Today, June 10, marks a landmark in reproductive rights and women’s sexual independence — the 50th anniversary of the debut of the Pill. Somewhat embarrassingly, my perspective of reproductive rights has always been largely self-centered, stemming from my own reproductive needs of the moment. From when I became sexually active until I became pregnant with my son, that was the need to avoid pregnancy.
A longtime committed proponent of access to sexual education and contraception, I view the abortion issue rather simplistically: Like it or not, abortions are going to happen; therefore, they must be kept safe and legal. My likely romanticized image of the sexual revolution of the 1960s is one of women finally being able to explore their sexuality without fear of pregnancy. For much of my life, these ideas and goals were things I believed in largely because they dovetailed so seamlessly with my own interests.
Only when my reproductive needs changed did my narrow-minded perspective broaden a bit. This is probably utterly obvious to everyone else, but I did not realize until my pregnancy and the birth of my son that reproductive rights include the right to choose not only whether to reproduce, but also how to reproduce.
The choice my husband and I made to pursue a midwife-attended homebirth was met with more opposition than we had expected. I was surprised how often it came up, usually when someone would ask which doctor or hospital we were using. Judging by people’s responses upon hearing our plans, one might think a midwife-attended birth was something radical and untested at best, if not outright deviant or dangerous.
On the contrary, midwifery is not a radical but in fact a traditional and time-honored medical profession, and midwife-attended births are backed by compelling statistics that made me want to have my child at home. Once I started looking at the numbers, it simply seemed safer. According to the Centers for Disease Control and Prevention, the risk of infant death is 19% lower in midwife-attended births — whether they occur at home, at a birthing center or in a hospital — than in physician-attended births. The national rate of Cesarean deliveries is currently at 32% and rising, despite the fact that the World Health Organization has set optimal Cesarean rates at around 5–10% of births (above which Cesareans veer into the territory of doing more harm than good). Another definition for “traditional” might be “exercising the conscious decision not to use limited resources needlessly,” and hospitals and medical care are certainly precious resources. With the vast majority of pregnancies and births being normal and complication-free, many costly medical interventions regularly used during labor and childbirth are both risky and unnecessary.
Here is a local example that is compelling to me: The wonderful midwife here in Austin who helped deliver our son has attended around 2,000 births, with a transport-to-hospital rate of about 3%. That means that, of those 2,000 births, some 60 have required transport to the hospital for interventions such as the use of medications, forceps or, in some cases, a Cesarean delivery; the other roughly 1,940 have been normal, safe, vaginal births. If her numbers matched the national Cesarean rate, she would have had a whopping 640 births resulting in Cesarean deliveries.
These issues come down to relatively simple truths, the basic differences between midwives and obstetricians. In the words of my midwife, midwives are “experienced in what’s normal,” trained to recognize when anything during pregnancy or labor deviates from the norm. Obstetricians, on the other hand, are trained in pregnancy-related illnesses and surgeries. It seems no wonder that the vast majority of midwife-attended births proceed without complications and result in normal, vaginal deliveries, while one-third of obstetrician-attended births end in major abdominal surgery.
Here is another unpopular reproductive choice I made: When our midwife recommended a sonogram at 20 weeks of pregnancy, as she recommends to all her clients, I researched sonograms and, based on my findings, declined. I did not want to expose my unborn child to potential harm if it was not necessary to do so, and from all indications, the baby was thriving. Besides, I felt I would continue the pregnancy no matter what a sonogram might reveal. My midwife and husband supported my choice. But most people who asked the right combination of questions to make me reveal, ultimately, that I had not had a sonogram looked at me as if I were a criminally or at least insanely neglectful mother-to-be.
Then, after an exceptionally healthy, happy, 41-week-and-four-day pregnancy, a beautiful, excited start to a homebirth and then a rushed transport to St. David’s Hospital, our son August died at birth of a birth defect we hadn’t known he had. It was a defect that could have been detected by sonogram, though it was not detectable by any other measure (his heart rate, growth, movements and neurological responses all seemed completely normal and healthy throughout the pregnancy; there was nothing that indicated anything was amiss).
In the months since August’s death, I have wrestled with a lot of guilt, much of it centered on that choice not to have a sonogram. Guilt is a strange beast in that it tends to trump truth and logic: It’s true that I based the choice in research, my desire to protect my unborn child, and my conviction that I would continue the pregnancy no matter what. It’s also true that not knowing August had a fatal birth defect made for an absolutely joyful pregnancy — and August himself was likely content and stress-free as a result. Still, even knowing those truths, and knowing August would have died no matter what, for months after his death I tortured myself with obsessive thoughts of what I “should” have done differently.
Thanks in large part to our incredibly supportive friends, family members and midwife, I have worked through most of that guilt. Part of working through it involved the realization that I was exercising my reproductive rights: In quitting taking the Pill, I was choosing whether and when to reproduce. When I got pregnant and we began interviewing midwives, we were choosing how we wanted our child to be born.
Once, a friend told me she believed every woman should get to choose the birth that is right for her. “Not me!” I blustered. “I think everyone should choose homebirth — it’s just so much safer!” Since then, fortunately, I have become more flexible on the subject. Another of my best friends just had her baby girl in the hospital, where she felt safest, with an epidural that helped her stay calm, relaxed and pain-free. Should she have had a homebirth instead? Of course not. She got to choose. If I am lucky enough to have another child, I will again choose a homebirth.
How wonderful that we have such agency in such personally important matters. Thank god we still have the freedom to choose.
Happy birthday to the Pill.