This definitely resonates with me. I've had five c-sections-- which would not have been my plan.
My first birth started with my water breaking and checking into the hospital at about 10pm. I slept that night and labor didn't really progress. The next morning after my husband brought me breakfast, a bagel and orange juice, the doctor came in and they did an ultrasound and found the baby was breech. Suddenly they were telling me they needed to do a C-section and then that they would need to wait 8 hours since I had just eaten. It was a very long day. I was very thirsty because they wouldn't let me drink. They gave me IV fluids, but I still felt horribly dehydrated. I didn't understand, and still don't why they didn't try to turn the baby or let me try to give birth even if she was breech.
My second pregnancy ended before I even saw an OB. I had a very traumatic miscarriage in the ER.
Then I got pregnant within a few months of the miscarriage. This time I attempted a VBAC. Again it began with my water breaking. After laboring for more than a day with no progress, despite the Pitocin, it ended in a c-section. I had hemorrhaging after the birth and the my milk took too long to come in and the baby ended up dehydrated in the special care nursery where I had to drag my post-csection body up to a different floor to nurse her. My feet swelled like melons and it was horribly painful. After they discharged me they moved me to a room on the floor with the special care nursery but they no longer brought me food because I was no longer a patient. There are so many things I'm still angry about with that whole experience.
My third baby was born via planned C-section as no one would consider letting me try a vbac after two c-sections. I was so traumatized. I dreaded it so much. I cried all the way home after my pre-surgery appointment the day before the birth.
With my fourth baby labor started days before the planned C-section date. I felt the gradually increasing contractions with dread for a night and a day before I checked myself into the hospital.
With my fifth baby I was considered high risk-- I was never clear why. Was it advanced maternal age? (I was 38) Or was it the placenta accreta? I was in a huge practice where I never saw the same midwife or OB twice and I hated it, but I was too sick and overwhelmed to try to hunt for a different doctor. They sent me to MFM at the hospital for lots of extra ultrasounds. I ended up having my C-section four days after the planned date because I had just got over an awful stomach bug when I went in for my pre-op appointment and a kind nurse took in my wan appearance and pity on me: Are you sure you want to give birth tomorrow? You look awful! I agreed so fast: I am positive I don't want to. I had no idea I could even decline.
I am not good at pushing back against authority figures. I had undiagnosed anxiety. (It was only diagnosed and treated in the past couple of years, after my youngest was 10.) I hated the technocratic model-- an apt name!-- but I feared the holistic midwife births even more. Oh how I wish there had been a third way. I had so much trauma surrounding all my births and my miscarriage. I haven't even touched on half the details here in these very abbreviated birth stories.
I love your proposals at the end for doctors and midwives working more closely together to find a more humanistic way.
Refusing evidence based care (vba2c) is obstetric violence. Forced surgery without medical cause is assault. I sometimes wonder if it's possible for me to be any more disgusted by what passes for "obstetric care" and then I read yet another birth story....
I'm so sorry. Thank you for sharing. My own mother had 5 medically unnecessary cesareans. She said she wished she'd even known midwives existed back then. I can't make things right for her. What I can do is make damned sure my daughter knows her rights.
Lots of that resonates, and I appreciate you getting personal. One note that may be helpful to other readers is the “rituals” of prenatal care as well as what you mention surrounding labor and delivery - namely, urine tests and ultrasounds, which are essentially looking for problems. And as ultrasound tech gets better, we see more potential problems and make more murky measurements that require follow-up ultrasounds that cause anxiety, extra expense (and radiation), on repeat.
My third baby was a home birth with a cnm and one of the best parts was the whole prenatal focus on nutrition, my symptoms as the sign of health, not just urine tests (we did those), and I only had one ultrasound the whole pregnancy. Highly recommend.
Yes!! I totally agree. I generally decline all ultrasounds other than the 20 week anatomy scan (since I always know exactly when I ovulated and don’t need a dating scan).
With this last baby, I saw an OB (I moved away from my amazing midwives and none of the midwifery practices here would take me, because I’m considered too high risk) who’s part of a big practice. Even though I liked her - I searched high and low for a provider who would discuss and make decisions about my care collaboratively with me - I hated all of the red tape. I had high blood pressure again, this time developing earlier in the pregnancy, and was required to also see a Maternal Fetal Medicine specialist. Their procedure for anyone with chronic hypertension is twice weekly NSTs from 32 weeks onward… which just seemed absurd to me, especially since I would have had to get a babysitter for at least 3-4 hours each time, since the office was all the way down in Center City. Driving all that way through city traffic and shelling out for parking and childcare was enough to raise my BP even more!
There’s a tendency to think that more monitoring is always better, but I just don’t think that’s true. There’s data on it re: continuous fetal monitoring, and I think that applies to excessive ultrasounds and testing in general, too.
Serena - Thank you so much for your vulnerability in sharing the difficult experiences you encountered during birth.
I don't know if I agree with the the first statement - "too many obstetricians are more worried about legal liability than women’s holistic well-being," Is there data to back this up? Are they actually worried about liabilities or are they simply so consumed with the routine of pregnant mom after pregnant mom that they don't see us as individuals?
