When my friends and I reminisce, the talk often turns to births. They talk about the hospital they were born at or where they grew up. I usually wait to go last when I say, “Actually, I was born at home.” It’s usually met with shock, awe and confusion. Why would anyone decide to give birth at home without painkillers or a wing of doctors and nurses by your side? Isn’t it dangerous? Isn’t it frightening? Isn’t it outdated?
This year, I turned 26 and though I’m nowhere near having children yet, I’m pondering these questions myself. For me, I’m asking, “Why not?” I’ve always grown up in a very hands-off household when it came to illness. If you had a cold or a cough, you had tea, food with vitamins, plenty of rest and some alternative medicine. Antibiotics were an extreme last resource. Of course, we still took things seriously. In college I had a kidney disease and I went straight to antibiotics. You don’t mess around with that.
I’ve always wondered why my mother had decided to have home birth. I guess I shouldn’t be surprised. When my parents met, they were both macrobiotics (though that ended pretty quickly) and my mother was a vegetarian. They were health conscious people. Having a home birth is a brave thing to decide to do all on your own. “Wasn’t she nervous or worried?” I often wondered. My inner voice shuddered at the idea of all that unmedicated pain. “But, women have been giving birth naturally for years!” said the other voice in my head. “Surely I could handle it.” Should we have to though, when we no longer need to? For some reason, I never really thought to ask these questions until now.
I’ve started thinking about this more and more for a few reasons. The first and main one that got me thinking was when I saw the documentary, called The Business of Being Born. After a disappointing birth experience with her first child, Ricki Lake takes a look at the maternity care system in America. Together with filmmaker, Abby Epstein, they investigate the conventional wisdom obstetricians use to deal with childbirth. While, with any documentary, there’s a bias, with many interviews proving their point and a dearth of interviews to balance out their argument, there is a rationality to this type of thinking.
While C-sections are necessary, doctors often use them as as a resource, maybe more than necessary. C-sections help deliver babies more swiftly, saving doctors time and hospitals the worry over a potential lawsuit. Then there’s the overmedication. Who doesn’t want to avoid pain, if possible? When doing research on home births, I found that having unmedicated labor allows for hormones that help mother and child bond. Unmedicated births in hospital are rare nowadays. Lastly, there is an empowerment factor that mothers don’t find in hospitals. Sometimes their decisions are taken out of their hands, very quickly. With home births the mother is more in control. These are some of the things that make natural births seem more sensible.
On the other hand, C-sections can be vital and life saving. Some mothers even chose to have a C-section from the start, while some mothers go into labor, then find they need a C-section. However, there may be implications to an (elective or necessary) C-section that many mothers don’t realize.
A study from the New England Journal of Medicine found that over a third of C-sections are performed too early (before 39 weeks), putting newborns at a higher risk for all kinds of health problems. Having a C-section creates the possibility for the twice the risk of infant mortality and a slightly higher mortality rate for the mother. The amount of recovery time increases, as well. With a vaginal birth, mothers were able to leave one to three days after, whereas, with a C-section, this can mean three to five days. Another problem are the issues related to internal scar tissue. If not taken care of completely, scar tissue can cause lower back and pelvic pain, a need to pee more often (sometimes continuing even 10-15 years after surgery), pelvic pain, pain during intercourse and sometimes even infertility issues. Massaging the scar after it has healed can help, but many mothers are never told this.
One other major implication of having a C-section is the cost. Not everyone can afford to have such an expensive procedure. Those with good health insurance may pay over $5,000 in hospital bills, while mothers who are uninsured may wind up paying $30,000 for a vaginal birth to $50,000 for a C-section. This puts mothers who are from low-income situations in a hard place because they are left with limited options.
During an unmedicated labor, there are a number of hormones that benefit both a mother and the baby. Oxytocin, which is secreted during sex, after ovulation, during labor, birth and when breastfeeding creates loving and nurturing feelings. They also induce contractions and help move the birth process along. Endorphins, which are created in response to pain and stress create natural and pain-relieving effects. As the labor continues and the pain grows, so does endorphins, creating morphine-like effects. The pain decreases and the woman is able to shift into an instinctive mindset and focus on the work of labor. Lastly, adrenaline, which we know as the “flight or fight” response, is created when a mother feels threatened or afraid during labor, she can produce too much adrenaline, which can prevent labor. However, in an unmedicated birth, right before delivery, the woman receives a rush of adrenaline, which gives them a rush of energy, stimulating contractions activating a fetal ejection reflex.
While it’s important to have a hospital or doctor on call, giving birth naturally can not only be less stressful, but more empowering for the mother. When I asked my own mother more about her decision, she said that, while in her heart, she always knew she wanted to have a home birth because she was 34 when she was pregnant, she decided to go with the more conventional birth method in a hospital setting. However, leading up to my birth, she was working with a midwife practice. When she was five months pregnant, she realized that she wanted to have a home birth and began searching for a midwife who would do home births.
