against a mainstay of dental care.

Midwife Celena Brown speaks with Kayleigh Sturrup during a pregnancy checkup. Midwives at Commonsense Childbirth are striving to provide good, accessible care. (AP Photo/Laura Ungar)“Nervous and excited,” the 31-year-old replied. “As it comes closer, I worry: Am I going to be able to cope with the pain?”

“It’s normal to feel nervous,” Brown assured her. “You want to be open to the entire process. You got this. You can do it!”Brown said she’s constantly awed by her patients’ strength. She recalled a teen just out of jail who overcame addiction and wound up giving birth vaginally without pain medication.Joseph has no intention of returning to Europe. She has started a midwifery school, put together training programs for other health care professionals and convenes a national group of professionals and advocates who share ideas to improve maternal health and eliminate disparities over videoconference.

She figures America needs her more.“This is literally my life’s work,” she said. “I’m not stopping until it’s done.”

This story is the first in a two-part series examining how the United States could curb deaths from pregnancy and childbirth.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.Methodology: KFF Health News and The Associated Press analyzed data from the U.S. Centers for Disease Control and Prevention on the number of new HIV diagnoses and infections among Americans ages 13 and older at the local, state and national level. This story primarily uses incidence rate data — estimates of new infections — at the national level and diagnosis rate data at the state and county level.

Bose reported from Orlando, Florida. Reese reported from Sacramento, California. AP videojournalist Laura Bargfeld contributed to this report.The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is responsible for all content. This article also was produced by

, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at— the independent source for health policy research, polling, and journalism. KFF Health News is the publisher of