Even with the most recommended Catholic NaPro GYN in the area, with my first pregnancy I received a simple email after a dating ultrasound that read something like "there is something wrong with the heartbeat - please call to schedule another ultrasound". I received no reassurance, no information that early ultrasounds are notably unreliable etc. Not even a phone call. A cold email. Everything was fine! But again, no personal care from her. And she is indeed someone who will call certain medical systems evil.
What is it about medical training and hospital structures that doesn't support personal connection? I don't think it's simply worry about liability. I think the human nature of medical professionals is just as complex as that of pregnant and birthing mothers.
I do however, agree full heartedly here - "It shouldn’t be so hard to have a positive, empowering, safe birth in America. For too long, American mothers have been stuck with birth rituals that impart a deeply flawed and harmful set of cultural values: presenting the laboring mother as an ill patient who must be saved, the doctor as the unquestionable expert on women’s bodies, and quantifiable data as more important than personal encounter." It should not be so hard.
I had such a wonderful, positive birth with my second. At a hospital! With pitocin and AROM and an epidural! pushing on my back! All the things some influencers would tell me are Very Bad and would result in trauma. But the factors of such a birth are so many - very patient and skilled nurses, who never pressured but moved quickly when they needed to, a phenomenal resident OB who assured me at every step that my body was mine and I could ask her to stop at any point, my OB who just had the best energy in the delivery room - an excited coach who believed in my ability to push out a baby. And a large part I think is hormones. I think those hormones were aided by the fact that I had done it before, that at this new hospital golden hour was standard and women are left alone with their babies in the delivery room for as long as possible before transferring to recovery. Part of it is the mystery of the human person.
I think, additionally, that the expectation that every birth be empowering, spiritual, beautiful is incompatible with a fallen world. I think a lot of women may end up feeling frustrated that they failed., their body failed, they failed to advocate properly or pick the right birth plan. But in our fallen world, where our own bodies are mortal and painful - we also should focus not merely on the labor and delivery, but on the support and insight women need to deal with the physical, emotional and spiritual realities of becoming mothers in a fallen world.
You're right that it's a complex problem! I don't mean to sound as if I think most OBs or L&D nurses are ill-intentioned. I think that a lot of the structures and standard operating procedures that they're forced to operate within are put in place to minimize liability, and that doctors and nurses are human beings with limited energy and lots and lots of patients to see.
There are a lot of benefits to standardizing medical care, and I don't want to minimize or deny those. But operating at a large scale according to top-down directives doesn't really respect the doctor's status as a skilled and well-trained practitioner using their judgement and knowledge to practice the art of medicine to help heal or support a specific person through a physically and psychologically demanding experience. It's hard to balance legitimate oversight and quality control with autonomy... sort of analogous to the twin principles of subsidiarity and solidarity in catholic social teaching.
I am so glad your second birth went so well. Births with lots of interventions can be wonderful, positive experiences! I really think trusting and feeling seen and respected by your care providers makes the biggest difference.
Agree that it's complex! Overall I think the birth space is so complicated and would love to see you explore it further. How do we use science and data to support and inform, but not restrict? How should we grapple with the fact that there remain great disparities in maternal mortality here in the US? What does that mean about how standards are implemented? and on and on and on.
Agree that feeling seen and respected should be top of mind for providers. How should the emotional experience of women be factored in to standards of care and outcomes that are measured? and how can we expand the definition of a good experience beyond "I gave birth in agreement with my birth plan" (which is promoted as the goal in some more anti-hospital spaces)
Thank you for this comment….i’m in the UK so some of the birth conversation isn’t the same (because hospital care is free and midwife led care is the standard way of birth care), but in the mum world there still is a lot of talk about how the medical establishment Just Doesn’t Care about women, and how the only way to have an empowered birth is at home. But I’ve had three hospital births, and have felt empowered and emboldened in my motherhood and sense of womanhood through all of them. We live in a fallen world, as you said, and being prepared to deal with the “physical, emotional, and spiritual realties” of that is something that I think is missing from much of the positive birth discourse.
I think from a Christian perspective, before the fall, birth was intended to be glorious in every way - a joy of creation! But after the fall we're confronted not only with our human bodies, unpredictable, prone to pain, but the realities of all the humans that are involved as well. Mothering is so united with the reality of God as creator and also so impacted by the reality of where we live. Women deserve so much more support than what we have, not specific to labor and birth but beyond that - what is means to deal with all those realities and how we can remain positive and supported even in the most difficult of circumstances
Up here in Alberta, Canada, midwives are medical providers and fully covered under our public health insurance (i.e. they are free for anyone to access, just like an OB would be). I delivered both my babies out of hospital (and at a birth center, the other at home). Both were great experiences.
My husband and I only discovered the possibility of midwifery care after our doula, and the teachers at our private childbirth class, recommended it to us. We knew going in that we wanted minimal medical intervention, and ultimately we found an amazing midwife team. I went into labor spontaneously both times and the deliveries were without complications.
At the same time, the was definitely some amount of "holistic woo" that I found difficult. In particular, breastfeeding was presented as something which was so important that it would be tantamount to child abuse to give your baby formula. The breastfeeding guide I had been given by my midwives told me not to give my baby formula. When I worried about my supply, one midwife said that plenty of small breasted women produce plenty. That same midwife even shamed me for formula feeding, moments after telling me my baby's weight gain was great and that I must "be a rockstar [for breastfeeding this chubby baby]".
