Rights v. Responsibility: A Critique of the Natural Birth Movement

Posted: Jan 14, 2015 12:01 AM
Rights v. Responsibility: A Critique of the Natural Birth Movement

Sociologist Mark Regnerus recently penned an essay for Public Discourse in which he discusses two competing understandings of human dignity. Dignity 1.0, as he calls it, "refers to the idea that humans have 'inherent worth of immeasurable value that is deserving of certain morally appropriate responses.'" This kind of dignity is essential. It precedes the individual. It makes demands upon us. When a person acts "undignified," it is this first kind of dignity that they have violated. Dignity 2.0, on the other hand, "entrusts individuals to determine their own standards." This kind of dignity is the kind that results from "being true to yourself." It is a product of individualism; a byproduct of authentic expression that answers to nothing and no one outside itself, consequences be damned.

I found myself thinking on this distinction when I came across an article discussing a new reality television series called "Born in the Wild," which will document the experiences of women who choose to give birth unassisted and outdoors. According to a Lifetime network executive, "These are all people who have already had babies in hospitals who had unsatisfying experiences and who are choosing to have different experiences. This is something people are doing and we set out to document it."

He is correct. This is something people are doing. In the past decade or so, there has been a small but statistically significant move away from hospital birth towards midwife-assisted home birth. It has become a powerful and persuasive movement, particularly among middle to upper class white women. I do not doubt the sincerity and best intentions of women who choose this route, but I do believe that it is a misguided and reckless choice based upon the wrong motives. This trend is only possible in a culture that views motherhood through the lens of Mark Regnerus's "Dignity 2.0" paradigm, instead of viewing childbirth as a profound responsibility in which the health and welfare of the baby is of primary importance.

For the women who choose to give birth at home, childbirth is viewed in highly romantic, almost mystical terms. I'm guessing this is because modern women (here I am referring to women of socioeconomic privilege in the industrialized world) are several generations removed from the bloody, brutal experience that childbirth once was. Contrary to the propaganda distributed by leading natural birth advocates, childbirth is not safe. As Slate's Health and Science editor, Laura Helmuth reminds us, "Bearing a child is still one of the most dangerous things a woman can do. It’s the sixth most common cause of death among women age 20 to 34 in the United States." And no, this is not because of unnecessary interventions, as the natural birthers would have us believe. If that were the case then more women, not less, would be dying in childbirth, but the opposite is true. Thanks to advances in modern obstetrics, there has never been a safer time to give birth in the history of humanity. Nonetheless, childbirth is still a very dangerous business. More from Slate's Laura Helmuth:

"In the United States today, about 15 women die in pregnancy or childbirth per 100,000 live births. That’s way too many, but a century ago it was more than 600 women per 100,000 births. In the 1600s and 1700s, the death rate was twice that: By some estimates, between 1 and 1.5 percent of women giving birth died. Note that the rate is per birth, so the lifetime risk of dying in childbirth was much higher, perhaps 4 percent."

These are irrefutable statistics that women and their partners should take seriously. As much as we may wish to believe otherwise, it is foolish to "trust birth" simply because it is a natural biological phenomenon. Yes, birth is magical and birth is beautiful, but birth can also be quite deadly. It is an extremely complicated physiological process that can go wrong in countless ways. Women who fall victim to the ideology of natural birth ignore this at their and their child's peril. But we live in the age of Dignity 2.0, and these women want to preserve their dignity. They want to be "entrusted to set their own standards." They insist on being completely in control of their birthing process. They don't want to be attended to by strangers and they don't want their labor and delivery guided by predetermined time tables and protocols. They want a personalized experience, on their timeline, on their terms.

