Encountering the Person: Why Natural Birth Isn't Always Ideal

... but person-centered care IS.

A couple of months ago, I had the opportunity to speak at the inaugural “Fearless Future” conference, organized by the Guiding Star Project. Guiding Star is a network of women’s health centers that is pioneering a new, life-affirming approach to women’s healthcare. Their services range from teaching nine-year-old girls about the fascinating and complex beauty of the female menstrual cycle (shout out to

Amber Adrian

!), to providing postpartum women with breastfeeding to support, to accompanying women in their forties as they navigate perimenopause. Through all these programs, Guiding Star seeks to combat our culture’s widespread fear of pregnancy “by equipping women through education, healthcare solutions, and community to embrace fertility, childbirth, breastfeeding, and motherhood.”

The Fearless Future conference was a call to action, bringing together women and healthcare providers in order “to build a future where women’s healthcare is rooted in dignity, respect, and empowerment.”

My panel took place right in the middle of the conference. That seemed fitting, since it focused on birth, the single most intense, feared, and formative experience of female fertility. The other panelists included writer

Rachael Killackey

, midwife Tammy Masut, and OBGYN John Bruchalski (founder of Divine Mercy Care and the Tepeyac Center and the author of Two Patients: My Conversion from Abortion to Life-Affirming Medicine).

The founder of Guiding Star, Leah Jacobson, asked us each to answer a deceptively simple question: “What is the ideal birth?”

As anyone who has spent time around mothers (either in-person or online) knows, birth is a deeply emotionally charged topic. Divergent opinions and experiences about birth fuel not only division but an incredible amount of shame and judgement, both of oneself and others. I wanted to answer Leah’s question in a way that honored both the goodness of natural birth and the necessity of prudential judgement in women’s particular circumstances. There are many ways to have a beautiful birth. It is possible to have a traumatizing, disempowering natural birth. It is also possible to have a healing, empowering medicated or surgical birth.

A core part of the mission of Guiding Star is its reclamation of the natural functions of the female body as inherently good. Like me, many of the women in the room at the conference that day are dedicated to pushing back against a medical system is built upon the technological manipulation and control of female fertility. We are fighting against a culture that teaches women to see their bodies as their enemies instead of embracing them—with all their weaknesses and vulnerabilities—as a core part of who they are. So I anticipated that many in the room would be proponents of natural, physiologic birth, uninterrupted by medical interventions. And, to be fully transparent, that’s where my own inclinations and beliefs lie, too. Yet, statistically, I knew that there would be many women in the room who had given birth with the aid of inductions, epidurals, or caesarean sections. I wanted to make space for their experiences, too, not moralizing medical decisions that truly are matters of personal discernment.

As I prepared my remarks, I kept returning to an analogy informed by my Catholic faith. The Catholic Church teaches, as dogma, that celibacy is objectively superior to marriage. Yet, as a married woman, I have no doubt in my mind that God called me to marry my husband. Even if the consecrated life is the theoretical ideal, in practice, for me, it wouldn’t have been ideal at all. Being a wife and a mother are the way that God has called me to serve Him, and it would have been a mistake for me to ignore that call, even for the sake of an objectively higher vocation. In the same way, when we talk about birth, we need to be able to hold two seemingly contradictory truths in tension with one another. A physiologic birth is the objective ideal, yet, for any given woman, it may not be the birth she is called to or even desires to have.

In light of that paradox, I proposed this definition: the ideal birth is one in which those who care for the mother truly encounter her and care for her in the fullness of who she is—as body-soul composite, an autonomous individual who nonetheless is deeply influenced and even defined by relationship. In this essay, I’m going to unpack what I mean by that statement, and I’m going to identify the aspects of that vision that I think our maternal medical system makes the most difficult to attain.

When Complications Arise

In our fallen world, even though our female bodies were designed to give birth, the reality is that birth can be very dangerous. Medical interventions are sometimes necessary, and they save lives. I know this from experience. I have given birth three times, and all of my births have involved unexpected medical complications. In physiological terms, even though I’ve never gotten an epidural, I’ve also never had a perfect, uninterrupted natural birth.

With my first daughter, I developed extremely high blood pressure at the end of my third trimester, was induced, and had excessive bleeding immediately postpartum. With my second daughter, the labor itself was peaceful and perfect, with no medical interventions. I labored in the tub during transition, got out of the water, and delivered my daughter en caul on my first push. The amniotic sac broke as the midwife caught her. But, during the golden hour, I had a severe postpartum hemorrhage. To stop the bleeding, I needed three different medications (Cytotec, misoprostol, and both a shot and an IV of Pitocin), as well as what my midwife euphemistically called an internal uterine “massage,” which was far more painful than giving birth. With my third daughter, I had high blood pressure from the very beginning of the pregnancy, which eventually developed into pre-eclampsia. I was able to avoid induction by having my membranes swept, which kick-started labor, but again, I needed Pitocin to manage my bleeding postpartum.