Well, I struggled so hard to produce milk that for my first daughter, I ended up trying both domperudone and metformin (!!!) to increase milk supply. This was my choice, but my daughter was still partially formula fed. I obsessed unhealthily about how inadequate my body was in postpartum. And for my second, I said a big fat NOPE in advance to formula-shaming. I wish my body was capable of EBF but I am also deeply grateful that my babies had access to safe nutrition when my body couldn't adequately supply it.
All that to say - I never encountered the extreme "freebirth" side of things. The midwifery model worked great for my family, and I am so grateful to have had access to it. Despite all those things lining up for me in the most amazing way, I still had a huge emotional ordeal as a new mom.
They say it takes a village. In addition to the midwife + doctor integration you propose, we also need to normalize (and indeed, cover the cost of) doulas. We need more sisters, moms, grandmothers, aunts and partners in the room advocating for the birthing mom. And everyone in that village deserves to be better informed and what it looks like to give birth on one's own terms.
Thank you for writing this powerful piece. I will be sharing it.
Thank you so much for sharing your story here: my first birth was so similar...induced delivery with no epidural due to rising blood pressures (but they were good at home and labs were also fine, like yours...I've never heard someone with a story so similar to mine!). I still wonder to this day what would have happened if I said no to the protocol induction at 39 weeks; I just felt like I didn't have a choice even though I didn't feel at all convinced the interventions were necessary for my or baby's safety. Stress tests were fine, I felt great, etc. The birth was traumatic for me, and I had the same PTSD type symptoms you describe later approaching my second...which was so much better because, although I ended up at the hospital with an induction again for the same reasons (white coat hypertension is my nemesis), my bishop's score was so much better and I had a doula at my side that time. I went on to have my third at home with a CNM midwife (and my BP did spike a bit during labor, but we didn't have any time to transfer me), and it was such a night and day experience, I'm planning my second home birth for my upcoming delivery with a midwife who does not contract with insurance for exactly these reasons. But I absolutely agree that a hospital birth doesn't have to be as unnatural and difficult as it tends to be...I too mostly blame liability concerns for the way the whole process is over-engineered. Sometimes I feel like I didn't have the right to feel hurt or traumatized by that first birth experience, since so many women experience much worse, but your experience was so validating to read. Thank you.
I’m so glad to hear that my story resonated with you - and so sorry that you had a similar experience. Even after I submitted this piece, I worried that maybe readers would think I was being overly dramatic by talking about trauma. My baby and I ended up healthy, with no C section or NICU time; I know so many people whose outcomes have been so much worse. But labor - especially your first labor - is such a vulnerable time. Having a midwife who knows you and cares about you makes such a big difference.
I have straddled these worlds, perhaps in a small way like your own mother (her being a doctor who home birthed as you shared here), as a previous Labor and Delivery nurse and a mother who has birthed in the hospital and at home on her own. I agree that neither holds the full weight of what it means to birth life into this world in a woman in this time. I used to take pride in my “L&D” RN title and I also used to be militant in my freebirthing advocacy. In my nursing experience, I became very disillusioned about the “policy and procedure” version of birth the hospital has to offer women. In the years following my free births, I have tempered my enthusiasm with the knowledge that birth is meant to be witnessed and supported by other women, it doesn’t have to be all or nothing. I truly hope I have a fourth baby so I can use the integration I have experienced from all of the above.
I have not read your essay yet but I think I may have to answer all of these questions in a post because they are so thought provoking! (Also your journal entry brought up tears in my eyes as I have a very similar entry from my first baby).
So appreciate your story and thoughts. Modern hospital-based maternity care has left swathes of women disconnected from their bodies, afraid to be mothers, and subservient to inappropriate authority, which is why I’ve mostly opted out of it. But reality is that most women are still there, whether by choice or necessity. Birth is sometimes traumatic, sometimes dangerous, even unavoidably so. But it should never be dehumanizing.
I too had to battle against medical professionals as a first-time mom. Multiple times. I couldn't believe the way I was bullied and condescended to! Oof. But as you say, it's a broken system, not a system full of bad people.
I've never heard of that book but it sounds great! I totally agree with your premise that women shouldn't have to choose homebirth to have an experience where they are respected (and birth is as well). Sadly, that's how it feels. I had my third at home and it was absolutely incredible, and totally redemptive. (I just hit publish on that!)
Such a great piece - thank you for writing it. I want to share and write more about birth in the future as there's just so much to explore. I do feel that our birth experiences set us up energetically for motherhood, and that processing our experience, no matter what it is, is super important (and can make up for one that isn't great).
I planned on having a natural birth in the hospital for my first baby; no pain meds, no Pitocin, no internal monitors. Well, my water broke at 35 weeks and I wasn't having contractions, so they had to induce me right away. Just about every single medical intervention besides a c-section was employed so I could birth my baby, and then she was in neonatal intensive care for 14 days, much of that on oxygen support. Definitely not the birth I had planned. I wrote about it here, specifically from the perspective of the medical community's overreliance on data vs. lived experience: https://substack.com/home/post/p-144985447
I don’t think I’ve seen anyone commenting on the offhand remark you made about medicalized ritual entry into motherhood—and what those rituals communicate to mother, baby, and wider society about the value of the family, etc.—but that blew my mind. I will be pondering for some time.