The type of women who advocate for natural birth rights rely upon the same kind of sentimental, subjective rights language employed by abortion advocates and their disciples: A woman has the right to choose! To choose whether or not to allow her child to live, and to choose how that child will be born into this world. No one has the right to pressure a woman to do something she doesn't want to do, whether it is keeping an unwanted child, or submitting to a medically-indicated C-section delivery or induction. Everyone and everything must defer to the woman's wishes, period, up to and including her unborn child's very life. A midwife in Australia said as much after she was implicated in the deaths of multiple home-birthed infants. Each of the infants was known to be in distress or at risk of complications and yet the midwife allowed the home births to continue instead of transporting her clients to the hospital (which, had she done, all three babies would have lived). In an interview with investigators, "Ms Barrett told the court that although she gave consideration to the unborn baby, ultimately the woman had the right to choose how she gave birth. She supported women who wanted a home birth, no matter the risk."

A tertiary review of prominent natural birth advocacy websites echoes this attitude. There is a lot of talk about maternal empowerment co-mingled with a hefty sprinkling of New Agey mantras like "trust birth" and "birth without fear." There are feature stories of successful breech deliveries, vaginal twin deliveries, VBACs in the bathtub, you name it. Ubiquitous is the denunciation of the patriarchal medical system that seeks to rob women of their preferred birthing experience through the imposition of impersonal protocols and arbitrary timetables. Seemingly endless are the accounts of premature inductions and coerced C-sections, horror stories told by women who are positive that they would have given birth safely and naturally had they only been given the chance.

The only problem with this narrative is that it's completely bogus. These women have no way of knowing what the outcome would have been for themselves or their child had the doctors allowed nature to take its course. Perhaps everything would have been fine, but history paints a very different picture. So why would any responsible mother choose to forgo all the life-saving medical benefits that 21st century medicine has to offer? Why would she take a chance with her child's life and health? Is it pride? Ignorance? Selfishness? The classic "it could never happen to me" fallacy?

Natural birthers are quick to demonize doctors and nurses. They are impersonal and cold! They don't listen to women! The list of complaints goes on and on. Frankly, this is sometimes the case. Poor bedside manner is a legitimate problem. Not every medical provider is good at empathy, but then again, this is not their primary job. Doctors are legally bound by an oath of great responsibility. They are committed first and foremost to "do no harm." This doesn't mean "do no harm" to the mother's pride, or "do no harm" to her rigid and idealistic birth plan. It means "do no harm" to the life, health, and safety of the patients under their care. Doctors make decisions based on what course of action is likely to result in the best possible outcome. Their decisions are not made arbitrarily; they are best-practices policies backed up by statistical data. So when, for example, a doctor determines that a C-section is "medically indicated" it means that the risks associated with delivering the baby surgically are statistically lower than the risks associated with allowing the mother to continue laboring vaginally. The mother might be worried about her "birth experience" being ruined; the doctor is worried about cerebral palsy, placental abruption, intrapartum hypoxia, hypoxic ischemic encephalopathy, and a host of other complications that can occur when a woman labors too long without medical intervention. These are not figments of the doctor's imagination. They are the kinds of things that used to kill women and their babies in great numbers and will still kill them today if medical intervention doesn't occur.

In an age where most hospitals bend over backwards to accommodate the wishes of laboring women, including most if not all of the home comforts so often cited by natural birth advocates – birthing tubs and soft beds and lighting and music and doulas and midwives and immediate postpartum skin-to-skin contact, etc. – it's ludicrous and offensive that more and more women are swallowing the natural birth propaganda and taking such grave risks with the lives of their unborn children. What's more, it's a terrible insult to the memory of so many mothers who have come before, who gave their lives in childbirth because they weren't lucky enough to live in a time when most if not all childbirth complications are medically avoidable. It's a terrible insult to women all across the world today who would kill for the chance to give birth in a sanitary, safe, state-of-the-art medical facility but must make do in primitive conditions and hope for the best.

This trend is only the latest symptom of a culture that worships at the altar of the self: self-empowerment, self-actualization, self-determination... all unmoored from any sense of obligation or duty to greater goods. Motherhood is one of the most profound offices that a human being can hold. It requires a level of selflessness and sacrifice that few other human endeavors can match. Women should not wear this mantle lightly, and they should not eschew their responsibility to do everything in their power to protect their children, including educating themselves about the very real dangers of home birth complications and making a responsible decision about how, where, and under whose supervision they are going to labor and deliver.