What if we didn’t fear birth?

Image from film ‘Of Woman Born’

There is a lot of attention being given to the dangerously high maternal mortality rate in the United States right now. With this, there are plenty of questions about why we are seeing such high numbers and how our rate is rising as other developed nations’ rates fall. NPR and ProPublica recently teamed up to perform a six-month investigation into the reasons behind the rise in deaths: their summary includes a rise in pregnancy-related complications, inconsistent hospital protocols, a lack of funding for hospitals, and doctors who lack experience with birth. On the surface, these factors are huge red flags that need to be urgently addressed; however, I believe there is a deeper issue that needs to be exposed: Does our culture trust the natural birth process, or even understand what it is?

Definitions of the natural birth process vary. For example, WebMD offers a breakdown of labor stages that includes a description of common medications used for pain management. For this article, consider the use of pain medications, such as epidural or nitrous oxide, to be an interruption to the natural birth process. What parents experience in a hospital setting is almost never a natural birth experience; in fact, most doctors have never actually witnessed a birth undisturbed from beginning to end. It comes as no surprise that a Pitocin drip and an epidural are parts of their daily birth experience. Pregnancy is treated like an illness that needs to be managed, just like most other reasons people end up in the hospital. It’s all doctors know, and many parents believe it is their only — and safest — option.

When I studied midwifery, my colleagues and I discussed the birth process relentlessly, always hammering on the mechanisms that the body has to deliver a baby safely to the outside world. We studied the perfect geometry of the pelvis, the ability of the uterus to push without a conscious effort to bear down, the fetal ejection reflex, the cardinal movements of a baby’s descent. Many times we argued that our bodies have been doing this since the beginning of human existence — so why now does our culture believe that the best way to give birth is at a hospital, laying on our backs, hooked to IVs and monitors? We’ve all experienced birth, but we don’t trust the process to be left unattended. We need to establish an understanding of our body’s baseline experience during childbirth before we can identify dangerous complications.

Midwives talk about the ‘cascade of interventions’ that involve standard procedures at hospital births and can lead to complications. It begins with induction of labor and the use of synthetic hormones to speed up the process, which in turn cause contractions to be stronger and more painful. An epidural is given to treat the pain, which causes labor to slow. Then comes more hormones to speed up the process. The uterus is pushing, but the cervix isn’t dilating fast enough. You’re told to push, but you can’t feel where you’re pushing — you’re numb from the waist down. You can’t get up to walk or change your position. The baby isn’t coming and its heart rate isn’t recovering well between contractions. You’ve been laboring too long. The doctors decide it is time to prepare you for an emergency cesarean.

What would have happened if the labor had progressed without the help of hormones or pain medication? Surely, complications happen as a part of the normal birth process for some people, but how can we know how often they really occur if the natural process isn’t allowed to happen?

I have a rather unusual perspective on birth. While I have witnessed dozens of them, I have never seen one that took place in a hospital. Most births I attended were in the middle of the night — the midwife and I tiptoed into the room, quietly unpacking our bags in the corner. We tried to relax before the labor noises started to sound grunty, suggesting pushing would start soon. We’d wait, motionless, as we watched like birds on perches for the baby to emerge. Then we’d swoop. Is everyone okay? Yes? Let’s get them in bed, they need rest. We’ll clean up.

I didn’t witness any complications. Maybe I was lucky, or maybe the complications we expect to accompany a natural childbirth are less common than we are led to believe. We often hear stories about how lucky someone was to have made it to the hospital — just in time — to not deliver their child in the back of a cab, etc. What do we fear would happen in that scenario? Do we understand what exactly we are afraid of?

I sit with a group of women at a kid’s birthday party. The moms have escaped to child-free room to sip sangria and talk about the frustrations with parenting. We get on the topic of birth and my ears perk up. 24-hour labors, emergency cesareans, vacuum extractions, episiotomies, and a few “thank God”s for epidurals. I nod along, but they notice I’m quiet.

“What was your labor like?” they ask.

I invited a midwife and a doula. They slept and knitted in the other room while I breathed through each six-second contraction in bed. It was dark and quiet — no interruptions. I was wearing my husband’s old, ripped up pajama shirt and a pair of boxers. He lay next to me, trying to sleep, while I let out an occasional moan. I focused on my body and then I’d try to forget about it — let it do the work. Active labor started around 9pm and went until 5am, when my daughter was born after three good pushes. It wasn’t painless or easy by any stretch of the imagination, but it was exactly what I wanted it to be.

I’m usually the outlier in a room full of moms. I believe it’s due to my personal experience with the natural labor process, seeing it happen so many times that I knew it was completely possible.

Nobody has ever outright told me they thought I was crazy to have a homebirth, but it has been implied. I’ve had women tell me how they almost died, how if they had been home instead of at the hospital they’d be six feet under. It isn’t my goal to invalidate the personal experiences of others, but when I hear these stories I immediately wonder what happened before they almost died — what factors surrounding their normal labor turned potentially deadly?

Midwives are common in many European countries and have remained an integral part of maternal health care. The United States has ramped up an effort to include nurse-midwives in hospital settings, but the idea of homebirth midwifery is still very controversial. According to a 2001 report by the World Health Organization, over 75% of European births are attended by midwives to only 4% in the United States. Midwives attend births in hospital and home settings, but generally are more focused on each individual patient’s labor process than doctors who may be the only one staffed for an entire ward at a time. The United States has also seen a demand for more birthing centers, laboring tubs, and doulas in attendance — parents are trying to reclaim ownership of their birth experience.

The consequences of not allowing patients to be empowered to make decisions around birth can be severe. Additionally, it is important to point out that the maternal mortality rate is 3–4 times higher for women of color in the United States. Racism within the medical community and assumptions about the lifestyle choices of people of color may be a root cause of higher rates of intervention and the belief that pregnancy and labor management is necessary. This perception perpetuates feelings of fear and frustration for patients and medical professionals.

If there is to be an understanding of the natural birth process without interruption, where do we find examples to learn from? To my knowledge, there are few resources on the subject of natural labor that are available to the public. There are books, stories of personal experience, and short videos that focus mostly on the actual birth itself, but not the labor. Mainstream media portrayals of birth don’t help. It is rare to find a movie that presents labor without a rush to the hospital, the comedic bit of a wife crushing her husband’s hand, screaming, and the doctor counting out pushes before a baby that looks three months old appears on screen. It is the same old, tired story, and while most people don’t always believe what they see on the TV, it does indicate that our culture accepts a representation of birth that creates fear and anxiety.

Recently, I was introduced to an unreleased film called Of Woman Born that is dedicated to the experience of undisturbed labor and birth from beginning to end. The trailer of the film shows a slow, intimate experience with labor and a mother’s insights throughout the process. Hopefully, its release will shine a light on the need for our medical community to acknowledge the validity — not oddity — of an undisturbed birth experience.

Having a baby is an incredibly profound event that opens the gateway to parenthood. In tandem with the rising rate of maternal deaths, it is no wonder that such a process is the center of heated discussion. When the debate elevates, it is beneficial to remember the root of the issue in its simplest form: What is our expectation of birth and how do we learn to trust the process again?

For more information on the film, visit ofwomanbornfilm.com

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