Oh my word, as a woman in England your article is shocking. I had some rude medical professionals during my birth experiences but nothing to the scale it sounds like you have to put up with in the US. Here, as far as I know, free birthing isn't really a thing. I'm sure some women do it, but it's not common, as we have a middle ground in hospital settings in our birth centres - essentially midwife lead spaces that are made up to be very homely, with birth pools and relaxing music and what have you, where women are encouraged to listen to their bodies and give birth naturally, with as little intervention as possible. I didn't really understand why anyone would risk a free birth before now, but reading your description of how things are there (are you truly still told to put your legs in stirrups? I might be being naive because my own experiences were wildly different to this, but I only know one person that gave birth that way, and it was due to an emergency) I get it.
I'm so sorry your healthcare system is so awful. Thank you for sharing.
I live in Hong Kong, a heavily medicalized birth culture and more than once I have thought of ghosting my doctors and just let fate run its course. I did not feel ok doing that (nor did my husband) in the end, but the temptation is always there. I ended up on pitocin both times. And while the second time was expected, the first time I had so many unwanted and unneeded interventions just to ensure the baby came within 12 hours of checking into L&D- when the average length of labor of first time mothers was THIRTEEN hours according to research. As I approached the 11 hour mark my husband overheard whispers of a C section, even though NOTHING was wrong. If my daughter didn’t come when she did (at almost 11 hours to the dot) I don’t know what would have happened to me. I was in so much pain I was in no state to refuse. In any case, I’m not sure I would have been heeded had I tried.
I had an European friend who had a much worse experience than I did. She said if she stayed here she would never have another child.
Serena -- could you explain more what "processing the birth and integrating the experience into your understanding of yourself as a mother" means? Thinking about it a lot? Writing in a journal? Or what?
I think it likely depends on the person! For me, yes: there was a lot of thinking about it - but I tend to be pretty introspective and prone to rumination. I know writing birth stories or journalling is really helpful for a lot of people (that's probably part of why birth stories are so common on the internet!).
At the same time, I don't want to overgeneralize or make sweeping pronouncements about how becoming a mother affects your sense of self. Anastasia Berg has written very thought-provokingly about the pitfalls of presenting motherhood as transformative, and I can see the validity of a lot of her critiques. https://www.thecut.com/article/excerpt-what-are-children-for-anastasia-berg.html
But for me, the transition to motherhood was pretty destabilizing, at least in the short term. It didn't ultimately change my underlying temperament or foundational beliefs, but it did shear away much of what had previously made up the bulk of my life. I have a tendency to live in the world of ideas, but early motherhood is so intensely physical. I often felt totally inadequate.
Yet giving birth also made me feel incredibly powerful. It called forth all sorts of physical/muscle memory in me; I drew on years of singing lessons, for example, to relax my jaw and muscles. For me, it's an experience with so much spiritual richness too - the way that you have to surrender and stop trying to control your body in order to access that sense of intuitive life-giving power, and the way that physical pain isn't necessarily the same thing as emotional suffering - how strangely freeing it is to actively welcome pain for the sake of love. It was also a pretty huge thing for me to stand up to authority figures, since I naturally tend to be compliant and conflict-avoidant.
I have friends for whom birth and the first newborn stage was really not a huge deal: they feel safe and cared for in hospitals and like having it medically managed, or they had tons of experience with babies or a natural tendency to be very physically nurturing. So again, I don't want to imply that it always is or should be such an intense experience. But I do think, for many women, it is. And they don't always have the resources to help them make sense of it.
I completely understand why women want to give birth at home. I've had a c/section, 5 v/bacs. and 2 more c/sections. I wanted to have my babies as natural as possible in a hospital setting, and I was able to have some that way - 2 with no interventions, 1 with minimal interventions and 2 with lots of interventions. I found that as soon as one arrives at the hospital the nurses are trying to rush things along - generally. It's helpful to have a doula (I did with 4 of mine), as they can advocate for you and spell your husband in rubbing your back, etc. I also found that as soon as some type of intervention is started - breaking the water, for instance, they seem to be just itching to begin another intervention. It's just aggravating that many - not all - labor and delivery staff don't seem to respect the natural process of giving birth. I did encounter one nurse - a rebel nurse - who told me she had helped deliver a breech baby in the parking lot. I got a chuckle out of that. I confess I was blind-sided by my 1st baby, as he was breech, and I was 41 weeks when that was discovered (I'm not sure how it wasn't known sooner, or if he turned and why I didn't know that) so they just did a c/section. That was probably a mercy, because he was 10 lbs. 11.2 ozs., and I don't know how I would have got him out. (However, I can say that my other 2 10 lb. + babies were born vaginally and with no interventions or pain meds.) Anyhow, I do have more to say, but I think it's good when women have a plan AND I think it's important to be flexible, as so many unexpected things can happen. Also, prayer during labor is SO helpful - and birth balls are great for giving some measure of comfort in labor. God bless!
This definitely resonates with me. I've had five c-sections-- which would not have been my plan.