When I asked her what had changed her mind, she explained that she just went back to her original feeling. She had been listening to this societal belief that it was better to give birth in a hospital. She felt that when giving birth in hospital, your power is taken away from you, and often decisions are made for you. Mothers are in a vulnerable position while giving birth. They may find themselves getting a C-section or getting talked into decisions that they didn’t really want. Usually in a hospital setting, the baby is taken from the mother as soon as they’re born and they don’t see each other for some time.
Lastly, there are the considerable bills, whether you choose to have a home or hospital birth. Many women from low-income households can’t afford prenatal care, let alone the numerous expenses from giving birth in a hospital. Not to mention the number of undocumented mothers without healthcare coverage. These are commonly women from poor backgrounds, but women of color are not treated with the same respect that white middle (and upper) class women are given.
There’s a history of this in the United States, as well as throughout the world. Right-wing activists have always attacked women who consider abortions, no matter their race or background. However, when it comes to birth, their reasoning changes. During the 1990s, conservative activists were big proponents of the Personal Responsibility and Work Opportunity Reconciliation Act, also known as the “welfare reform” bill. They essentially tried to discourage women on welfare from getting pregnant by introducing a “family cap” that denied an increase in payments to women who became pregnant or gave birth to a child while on welfare. Another policy that the right practice is to encourage or mandant low-income women to use long-term birth control, such as Depo-Provera.
Then there’s the long history of sterilization abuse. In the past, doctors would often try to dissuade white women, especially of the middle-class to think more about sterilization. Often they would make it difficult for these women, trying to convince them to come back the next day, after thinking about it. However, when it came to people of color and poor white women, these doctor’s attitudes would shift dramatically. They would encourage these women to be sterilized, often going so far as to manipulating them into having the procedure. In one case, during 1968, private agencies and the Puerto Rican government led a campaign that resulted in one-third of Puerto Rican women of childbearing age to be sterilized. Another campaign during the ’70s resulted in the sterilization of 25% of Native American women living on reservations. Most recently, in 2013, the Center for Investigtive Reporting found that numerous female inmates in California had been illegally sterilized.
This isn’t just an issue for the United States either. Recently, the University of Bristol and Chaka Studio collaborated to create the Quipu project, which revealed that from the mid-to-late 1990s, as many as 300,000 women in rural areas of Peru may have been tricked into being sterilized to help “bring an end to poverty.” They initially planned to make a film, but they found a better way to educate people about this issue by letting the women who had experienced this speak for themselves. Their solution was to create an online archive of women’s voices, telling their story in their native tongue. This would be the basis for a multimedia documentary that focused on the women. This method was empowering because women could others, like them speaking first-hand (often in Quechua, instead of Spanish, which is the government’s language). Women can also call in and record their own story.
On top of trying to have a safe birth, women should never have to worry about being coerced (or in some cases forced) to have a doctor prevent them from ever having children again. Miriam Zoila Pérez, a writer, doula and reproductive justice activist, writes the blog Radical Doula. Through her practice, she noted that,
“I experienced resistance from Latina immigrant women to midwifery care because of the stigma toward parteras (midwives) in their home countries. In many places in Latin America, midwives and home birth are seen as the option used by women who can’t afford to go to hospital for birth–basically an option only for those who have no other option. That creates class and race stigma on home birth and midwifery care.This stigma is no accident. Global socioeconomic policy in Latin America (and I assume elsewhere as well) has long promoted hospital-based childbirth as a marker of development, and encouraged this move with foreign aid dollars and other development initiatives. The medical students I observed in Ecuador were clear that their obstetrical training and guidance came from US practice.”
She goes on to explain that a lack of access to emergency obstetrical care and trained birth attendants often leads to increased maternal and infant mortality. In the US, 98% of births happen in the hospital, but the maternal and infant morality rates fall behind 48 other countries. Some midwives try to meet these needs in various ways. In Florida, there is an Easy Access Prenatal Clinic that takes all pregnant women, regardless of one’s ability to pay, insurance status, citizenship or crisis. Many, like Mariah Valenzuela Farrell try to make their services more accessibly to low-income women who need prenatal services can’t reach out to hospitals due to their citizenship status. Midwives can be a resource and when hospitals can’t. They are not the only answer, but it’s important to remember there’s more than one way to have a healthy delivery.
Just last year, I considered becoming a doula, also known as a birth coach. Though I later decided that my career lay in another direction, through my research, I came to understand how exactly having a home birth can be empowering for mothers. I’m not (completely) trying to discredit hospital births. You want to make sure that whatever decision you’re making will be the safest for you and your baby. I understand that. Nevertheless, considering a natural birth or home birth could actually be very rewarding. You can have a birth coach or midwife with you in the hospital. If you know you won’t be able to make decisions while in labor, you can discuss beforehand your choices with the midwife, who will make sure that your wishes are respected.
In the end, a mother’s birth decision should be the one that is best for her and the child. While I’m a huge fan of home births and natural births, if it’s a question of either one’s life being in danger, the hospital is key. However, I think natural or home births should factor more into the birthing decision. My mother did and she never regretted it. “It just seemed to me that having a baby at home would be a more peaceful, gentle and nurturing experience.” She said. “And it totally was the best decision I made in my life and I wouldn’t have it any other way.”