Motherhood Quilt Project gestated within me over a period of several years. It was in the early 1990s that I began to be curious about maternal death in my country, after an unusual couple-they were both obstetricians-enrolled for care at the Farm Midwifery Center, Summertown TN, for their first pregnancy and birth. I learned from them and from a nurse-midwife who wrote a remembrance about a close friend that death was still an occasional possibility for U.S. women during pregnancy, birth and the year after the end of pregnancy. Curious about how many deaths occurred per year and what factors might be causing them, I began looking for information from the Centers for Disease Control (CDC) and the National Center for Health Statistics (NCHS). I learned from the officials with whom I talked at both agencies how little they actually know about the continuing problem of preventable maternal death in the U.S.

Here is what we do know:

• At least 30 other countries have lower maternal death rates than the U.S.
  
• There has been no reduction in the maternal death rate in the U.S. since 1982.
  
• The CDC acknowledges that we have a massive problem of underreporting of maternal deaths in the U.S. and that our reported rate may be only 1/3 to 1/2 of the actual total number.
  
• Maternal death rates are four times as high in the African-American community as in the Caucasian community.
  
• There is no federal requirement that the states carry out a confidential review of all maternal deaths in order to be sure that all are counted, to analyze the principle causes of preventable deaths and to make policy recommendations to prevent such deaths in the future. In most countries with lower maternal death rates than ours, maternal deaths are systematically reviewed and there are lower levels of underreporting of such deaths than the CDC says we have in the U.S.
  

My inspiration for the Safe Motherhood Quilt came from the AIDS Quilt. That project taught me how powerful it can be for bereaved family and friends to honor and remember people who died from causes that aren't well understood by the overall society. It is my hope that the Safe Motherhood Quilt Project will be as effective as the AIDS Quilt was in identifying a problem that should have national priority and bringing it to the forefront. Women need better information as they make the important decisions they must make with regard to maternity care. We owe our daughters, our granddaughters and all future generations no less.

Ina May

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Ina May Gaskin, the mother of modern direct-entry midwifery, began "catching babies" in 1970. Since then, she has emerged as a leading spokesperson for the midwife model of care. Her 1975 book Spiritual Midwifery is still in print; it encourages readers to view birth as a natural life process, rather than a medical emergency. Her latest book, Ina May's Guide to Childbirth published in 2003, informs a new generation.

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