My first birth started with my water breaking and checking into the hospital at about 10pm. I slept that night and labor didn't really progress. The next morning after my husband brought me breakfast, a bagel and orange juice, the doctor came in and they did an ultrasound and found the baby was breech. Suddenly they were telling me they needed to do a C-section and then that they would need to wait 8 hours since I had just eaten. It was a very long day. I was very thirsty because they wouldn't let me drink. They gave me IV fluids, but I still felt horribly dehydrated. I didn't understand, and still don't why they didn't try to turn the baby or let me try to give birth even if she was breech.
My second pregnancy ended before I even saw an OB. I had a very traumatic miscarriage in the ER.
Then I got pregnant within a few months of the miscarriage. This time I attempted a VBAC. Again it began with my water breaking. After laboring for more than a day with no progress, despite the Pitocin, it ended in a c-section. I had hemorrhaging after the birth and the my milk took too long to come in and the baby ended up dehydrated in the special care nursery where I had to drag my post-csection body up to a different floor to nurse her. My feet swelled like melons and it was horribly painful. After they discharged me they moved me to a room on the floor with the special care nursery but they no longer brought me food because I was no longer a patient. There are so many things I'm still angry about with that whole experience.
My third baby was born via planned C-section as no one would consider letting me try a vbac after two c-sections. I was so traumatized. I dreaded it so much. I cried all the way home after my pre-surgery appointment the day before the birth.
With my fourth baby labor started days before the planned C-section date. I felt the gradually increasing contractions with dread for a night and a day before I checked myself into the hospital.
With my fifth baby I was considered high risk-- I was never clear why. Was it advanced maternal age? (I was 38) Or was it the placenta accreta? I was in a huge practice where I never saw the same midwife or OB twice and I hated it, but I was too sick and overwhelmed to try to hunt for a different doctor. They sent me to MFM at the hospital for lots of extra ultrasounds. I ended up having my C-section four days after the planned date because I had just got over an awful stomach bug when I went in for my pre-op appointment and a kind nurse took in my wan appearance and pity on me: Are you sure you want to give birth tomorrow? You look awful! I agreed so fast: I am positive I don't want to. I had no idea I could even decline.
I am not good at pushing back against authority figures. I had undiagnosed anxiety. (It was only diagnosed and treated in the past couple of years, after my youngest was 10.) I hated the technocratic model-- an apt name!-- but I feared the holistic midwife births even more. Oh how I wish there had been a third way. I had so much trauma surrounding all my births and my miscarriage. I haven't even touched on half the details here in these very abbreviated birth stories.
I love your proposals at the end for doctors and midwives working more closely together to find a more humanistic way.
Refusing evidence based care (vba2c) is obstetric violence. Forced surgery without medical cause is assault. I sometimes wonder if it's possible for me to be any more disgusted by what passes for "obstetric care" and then I read yet another birth story....
I'm so sorry. Thank you for sharing. My own mother had 5 medically unnecessary cesareans. She said she wished she'd even known midwives existed back then. I can't make things right for her. What I can do is make damned sure my daughter knows her rights.
Lots of that resonates, and I appreciate you getting personal. One note that may be helpful to other readers is the “rituals” of prenatal care as well as what you mention surrounding labor and delivery - namely, urine tests and ultrasounds, which are essentially looking for problems. And as ultrasound tech gets better, we see more potential problems and make more murky measurements that require follow-up ultrasounds that cause anxiety, extra expense (and radiation), on repeat.
My third baby was a home birth with a cnm and one of the best parts was the whole prenatal focus on nutrition, my symptoms as the sign of health, not just urine tests (we did those), and I only had one ultrasound the whole pregnancy. Highly recommend.
Yes!! I totally agree. I generally decline all ultrasounds other than the 20 week anatomy scan (since I always know exactly when I ovulated and don’t need a dating scan).
With this last baby, I saw an OB (I moved away from my amazing midwives and none of the midwifery practices here would take me, because I’m considered too high risk) who’s part of a big practice. Even though I liked her - I searched high and low for a provider who would discuss and make decisions about my care collaboratively with me - I hated all of the red tape. I had high blood pressure again, this time developing earlier in the pregnancy, and was required to also see a Maternal Fetal Medicine specialist. Their procedure for anyone with chronic hypertension is twice weekly NSTs from 32 weeks onward… which just seemed absurd to me, especially since I would have had to get a babysitter for at least 3-4 hours each time, since the office was all the way down in Center City. Driving all that way through city traffic and shelling out for parking and childcare was enough to raise my BP even more!
There’s a tendency to think that more monitoring is always better, but I just don’t think that’s true. There’s data on it re: continuous fetal monitoring, and I think that applies to excessive ultrasounds and testing in general, too.
Serena - Thank you so much for your vulnerability in sharing the difficult experiences you encountered during birth.
I don't know if I agree with the the first statement - "too many obstetricians are more worried about legal liability than women’s holistic well-being," Is there data to back this up? Are they actually worried about liabilities or are they simply so consumed with the routine of pregnant mom after pregnant mom that they don't see us as individuals?
Even with the most recommended Catholic NaPro GYN in the area, with my first pregnancy I received a simple email after a dating ultrasound that read something like "there is something wrong with the heartbeat - please call to schedule another ultrasound". I received no reassurance, no information that early ultrasounds are notably unreliable etc. Not even a phone call. A cold email. Everything was fine! But again, no personal care from her. And she is indeed someone who will call certain medical systems evil.
