A Hospital Birth Doesn't Have to be Dehumanizing

My parents love to tell the story. 

How, while in active labor, my mom—a medical doctor, giving birth at home for the fourth time—told her midwife not to hurry. How, in between contractions, my mom turned to my dad and said, “Wayne, I think you’d better go wash your hands.” How my dad gripped the bathroom sink and swayed dangerously, trying not to pass out at the thought of this unexpected duty. How he was the one who caught me. How he gazed into my eyes in the quiet, otherworldly moment of calm after my head had emerged but while my body was still inside my mother’s womb. 

This was the vision of birth that I grew up with: beautiful, intimate, natural, and sacred. I still believe that birth can and should be all those things. But after having three children of my own, I know that our medical system makes this almost impossible. 

The Technocratic Model Hurts Women

Today, too many obstetricians are more worried about legal liability than women’s holistic well-being, and too few providers will turn away from the screen to actually encounter the woman in front of them. Electronic medical records, contraction monitors, blood pressure cuffs—these are all excellent sources of information. But when it comes to birth, an obsessive focus on quantifiable data can hurt more than it helps.  

Anthropologist Robbie Davis-Floyd opens her groundbreaking 1992 book, Birth as an American Rite of Passage, by observing that, at first glance, it seems as if there is “no society-wide spiritual or humanistic rite of passage to initiate newborn mother and child into American life.” Look closer, though, and a hidden set of rituals appear—rituals that are “more elaborate than any heretofore known in the ‘primitive world.’” The hospital gown. The invasive pelvic exams. The IV. The fetal monitor. The epidural. The pressure to give birth on your back, with your feet in stirrups. “These rituals, also known as ‘standard procedures for normal birth’ work to effectively convey the core values of American society to birthing women,” writes Davis-Floyd.

So what do our labor and delivery practices teach new mothers about “the core values of American society”? Why do so many women feel forced to choose between being treated as a human being and having access to lifesaving interventions? 

One in eight mothers report being mistreated by healthcare providers during childbirth. With such high rates of c-sections, maternal mortality, and trauma from past births, perhaps it’s unsurprising that a growing number of moms are opting out. CDC data indicate that rates of homebirth are rapidly rising (from 29,592 in 2016 to 46,183 in 2022). 

It can be difficult, though, to find a skilled and competent homebirth provider, such as an certified nurse-midwife (CNM). Too often, women are forced to choose between a huge, dehumanizing OB practice, or a lay midwife, whose education and training varies widely. Our country’s confusing, contradictory mess of state laws nudges many lay midwives to practice under the radar, and legal concerns may make them hesitant to transfer women to the hospital if complications arise. 

Why do so many women feel forced to choose between being treated as a human being and having access to lifesaving interventions? 

Some women decide to refuse all prenatal care and plan unattended “freebirths.” They take their safety and that of their babies into their own hands, believing that this is a small price to pay for a “sovereign birth.” Midwives turned influencers and spiritual gurus assure women that their bodies “were made for this.” But what if “this” is giving birth after a c-section, to breech twins or far-overdue babies, at home, alone? 

Yes, we should reject data-driven dehumanization, but we need not swing all the way to the other end of the spectrum. The technocratic and holistic models of birth are not our only two options. As Davis-Floyd rightly argues, a humanistic vision of birth can and should be integrated with evidence-based medicine. 

My First Birth 

I know what it’s like to have a traumatic birth, one that leaves you wanting out. Yet after my first daughter was born, the story I told myself was one of strength—a narrative of victory against a system that was stacked against me. 

At my 38-week appointment, after several high blood pressure readings, the brusque midwife in charge laid down the law. The rules said it was time to induce—today. I tried to tell her that my blood pressure was much lower at home. I tried to discuss my very low Bishop score (which indicated that my body was not ready for labor) and my urine and blood tests (which showed no sign of pre-eclampsia). I tried to convince her to let me wait until 39 weeks, when outcomes for babies are better and the chances of a failed induction ending in a c-section are lower. She would have none of it. 

Finally, I agreed to go to the hospital—not to be induced, I emphasized, but for out-patient monitoring, to check on the baby. There, a kind nurse squirted goo on my round, stretch-marked stomach and positioned the fetal monitor. “Just look at that,” the nurse said to me. “That’s a beautiful strip—straight out of a textbook. That’s exactly what you want a fetal heart tracing to look like.” I felt reassured. 

But when I tried to leave, things suddenly changed. The head midwife had lied to me. At her instruction, without my realizing or consenting to it, I had been admitted to the hospital. If I wanted to go home, I had to check myself out of the hospital AMA (“against medical advice”). I was forced to sign paper after paper certifying that I wouldn’t sue if my baby died or developed the disabilities the forms described in graphic detail. I had to stand up to not just the midwife on call, but a parade of intimidating OBs I had never met before. 

