On Giving Birth

Jun 13, 2007 | Updated Nov 17, 2011

On May 27, I gave birth to my second son. He was born in a large bathtub at a birth center, where I had the assistance of a doula and a certified nurse midwife (CNM). I gave birth without drugs or an epidural. Fewer women give birth this way, or even can choose this type of birth, because birth centers have been closing -- in spite of the fact that birth centers and CNMs provide quality woman-centered care that is much more cost-effective than standard obstetrical care.

You may be thinking "So what? Natural childbirth is over-rated anyway. Why would anyone want to go through the pain of childbirth?" I remember hearing someone I know talking to a pregnant woman and saying that giving birth without drugs doesn't make you a better mother. I agree. I have given birth twice without drugs and I am still an imperfect mother. But the claim to superiority is not what made natural childbirth the right choice for me. Being able to give birth to my babies without medical interventions was empowering. I used to teach four aerobics classes in a row, but giving birth was the most strenuous physical challenge of my life. I did it. I have no need now to do Iron Man. And my sons were born in a softly lit room, both of them so calm that they didn't even cry. You forget the pain so quickly -- all you remember is the beautiful experience of bonding with your baby right from the start. Most women who choose this type of birth describe it as a positive and empowering experience. (In contrast, many women remember their hospital births as horrible experiences.) And it is well known that birth centers provide safe and effective care with a much lower incidence of cesarean sections, even accounting for the fact that they only deal with low-risk pregnancies.

So why are birth centers closing? Why has the natural childbirth movement been dying out? With all of the talk about "choice" -- the choice to have a cesarean, the choice to have an epidural, the choice to induce early to avoid stretch-marks or to accommodate the schedule of one's doctor or relatives -- why is the choice to give birth outside a hospital becoming less common and increasingly scorned? People have largely forgotten some of the abuses of the 1950s and 1960s, which led to the natural childbirth movement in the first place. There seems to be greater cultural acceptance of the choice to have a surgical birth than there is to have a natural one. Perhaps the prevalence of cosmetic surgery leads people to think of surgery as no big deal. Some of the reason that the movement is dying out is that women are reluctant to trust their own bodies or are discouraged to do so. And mothers don't want to do anything to jeopardize the well-being of their babies. (Of course, the evidence suggests that natural childbirth, especially in a birth center setting with physician back-up, is as safe as hospital birth, although most people don't know this.)

Another reason that we are losing birth centers is because they, and CNMs more generally, face rising malpractice insurance costs that make continued operation financially infeasible. Midwifery care costs insurance companies less that hospital births, but this makes it harder for birth centers to offset the rising costs of their insurance. Also, obstetricians are increasingly discouraged from working with CNMs by medical malpractice insurance companies, making it difficult for birth centers to find physician back-up. Ignoring the evidence about safety and cost-effectiveness, medical malpractice insurance companies view CNMs as risky.

In January I attended a conference of the National Advocates for Pregnant Women on reproductive justice. Many of the birth activists there attend or encourage homebirths, but only 1% of American births occur at home. Most women are simply too frightened of what would happen if there were complications. Birth centers offer the opportunity for a woman-centered natural birth experience, with hospital and physician back-up in the case of complications. One of the other scholars who studies birth asked me what women who use birth centers would be likely to do if they didn't have access to a birth center. I replied that most of them -- including me -- would choose a hospital birth over a homebirth. This is all the more reason that we need birth centers as an option for women who want natural childbirth. The loss of birth centers is a tragedy for reproductive justice, which involves the right to choose where and how to give birth as well as the right to decide when to have children and how many to have.