What is it about medical training and hospital structures that doesn't support personal connection? I don't think it's simply worry about liability. I think the human nature of medical professionals is just as complex as that of pregnant and birthing mothers.
I do however, agree full heartedly here - "It shouldn’t be so hard to have a positive, empowering, safe birth in America. For too long, American mothers have been stuck with birth rituals that impart a deeply flawed and harmful set of cultural values: presenting the laboring mother as an ill patient who must be saved, the doctor as the unquestionable expert on women’s bodies, and quantifiable data as more important than personal encounter." It should not be so hard.
I had such a wonderful, positive birth with my second. At a hospital! With pitocin and AROM and an epidural! pushing on my back! All the things some influencers would tell me are Very Bad and would result in trauma. But the factors of such a birth are so many - very patient and skilled nurses, who never pressured but moved quickly when they needed to, a phenomenal resident OB who assured me at every step that my body was mine and I could ask her to stop at any point, my OB who just had the best energy in the delivery room - an excited coach who believed in my ability to push out a baby. And a large part I think is hormones. I think those hormones were aided by the fact that I had done it before, that at this new hospital golden hour was standard and women are left alone with their babies in the delivery room for as long as possible before transferring to recovery. Part of it is the mystery of the human person.
I think, additionally, that the expectation that every birth be empowering, spiritual, beautiful is incompatible with a fallen world. I think a lot of women may end up feeling frustrated that they failed., their body failed, they failed to advocate properly or pick the right birth plan. But in our fallen world, where our own bodies are mortal and painful - we also should focus not merely on the labor and delivery, but on the support and insight women need to deal with the physical, emotional and spiritual realities of becoming mothers in a fallen world.
You're right that it's a complex problem! I don't mean to sound as if I think most OBs or L&D nurses are ill-intentioned. I think that a lot of the structures and standard operating procedures that they're forced to operate within are put in place to minimize liability, and that doctors and nurses are human beings with limited energy and lots and lots of patients to see.
There are a lot of benefits to standardizing medical care, and I don't want to minimize or deny those. But operating at a large scale according to top-down directives doesn't really respect the doctor's status as a skilled and well-trained practitioner using their judgement and knowledge to practice the art of medicine to help heal or support a specific person through a physically and psychologically demanding experience. It's hard to balance legitimate oversight and quality control with autonomy... sort of analogous to the twin principles of subsidiarity and solidarity in catholic social teaching.
I am so glad your second birth went so well. Births with lots of interventions can be wonderful, positive experiences! I really think trusting and feeling seen and respected by your care providers makes the biggest difference.
Agree that it's complex! Overall I think the birth space is so complicated and would love to see you explore it further. How do we use science and data to support and inform, but not restrict? How should we grapple with the fact that there remain great disparities in maternal mortality here in the US? What does that mean about how standards are implemented? and on and on and on.
Agree that feeling seen and respected should be top of mind for providers. How should the emotional experience of women be factored in to standards of care and outcomes that are measured? and how can we expand the definition of a good experience beyond "I gave birth in agreement with my birth plan" (which is promoted as the goal in some more anti-hospital spaces)
Thank you for this comment….i’m in the UK so some of the birth conversation isn’t the same (because hospital care is free and midwife led care is the standard way of birth care), but in the mum world there still is a lot of talk about how the medical establishment Just Doesn’t Care about women, and how the only way to have an empowered birth is at home. But I’ve had three hospital births, and have felt empowered and emboldened in my motherhood and sense of womanhood through all of them. We live in a fallen world, as you said, and being prepared to deal with the “physical, emotional, and spiritual realties” of that is something that I think is missing from much of the positive birth discourse.
I think from a Christian perspective, before the fall, birth was intended to be glorious in every way - a joy of creation! But after the fall we're confronted not only with our human bodies, unpredictable, prone to pain, but the realities of all the humans that are involved as well. Mothering is so united with the reality of God as creator and also so impacted by the reality of where we live. Women deserve so much more support than what we have, not specific to labor and birth but beyond that - what is means to deal with all those realities and how we can remain positive and supported even in the most difficult of circumstances
Oh goodness. Thank you for sharing.
Up here in Alberta, Canada, midwives are medical providers and fully covered under our public health insurance (i.e. they are free for anyone to access, just like an OB would be). I delivered both my babies out of hospital (and at a birth center, the other at home). Both were great experiences.
My husband and I only discovered the possibility of midwifery care after our doula, and the teachers at our private childbirth class, recommended it to us. We knew going in that we wanted minimal medical intervention, and ultimately we found an amazing midwife team. I went into labor spontaneously both times and the deliveries were without complications.
At the same time, the was definitely some amount of "holistic woo" that I found difficult. In particular, breastfeeding was presented as something which was so important that it would be tantamount to child abuse to give your baby formula. The breastfeeding guide I had been given by my midwives told me not to give my baby formula. When I worried about my supply, one midwife said that plenty of small breasted women produce plenty. That same midwife even shamed me for formula feeding, moments after telling me my baby's weight gain was great and that I must "be a rockstar [for breastfeeding this chubby baby]".
