Choosing The Right Birth Experience Despite A Fraught Childbirth Landscape

Childbirth is a feminist issue. Many progressive feminists have pointed out that the current system of maternity care is, largely, a patriarchal one fraught with inequities.

In particular, minority women are at increased risk for death in childbirth under the current system in the United States. Experts at the Center for Disease Control have pointed out that black women suffer a three to four times greater likelihood than white women that they will die from pregnancy complications. This unfortunately even holds true in developed countries such as the United States, where outcomes should be better.

One Manhattan-based OBGYN, writing in the prestigious American Medical Association Journal of Ethics, describes the collective global attitude towards pregnancy and childbirth as being

“one of obscene maternal and neonatal apartheid.”

When one gets educated about these issues, it becomes obvious why the United Nations included the reduction of child mortality and the improvement of maternal health in the organization’s millennium development goals. While the world has made significant progress towards achieving these goals, more work has yet to be done.

In developed countries like the United States and Australia, most pregnant women give birth in hospitals. But, tragically, pregnant women are not always routinely made aware that they have additional choices beyond the standard hospital birth. This is unfortunate, as women should all have the opportunity to consider their entire range of options and choose the one that will best meet their unique individual needs.

Birthing options can vary, depending on national and local laws and the local availability of relevant healthcare facilities and providers.

For many women, financial considerations also play an important role in the range of available options. If a particular option is unaffordable to the woman who desires it, it isn’t really a viable option after all.

For that reason, planning far ahead of pregnancy is beneficial, particularly for women who do not want a standard hospital birth that will be covered by either a families health insurance policy or universal healthcare (where available). Planning ahead allows for financial savings and the possibility of strategic relocation, either of which may be advantageous in some circumstances for a pregnant woman to enjoy the birth experience she truly desires.

The following are some of the most important points to consider when choosing your birth experience:

Hospital Births

In the United States, most pregnant women give birth in hospitals and are attended by doctors. However, women should be made aware that they also have the choice to be attended by midwives in a hospital setting. A fascinating film called the Mama Sherpas is helping to educate the public about the growing trend towards teams of medical professionals including midwives, doctors and nurses who work in tandem to provide care for women who desire this sort of birth experience.

Midwives and doulas may hold the keys to solving the black maternal mortality crisis.This is because these birth workers are on the front lines fighting for more equitable treatment of minority women in hospital settings.

As of right now, in the United States, it’s more the norm for out-of-hospital births to be the primary domain of midwives. So in the USA, it’s important for all women, but particularly minority women, to be made aware that they do have more options for midwife-centered care than they may currently be aware of.

Hospital births have many advantages but also some disadvantages. A primary disadvantage is that hospital birth tends to put women at risk of receiving medical interventions that are convenient (and lucrative) for hospital staff, but are not always necessarily in the best interests of women and their newborns. These can include episiotomies, vacuum extractions and inductions.Women absolutely need to be made aware that these are possible outcomes resulting from hospital birth, because the results of some interventions can be traumatic and long lasting.

Natural Birthing Centers

A natural birthing center tends to be an excellent option for low-risk pregnant women who would prefer to give birth in a safe environment that is less “clinical” than a hospital. Birthing centers tend to encourage freedom of movement for laboring women. Midwives are frequently the overseers at natural birthing centers, although birthing centers do often have doctors on staff, too.

Birthing center births are generally not appropriate for women whose pregnancies are considered high risk, or for those who choose to have pain relief via an epidural.

In the United States, birthing centers are broadly available. Many, but not all, states regulate the birth centers that operate within their borders. The New York Times has reportedthat birthing center births in the USA tend to be far less expensive than hospital birth, costing only half as much on average.

Birthing centers are also a viable option for low-risk women in the UK. However, their availability isn’t always guaranteed. In England, women’s rights advocates have been outraged over the National Health Services’ 2019 decision to close 8 midwife-led birthing centers.These closures have limited the availability of birthing center births to women in some British communities.

In Australia, there are limited numbers of hospitals that also include birthing centers.

Water Births

Water is one of the most effective ways for pregnant women to naturally relieve the pain associated with childbirth. Water births have therefore historically been popular with women who choose to give birth naturally, without chemical pain relief.

Water births can only take place in locations that are equipped for them; this has the effect of greatly limiting their availability. Some hospitals and birthing centers have the needed facilities to offer them as an option. Women who choose to birth at home also have the option to choose a water birth, because they can use their own bathtub or set up a wading pool in the backyard.

