I thought I did everything right.

I went to every prenatal appointment. I took my vitamins. I read the books, attended Lamaze classes, and carefully documented each milestone in my pregnancy journal. I was healthy. My baby was full term.

When I went into labor, I was surrounded by the people I loved most. I remember holding my son for the first time, overwhelmed with joy and pride, believing the hardest part was behind me.

It wasn’t. What happened after delivery nearly cost me my life.

In the minutes following my son’s birth, my doctor spent a total of seven minutes in the room with me. I know this because it is time-stamped on my labor video.

During that brief window, a uterine tear went undetected. Over the next several hours, I was bleeding internally.

As a first-time mother, I did not know what amount of bleeding was normal. I was told it was expected, so I trusted the system and stayed quiet.

By the time it became clear something was wrong, a new physician was on call. The tear was addressed unsuccessfully in my recovery room without the proper equipment. The pain and trauma I experienced after birth far exceeded labor itself. Some details are ones I will carry with me for the rest of my life.

That experience taught me just how fragile childbirth can be, and how much a woman’s survival depends on the awareness, compassion, and vigilance of those responsible for her care.

At the time, I was 23 years old. I did not yet understand that my experience was not rare, especially for women of color.

It was only later, as I began working in healthcare and particularly within Medicaid, that I learned how common and deadly maternal health disparities are for black and brown women.

As I studied the data, I heard echoes of my own family’s stories. My mother delivered my sister on a gurney because a nurse did not believe she was in active labor.

My sister nearly died from preeclampsia during the births of both of her children. Too many of the women I love associate childbirth with fear and uncertainty rather than joy.

That should never be our legacy.

What saved my life was my mother. She knew something was not right and refused to stay silent when I could not advocate for myself.

That is why advocacy matters.

That is why doulas matter.

Not every woman has a partner, family member, or friend who can speak up when she cannot. Yet we know that having a trained advocate present can dramatically improve outcomes for both mothers and babies.

In recent weeks, maternal health has once again made headlines in Pennsylvania, with new reporting shining a light on just how dangerous childbirth can still be for too many women.

These stories are not isolated incidents. They reflect systemic failures that have persisted for far too long.

According to the Pennsylvania Department of Health’s 2025 Maternal Mortality Review, 98 percent of maternal deaths in our Commonwealth are preventable.

When I see these stories, I see myself — because I did everything right, and I still almost died giving birth.

That statistic should stop us cold.

Preventable means these outcomes are not inevitable. Preventable means systems are failing women. Preventable means we can and must do better.

Today, as a healthcare executive, policy advisor, and Commissioner on the Pennsylvania Governor’s Advisory Commission on Women, I approach this work knowing that titles matter far less than lived experience. I am a woman first. I am a mother always. The statistics are not abstract to me. I am living proof of them.

We must invest in prevention, strengthen postpartum care, expand access to doulas and community-based providers, and truly listen to women, especially women of color.

We must examine where our systems break down and be willing to fix them.

There is progress. The Pennsylvania Black Maternal Health Caucus has elevated these issues through data, community engagement, and legislative action.

The PA Momnibus has already resulted in meaningful policy changes signed into law. This work shows that when communities are heard, solutions follow.

Gov. Josh Shapiro has also demonstrated his commitment to improving maternal health in Pennsylvania, investing $2.3 million in his administration’s inaugural budget to address maternal mortality — the first time the Commonwealth has made a dedicated budgetary investment in this issue — and advancing universal postpartum depression screenings and intervention efforts to ensure timely and equitable access to maternal and mental health care for mothers, as enacted in the most recent budget.

Ensuring safe birth outcomes ensures our future. How we care for mothers reflects who we are as a society.

I refuse to accept a future where my daughter inherits a family history of traumatic births.

Maternal health is not a women’s issue. It is a societal responsibility. And it is time we act like it.

Paula Starnes is a healthcare executive, maternal health advocate, and Commissioner on the Pennsylvania Governor’s Advisory Commission on Women. With more than 25 years of experience in Medicaid and managed care leadership, she works to advance equity and improve maternal and community health outcomes across Pennsylvania.