The human female is unique among all species of animal on this planet in that she is the only one that can doubt her ability to give birth, despite the fact that most human females are perfectly physically capable of doing so (we evolved to give birth and the system works pretty well!)
The medical and health-related decisions that face any pregnant woman today are too numerous to count. Which doctor to see? How frequently should I exercise? What medicines or food should I avoid? What tests should I get? How often do I need an ultrasound? What delivery options do I have? What happens if I choose to be induced? What happens if I don’t? What circumstances might lead me to have a C-section? What postpartum care will I need? How am I going to pay for this? How am I going to support the new life I’m carrying? What if I don’t have the strength to give birth naturally? How will I handle the pain? What if something goes wrong?
Our medical system (and media) profits on this doubt. In many ways, it dehumanizes mothers, casting unnecessary fear and anxiety into the birth experience and making them the objects of medical processes and policies that prioritize profit. This is manifest in our staggeringly high national C-section rate of 32%.
When we discovered we were pregnant, we were over the moon, but also full of anticipation about how our lives were rapidly changing. I took the happy news in stride, knowing that we would have several months to plan and prepare to bring a baby home. But home from where, I wondered? I knew that most people give birth in a hospital, but I have a friend who delivered her first child at a birthing center. She, however, was the only friend or even acquaintance I knew at that time who had not birthed in a hospital.
At first, I was apprehensive about not being in a hospital. After all, if we had a complication, I wanted to be as close to medical help as possible. I was more concerned about cost. I knew our insurance company would at least partially cover a hospital birth, but I doubted it would cover any other alternative birthing place or method. I knew that if at all possible, I wanted to have a natural birth experience – to give birth vaginally without medication or other medical intervention. My own birth was the complete opposite. My mother endured hospitalization for nearly her entire pregnancy with me, and I was delivered by C-section at 35 weeks, weighing just 4 lbs, 6 oz. Fortunately, for this pregnancy at least, I was experiencing none of the complications or hyperemesis that my mother had. By all accounts, according to my OB, I was set to have a healthy and uncomplicated pregnancy. Great! Now what?
I started taking the Centering Pregnancy class that my doctor’s office offered for free to all expecting mothers. The class was run by one of the Certified Nurse Midwives at the practice and combined group lessons on birth and parenting with our prenatal checkups. I liked this option rather than scheduling individual prenatal appointments because, if I took the class, I would be sure to see the same two nurses at each visit. I wanted to get to know my care providers.
In the first class session, we were told that any one of the nurses and doctors at the practice might be on-call the day we are admitted to the hospital, so it would be impossible to know who would actually be with us on Delivery-Day. Hm. Then, we were told we could labor in water using one of the tubs in the delivery room – but then we would be moved out of the tub to actually deliver, since the hospital doesn’t permit water births. Hm. I wasn’t too discouraged by these two new pieces of information, but it gave me a chance to consider more deeply how important it would be to me to know the people in the room with me on D-Day. I had read that unfamiliar people coming and going from a delivery room could stall labor.
Then I really started to dig into my research. I looked up our local hospital, Augusta Health, to check out its C-section rates. I had seen previous news stories that the C-section rate in the US was staggeringly high, but how high was high? I was shocked to learn that the hospital’s last reported C-section rate for low-risk births was 27% (I would add a citation here, but the Consumer Report I originally found is no longer available at the link I saved. Augusta Health declined to participate in the 2017 Leapfrog Group Hospital Survey.) This, I thought, wasn’t a good sign. I didn’t want my chances of having surgery to increase by over 20% just by stepping foot into the hospital. Other mothers I spoke with also shared stories of how they were pressured into having C-sections, usually after a cascade of other interventions (typically starting with induction). Others shared that they were told if their labors didn’t progress fast enough (after 10-12 hours or so) that they would need to have C-sections. This didn’t seem right. Labor, if allowed to progress naturally, could take just a few hours or over 24 hours. I wasn’t feeling up to being under a hospital or doctor’s time limit.
According to a report by the LeapFrog Group, “One of the most effective ways to lower your chance of having a C-section is to have your baby in a setting with a low C-section rate. Overall, women who labor in a birth center are much less likely to have a cesarean than similar women in hospitals.”
I decided to transfer my care to Brookhaven Women’s Health and Natural Birth Center. Fortunately, our insurance company covers birth center facilities. We were a step closer to the natural birth experience I hoped for. We are lucky. There are only about 345 freestanding birth centers in the US in 37 states and DC. This means that very, very few women have access to this out-of-hospital option.
I continued my research and found the following books and articles to be very informative and helpful in preparing us in our birth decisions:
- Approaches to limit intervention during labor and birth. Committee Opinion No. 687. American College of Obstetricians and Gynecologists. 2017.
- What Every Pregnant Woman Needs to Know About Cesarean Birth. National Partnership for Women and Families. 2016.
- Your Biggest C-Section Risk May Be Your Hospital. Tara Haelle. Consumer Reports. 2017.
- WHO Statement on Cesarean Section Rates. World Health Organization. 2015.
- Birth Matters: A Midwife’s Manifesta. Ina May Gaskin. 2011.
- Ina May’s Guide to Childbirth. Ina May Gaskin. 2003.
Women have the right to make their own choices about their birth experiences, but our medical system is designed in such a way that too often a mother’s choice is removed or significantly impacted by unnecessary interventions and practices that do not place her or her baby at the center of the birth experience. Doctors’ schedules, hospital policies, time (and therefore money) too often take priority, leading to interventions that are usually not in the best interest of mother or baby.
Once we actually get to D-Day, there’s no telling just how things will go. I know, however, that I feel confident in my ability to give birth naturally, and that should I end up in the hospital, I’ve informed myself about the possible decisions, processes, and interventions that might be part of our experience there. My hope is that we can bring greater awareness to the risks of our nation’s high C-section rate and better inform women of their birthing and delivery options. We need a more humanistic approach to the care of pregnant women, mothers, and babies that honors our natural ability to birth and which promotes natural birth as a healthy, safe, and optimal choice for low-risk women.