In spite of all this, I unironically and enthusiastically love labor. Even though none of my births were technically ideal, I think of my second birth as being my ideal birth. Part of it might just be the fact that it was the only pregnancy in which I didn’t have high blood pressure. But I think the much bigger factor is the care that I received.

With my first pregnancy, I had seen midwives who were part of a large OB-GYN practice. Even though their materials advertised a commitment to natural birth, they were still operating within a standard, medicalized model of birth. The office was big, with dozens of different nurses and staff I didn’t know, who would immediately take my blood pressure at a station in the hallway as soon as I walked in. The appointments were quick and impersonal, and I didn’t feel like the midwives saw me as an individual. They didn’t respect my capacity to assess risks and benefits and make personalized decisions about my medical care. They just expected me to follow whatever the standard recommendations were, no questions asked.

With my second pregnancy, by contrast, I was cared for by an independent practice of certified nurse midwives who attended both home and hospital births. When I arrived at the office for my prenatal appointments, I would say hello to Linda, the office manager who had worked there for decades, and get my toddler settled playing with the toys they had there. Then I would go into the bathroom, weigh myself and test my own urine before going in to see the midwife, who would let me get settled in before taking my blood pressure herself. Even though I had no complications, my appointments would often last an hour. Each of the three midwives in the practice took the time to get to know me, talking through all of my emotions surrounding birth. They commiserated with me about all the many little physical struggles of pregnancy and the challenges of caring for my first daughter, who was only 7 months old when I got pregnant with my second. They let me borrow a book about tandem breastfeeding, and they comforted me when my milk dried up and I struggled to find a hypo-allergenic formula that Lucy could tolerate.

When it came time for me to have the baby, these women deeply knew me, and I felt safe with them. Yet, even so, I am a deeply private person. My labors are skittish. They slow down or even stall out if I feel like I’m being watched. So, after I arrived at the hospital and got checked into my room, my midwives made themselves scarce. With the lights low and my music on, I was able to be alone with my husband, leaning on him and letting my body do the work it needed to do. As I shared above, her delivery was peaceful and perfect, requiring only a single push.

After the birth, even as a crowd of nurses suddenly appeared by my bed, my midwives somehow maintained that atmosphere of peace. They responded rapidly to the medical emergency and did what they needed to do to save my life, but they did it without ever taking my child off my chest or making me feel afraid. I was wrapped up in that moment, staring into my baby’s eyes. Meanwhile, they quickly and quietly attended to their work so that I could do mine, bonding with my daughter and basking in the glow of finally holding her in my arms.

The next day, the midwife who had stopped the bleeding came to check on me. She told me more about what had happened, and she asked me if I was doing okay emotionally. Until that conversation, I hadn’t even realized how much danger I was in. What could have been a lasting source of trauma is just a minor note on my medical record—a history of postpartum hemorrhage. What I remember is how it felt to be so intertwined with my husband during labor and so deeply happy to hold my baby when it was over.

Encountering the Person

At the beginning of this essay, I said that the ideal birth is one in which all those who care for the mother truly encounter her and care for her in the fullness of who she is. To do that, I believe that care providers must have a right understanding of what it means to be a human being, whether or not they can articulate it in philosophical terms.

My second birth was so beautiful and healing because my midwives treated me as a whole person. They resisted the dualistic temptation to see my body as mere matter, something essentially separate from my soul, to be measured and quantified and controlled. They also honored the relationality that is at the heart of human personhood. They took the time to develop a relationship with me, and they respected the primacy of my relationship with my husband and my child.

Our modern medical system is a deeply technocratic one, which is built upon a severely impoverished understanding of human nature. Although modern medicine has enabled incredible, lifesaving advances in maternal care, it also encourages doctors and nurses to treat mothers as a set of numbers on a screen rather than as thinking, feeling people. Within this framework, medicine is treated as a set of rules to be applied rather than a practice that blends art and science, balancing competing risks and benefits in the pursuit of health while respecting the autonomy, moral beliefs, personal history, family relationships, emotions, and unique temperament of every mother. The reality is that each of these factors can affect a woman’s pregnancy and the progression of her labor in ways that defy and transcend simplistic models that treat the human body as a machine that functions (or malfunctions) in consistent, predictable ways.

I believe that the midwives who delivered my second baby have been able to hold onto this vision of the art of medicine and accompany women so sensitively precisely because they are an independent practice of certified nurse midwives. They have hospital privileges, but they also attended homebirths. This arrangement is extremely rare, but it comes with amazing benefits. My midwives were regularly reminded of what birth can and should look like when it is not disrupted unnecessarily.

If we want to build a medical system that honors the whole human person, we need systemic reform, the details of which are beyond the scope of this essay. Still, identifying the central problem that drives dehumanizing care is a good place to start.

We must reject the impoverished, materialist, dualistic vision of personhood that underlies so much medical care, seeking out and training care providers who see their work as a sacred calling, practicing the art of medicine by caring for the body while also honoring the soul.

If you liked this essay, you should check out Rachael’s (much less-belatedly published) comments from our panel: “What is the ideal birth?”