Aftershock

The heartbreaking and shocking reality of inequalities surrounding childbirth in the US healthcare system for Black women are brought vividly home by the opening minutes of Paula Eiselt and Tonya Lewis Lee's Sundance Grand Jury Prize-winning documentary. Home videos show Shamony Gibson and Amber Rose Isaac as the vibrant, expectant young women they were before they lost their lives shortly after giving birth.

Every loss of life is a tragedy, but that both these women's deaths could easily have been avoided, is damning as is the bald fact that, in America, Black women are four times more likely to die in or as a result of childbirth than their white counterparts.  .

Shamony died from a pulmonary embolism a fortnight after giving birth, with days of concern about her symptoms raised with and dismissed by doctors. Amber Rose's medics, meanwhile, failed to notice her blood platelet count was dangerously low, performing a C-section that ended up being catastrophic.

While Eiselt's documentary dives into what is going systemically wrong with the US pre and antenatal system - and there are enough facts and figures in this film to make your head spin - the emphasis is on exacting change within it, spearheaded by Shamony's partner Omari Maynard and her mother Shawnee Benton and Amber Rose's  Bruce McIntyre. Drawing on the energy of their campaigning to raise awareness and instigate support groups, the film opens out into wider considerations of exactly what is going on and why.

Latent racism - still a depressingly fundamental factor in so many US documentaries that investigate inequalities - is one part of it. As one contributor points out, a Black man getting angry about his partner's treatment is likely to face a very different reception than a white one. Beyond the question of "how it is possible that well-intentioned people are doing racist things?", emerges the question of money. The documentarians show a decline in midwifery at the same time as an explosion in C-section rates. This latter element is fuelled by the fact that while caesareans may be more risky from a patient perspective, it's all gravy to hospitals, because they're quicker than natural childbirth and incentivised by insurers, who pay 50 per cent more for them than vaginal deliveries. Meanwhile, the midwifery decline, it is noted, by one historian, has at least partially been driven by patriarchal urges in a system that has historically sought to control what is 'best' for women and which used Black enslaved women as guinea pigs in early obstetrics.

While all of the statistics - and Eiselt and Lee ensure they keep on coming - are brutal, the positive energy of activism is at the heart of this documentary. The emphasis is on "turning pain into power" as the film moves its focus to "birthing centre" options, where the mother's choice is more prominent. These, in a healthcare system like the US's, do not come cheap, but the film shows they are on the rise, with the filmmakers again putting the emphasis on the personal by following expectant mum Felicia Ellis as she goes through the natural childbirth she wants. While never pulling their punches in terms of what is wrong with the system, Eiselt and Lee keep the thrust of their documentary focused on a more hopeful future, while never losing sight of the energy and commitment from more than just the bereaved that will be required to achieve it.