In the aftermath of COVID-19, authorities in some locations have been restricting water births. This has had the effect of limiting women’s access to water births and reducing their availability. Many midwives and feminist activists have protested these limitations, viewing them as being an assault against women’s human rights. Nevertheless, in the affected locations, these recent legal limitations leave women who desire a water birth with only one option: home birth.

Home Births

For a pregnant woman who wants to give birth naturally and with a minimum of medical interventions, home birth is a valid option to consider. While home birth has recently been controversial, there are multiple credible peer-reviewed studies revealing that it is a safe option for low-risk pregnancies.

In some locations, particularly the Netherlands and the UK, women who wish to enjoy home births have historically been supported in this decision by their governments.

However, in England, officials have been making recent decisions in the aftermath of COVID-19 that have had the effect of placing increasing limitations on the availability of home births. Approximately one-third of British maternity services have recently suspended their formerly active home-birthing programs. This reduction in access comes at a time when demand for home births is increasing. However, despite these limitations, home birth is still broadly available in England to many of the women who want it.

Unfortunately, women in many other locations face substantial obstacles to enjoying home births.

In the United States, there are states that are friendly to home births and others that make it challenging to legally give birth at home with a midwife.

In Australia, the universal Medicare system only supports an extremely limited number of publicly funded home birth programs. These, generally, are only available to women whose pregnancies are considered to be low-risk.

It is typical for laws in many regions to place restrictions on home births, effectively limiting their availability to women whose pregnancies are low-risk ones. In some regions, the law may require insurance that is simply unattainable to women who have high-risk pregnancies. This is because no insurer can be found that will agree to underwrite a policy considering the risks involved. In some areas, the law might place the burden of risk on the midwife, with the end result being that midwives practicing in that area are reluctant to assume that risk for fear of losing their license and their livelihood. 

Tragically, this lack of access to midwives is one of the reasons that freebirthing is becoming more popular. 

Freebirthing

Freebirthing is the extremely risky practice of giving birth without any assistance from a healthcare provider. In developed countries, where healthcare is readily available and women are generally affluent enough to afford it, this has not historically been a popular option; however, in the aftermath of the COVID-19 crisis, numbers of freebirths have been rising dramatically.

This is a disturbing and preventable trend that has many women’s rights advocates feeling rightfully outraged. The primary root of the problem is the fundamental failure of legislators to acknowledge that women – even those undergoing high risk pregnancies – should have both the legal right and the human right to make their own choices relating to their maternity care. The women who choose freebirthing are demonstrating that, if their rights are not supported within the system, they are willing to circumvent the system entirely, despite the very real risks that this decision exposes them to.

Studies in the UK, Australia and Norway have examined the reasons that women choose to give birth at home and, in some cases, to freebirth. Keep in mind that these women all have access to highly progressive universal healthcare systems where maternity care is provided for them; in that context, the dramatic global rise in freebirths seems like a puzzling trend.

Researchers at Western Sydney University conducted research that was published in the journal Women and Birth.Their goal was to understand “the characteristics, needs and experiences of women choosing to have a homebirth in Australia”.

They found that the majority of home birthing women wanted to give birth legally with licensed midwives; however, suitable midwives were frequently unavailable to them. In a majority of cases, this was because of pregnancy risk factors that excluded them from being able to participate in one of the country’s publicly funded home birth programs.

Another influencing factor for these women was traumatic previous hospital birth experiences. Significant numbers of them had actually been diagnosed with post traumatic distress syndrome after a previous birth.

Half of the study subjects indicated they were willing to freebirth or hire an unregistered birth worker to deliver their newborns as a result of these circumstances.

The researchers concluded that women are feeling compelled to choose alternative methods of birthing, including freebirth, because of fundamental flaws in Australia’s system of maternity healthcare. They uncovered the existence of a broad disconnect between the birth experiences that Australian women want and the experiences that their maternity health system actually provides for them.

Australia is not the only country where women face these problems. Flaws and inequities in the maternal healthcare system are abundant globally. We need to raise awareness of these issues and take action to prioritize maternal health in both developing and developed countries around the world.

The above options briefly summarize the most broadly available choices that are typically available to pregnant women for their birth experiences. If you’re pregnant or considering a pregnancy, it is worthwhile to make a conscious decision about which type of care would be best for you. It’s also beneficial to carefully research which of these options are available to you locally. If you plan ahead, you’re likely to enjoy a broader range of options.

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