Well, I struggled so hard to produce milk that for my first daughter, I ended up trying both domperudone and metformin (!!!) to increase milk supply. This was my choice, but my daughter was still partially formula fed. I obsessed unhealthily about how inadequate my body was in postpartum. And for my second, I said a big fat NOPE in advance to formula-shaming. I wish my body was capable of EBF but I am also deeply grateful that my babies had access to safe nutrition when my body couldn't adequately supply it.
All that to say - I never encountered the extreme "freebirth" side of things. The midwifery model worked great for my family, and I am so grateful to have had access to it. Despite all those things lining up for me in the most amazing way, I still had a huge emotional ordeal as a new mom.
They say it takes a village. In addition to the midwife + doctor integration you propose, we also need to normalize (and indeed, cover the cost of) doulas. We need more sisters, moms, grandmothers, aunts and partners in the room advocating for the birthing mom. And everyone in that village deserves to be better informed and what it looks like to give birth on one's own terms.
Thank you for writing this powerful piece. I will be sharing it.
Thank you so much for sharing your story here: my first birth was so similar...induced delivery with no epidural due to rising blood pressures (but they were good at home and labs were also fine, like yours...I've never heard someone with a story so similar to mine!). I still wonder to this day what would have happened if I said no to the protocol induction at 39 weeks; I just felt like I didn't have a choice even though I didn't feel at all convinced the interventions were necessary for my or baby's safety. Stress tests were fine, I felt great, etc. The birth was traumatic for me, and I had the same PTSD type symptoms you describe later approaching my second...which was so much better because, although I ended up at the hospital with an induction again for the same reasons (white coat hypertension is my nemesis), my bishop's score was so much better and I had a doula at my side that time. I went on to have my third at home with a CNM midwife (and my BP did spike a bit during labor, but we didn't have any time to transfer me), and it was such a night and day experience, I'm planning my second home birth for my upcoming delivery with a midwife who does not contract with insurance for exactly these reasons. But I absolutely agree that a hospital birth doesn't have to be as unnatural and difficult as it tends to be...I too mostly blame liability concerns for the way the whole process is over-engineered. Sometimes I feel like I didn't have the right to feel hurt or traumatized by that first birth experience, since so many women experience much worse, but your experience was so validating to read. Thank you.
I’m so glad to hear that my story resonated with you - and so sorry that you had a similar experience. Even after I submitted this piece, I worried that maybe readers would think I was being overly dramatic by talking about trauma. My baby and I ended up healthy, with no C section or NICU time; I know so many people whose outcomes have been so much worse. But labor - especially your first labor - is such a vulnerable time. Having a midwife who knows you and cares about you makes such a big difference.
I have straddled these worlds, perhaps in a small way like your own mother (her being a doctor who home birthed as you shared here), as a previous Labor and Delivery nurse and a mother who has birthed in the hospital and at home on her own. I agree that neither holds the full weight of what it means to birth life into this world in a woman in this time. I used to take pride in my “L&D” RN title and I also used to be militant in my freebirthing advocacy. In my nursing experience, I became very disillusioned about the “policy and procedure” version of birth the hospital has to offer women. In the years following my free births, I have tempered my enthusiasm with the knowledge that birth is meant to be witnessed and supported by other women, it doesn’t have to be all or nothing. I truly hope I have a fourth baby so I can use the integration I have experienced from all of the above.
I have not read your essay yet but I think I may have to answer all of these questions in a post because they are so thought provoking! (Also your journal entry brought up tears in my eyes as I have a very similar entry from my first baby).
So appreciate your story and thoughts. Modern hospital-based maternity care has left swathes of women disconnected from their bodies, afraid to be mothers, and subservient to inappropriate authority, which is why I’ve mostly opted out of it. But reality is that most women are still there, whether by choice or necessity. Birth is sometimes traumatic, sometimes dangerous, even unavoidably so. But it should never be dehumanizing.
I too had to battle against medical professionals as a first-time mom. Multiple times. I couldn't believe the way I was bullied and condescended to! Oof. But as you say, it's a broken system, not a system full of bad people.
I've never heard of that book but it sounds great! I totally agree with your premise that women shouldn't have to choose homebirth to have an experience where they are respected (and birth is as well). Sadly, that's how it feels. I had my third at home and it was absolutely incredible, and totally redemptive. (I just hit publish on that!)
Such a great piece - thank you for writing it. I want to share and write more about birth in the future as there's just so much to explore. I do feel that our birth experiences set us up energetically for motherhood, and that processing our experience, no matter what it is, is super important (and can make up for one that isn't great).
I planned on having a natural birth in the hospital for my first baby; no pain meds, no Pitocin, no internal monitors. Well, my water broke at 35 weeks and I wasn't having contractions, so they had to induce me right away. Just about every single medical intervention besides a c-section was employed so I could birth my baby, and then she was in neonatal intensive care for 14 days, much of that on oxygen support. Definitely not the birth I had planned. I wrote about it here, specifically from the perspective of the medical community's overreliance on data vs. lived experience: https://substack.com/home/post/p-144985447
K I just looked that book up and hit purchase. Wow. Looks like a foundational read for anyone who cares about women!
I don’t think I’ve seen anyone commenting on the offhand remark you made about medicalized ritual entry into motherhood—and what those rituals communicate to mother, baby, and wider society about the value of the family, etc.—but that blew my mind. I will be pondering for some time.