Over and over, I told them no. I am not consenting to induction today.

Eventually, after leaving the hospital and going off the grid for several days, I did consent to be induced. The day I hit 39 weeks, as my at-home blood pressure readings were creeping up and a huge snowstorm was rolling into town, I checked myself into the hospital. 

The induction took more than 48 hours. During that time, I was cared for by a rotating cast of nurses. Some were lovely. Some—like the one who told me to “throw my birth plan out the window”—were not. Nearly all of them seemed confused and annoyed by my insistence on making them fiddle with the unreliable wireless electronic fetal monitor so that I could walk the halls of the maternity ward, pushing my rolling IV, encouraging the contractions that kept coming and going to come and stay. They didn’t understand why I wouldn’t just stay in bed like a good patient.

At long last—after laboring all day, on my third push, with the Pitocin turned up to 11—my baby came bursting into the world with such force that no one caught her. She landed on the end of the bed, coming to rest briefly on the shiny metal tools laid out by the nurses before she was scooped up and laid on my chest. 

I was so exhausted that I couldn’t even open my eyes, let alone lift my head to look at my child. But I had done it. 

In the months that followed, I repeated my victory story like a mantra. I did it. I gave birth on my own terms. I didn’t let myself be intimidated. I made informed, evidence-based decisions. I persevered, and I didn’t let the pressure or pain get to me. I gave birth without an epidural. I am strong. It was a happy story. But after I got pregnant again, as I sat in my amazing new midwives’ office, I started to cry. I cried with fear that I hadn’t realized I felt. I wasn’t afraid of labor, which I had loved, in spite of the pain. I was afraid of having to fight so hard again, of having to stand up for myself and my baby that way again, of being at the mercy of people I didn’t trust again… 

I was afraid of giving birth in the hospital again. 

When medical professionals present total adherence to one-size-fits-all protocols as the only option, they risk pushing women toward the other dangerous extreme.

The Way Forward

Despite my fear, I continue to give birth in the hospital, because I believe that it is the safest place for me and my babies. I have a history of severe postpartum hemorrhage, and I am thankful for the medications that have repeatedly saved my life. Yet my gratitude doesn’t erase my anger at a system that fails to respect the autonomy and personhood of pregnant women. 

When medical professionals present total adherence to one-size-fits-all protocols as the only option, they risk pushing women toward the other dangerous extreme. Yes, there is a stark contrast between technocratic and holistic approaches to childbirth. But the division between hospital and homebirth doesn’t have to be so stark. Indeed, the rise of the natural childbirth movement led to significant changes in standard obstetric procedures in American hospitals. There’s been a lot of progress since the days of “twilight sleep” and routine episiotomies. Still, there’s more work to be done. 

To begin, insurance companies should cover both home and hospital births attended by independent practices of certified nurse-midwives, and hospitals should welcome these birth professionals. Such practices—like the wonderful midwives I saw with baby number two—offer women the best of both worlds: birth attendants with extensive medical training, and the wisdom to know when not to use it. Doulas, too, should be covered by insurance. Research shows that their presence dramatically improves outcomes for laboring women and reduces costly medical interventions.

Even better: medical schools and teaching hospitals should consider partnering with local CNMs so that doctors-in-training can observe homebirths. Currently, only 4.2% of out-of-hospital births are attended by physicians. With maternity wards being shuttered in rural areas across the country, for low-risk women, a home birth with a family physician might be a better choice than a hospital birth with an OB hours away.

This type of collaboration would require a radical shift, but it could have incredible benefits for both patients and providers. Seeing uninterrupted, low-risk, physiologic births—within a woman’s own home and on her own terms—could remind both doctors and midwives what a normal, low-risk birth can and should look like. And regularly attending hospital birth allows midwives to develop strong working relationships with doctors and nurses, which makes coordination and transfer of care much easier when complications arise. 

It shouldn’t be so hard to have a positive, empowering, safe birth in America. For too long, American mothers have been stuck with birth rituals that impart a deeply flawed and harmful set of cultural values: presenting the laboring mother as an ill patient who must be saved, the doctor as the unquestionable expert on women’s bodies, and quantifiable data as more important than personal encounter.

It's time for doctors, midwives, insurance companies, and hospital administrators to work together to create a maternal medical system that respects women’s personhood—not just the bottom line.

Serena Sigillito is a writer and the editor of Fairer Disputations. Her work has appeared in outlets like Newsweek, America, National Review, Verily, First Things, and The American Conservative.