Oh my word, as a woman in England your article is shocking. I had some rude medical professionals during my birth experiences but nothing to the scale it sounds like you have to put up with in the US. Here, as far as I know, free birthing isn't really a thing. I'm sure some women do it, but it's not common, as we have a middle ground in hospital settings in our birth centres - essentially midwife lead spaces that are made up to be very homely, with birth pools and relaxing music and what have you, where women are encouraged to listen to their bodies and give birth naturally, with as little intervention as possible. I didn't really understand why anyone would risk a free birth before now, but reading your description of how things are there (are you truly still told to put your legs in stirrups? I might be being naive because my own experiences were wildly different to this, but I only know one person that gave birth that way, and it was due to an emergency) I get it.
I'm so sorry your healthcare system is so awful. Thank you for sharing.
I was in stirrups for my hospital birth. We found a lay midwife and birth center for our second.
I’m guessing the second was a much nicer experience?
Night and day. Birthing pool. Lights dimmed. No nurses changing shifts every twelve hours. 10/10 would recommend lol.
Three cheers for birth pools!
Amen to that!
I live in Hong Kong, a heavily medicalized birth culture and more than once I have thought of ghosting my doctors and just let fate run its course. I did not feel ok doing that (nor did my husband) in the end, but the temptation is always there. I ended up on pitocin both times. And while the second time was expected, the first time I had so many unwanted and unneeded interventions just to ensure the baby came within 12 hours of checking into L&D- when the average length of labor of first time mothers was THIRTEEN hours according to research. As I approached the 11 hour mark my husband overheard whispers of a C section, even though NOTHING was wrong. If my daughter didn’t come when she did (at almost 11 hours to the dot) I don’t know what would have happened to me. I was in so much pain I was in no state to refuse. In any case, I’m not sure I would have been heeded had I tried.
I had an European friend who had a much worse experience than I did. She said if she stayed here she would never have another child.
Serena -- could you explain more what "processing the birth and integrating the experience into your understanding of yourself as a mother" means? Thinking about it a lot? Writing in a journal? Or what?
I think it likely depends on the person! For me, yes: there was a lot of thinking about it - but I tend to be pretty introspective and prone to rumination. I know writing birth stories or journalling is really helpful for a lot of people (that's probably part of why birth stories are so common on the internet!).
At the same time, I don't want to overgeneralize or make sweeping pronouncements about how becoming a mother affects your sense of self. Anastasia Berg has written very thought-provokingly about the pitfalls of presenting motherhood as transformative, and I can see the validity of a lot of her critiques. https://www.thecut.com/article/excerpt-what-are-children-for-anastasia-berg.html
But for me, the transition to motherhood was pretty destabilizing, at least in the short term. It didn't ultimately change my underlying temperament or foundational beliefs, but it did shear away much of what had previously made up the bulk of my life. I have a tendency to live in the world of ideas, but early motherhood is so intensely physical. I often felt totally inadequate.
Yet giving birth also made me feel incredibly powerful. It called forth all sorts of physical/muscle memory in me; I drew on years of singing lessons, for example, to relax my jaw and muscles. For me, it's an experience with so much spiritual richness too - the way that you have to surrender and stop trying to control your body in order to access that sense of intuitive life-giving power, and the way that physical pain isn't necessarily the same thing as emotional suffering - how strangely freeing it is to actively welcome pain for the sake of love. It was also a pretty huge thing for me to stand up to authority figures, since I naturally tend to be compliant and conflict-avoidant.
I have friends for whom birth and the first newborn stage was really not a huge deal: they feel safe and cared for in hospitals and like having it medically managed, or they had tons of experience with babies or a natural tendency to be very physically nurturing. So again, I don't want to imply that it always is or should be such an intense experience. But I do think, for many women, it is. And they don't always have the resources to help them make sense of it.
I completely understand why women want to give birth at home. I've had a c/section, 5 v/bacs. and 2 more c/sections. I wanted to have my babies as natural as possible in a hospital setting, and I was able to have some that way - 2 with no interventions, 1 with minimal interventions and 2 with lots of interventions. I found that as soon as one arrives at the hospital the nurses are trying to rush things along - generally. It's helpful to have a doula (I did with 4 of mine), as they can advocate for you and spell your husband in rubbing your back, etc. I also found that as soon as some type of intervention is started - breaking the water, for instance, they seem to be just itching to begin another intervention. It's just aggravating that many - not all - labor and delivery staff don't seem to respect the natural process of giving birth. I did encounter one nurse - a rebel nurse - who told me she had helped deliver a breech baby in the parking lot. I got a chuckle out of that. I confess I was blind-sided by my 1st baby, as he was breech, and I was 41 weeks when that was discovered (I'm not sure how it wasn't known sooner, or if he turned and why I didn't know that) so they just did a c/section. That was probably a mercy, because he was 10 lbs. 11.2 ozs., and I don't know how I would have got him out. (However, I can say that my other 2 10 lb. + babies were born vaginally and with no interventions or pain meds.) Anyhow, I do have more to say, but I think it's good when women have a plan AND I think it's important to be flexible, as so many unexpected things can happen. Also, prayer during labor is SO helpful - and birth balls are great for giving some measure of comfort in labor. God bless!