“With my nurse, it wasn’t about health or safety. It was a power struggle.”
“The doctor said if I didn’t agree to a c-section, she would dislocate my baby’s shoulders.”
“The midwife shouted angrily, ‘I’m in charge here!’”
“I didn’t know I could complain. They told me it was all my fault.”
As a journalist and maternal health advocate, I listen to people talk about childbirth. The language, usually flawed and often disturbing, is everywhere: at school drop-off, from health-care providers, on social media. The stigma and silence around birth and birth trauma have become so normalized that most people do not realize the impact of their words. Others should know better. Julie Satow’s recent New York Times article, “Why New York Lags So Far Behind on Natural Childbirth” exemplifies how news outlets can perpetuate damaging language around birth. The article’s terminology and tone reflect a mischaracterization of the current crisis in U.S. maternity care, and they reinforce cultural attitudes that shame and misinform birthing people.
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Certainly, Satow is correct in pointing out that the closure of hospital birth centers is contributing to a lack of childbirth options that is especially stark in New York state. And as Dr. Laura Zeidenstein says in the piece, media outlets are finally discussing “racial disparities, high maternal and infant mortality rates, [and] the disrespectful treatment of women in obstetrics,” which is a positive step forward.
But the phrase “natural childbirth,” which Satow uses throughout the article, is an outdated term that is indefinable, offensive, and does not apply to modern maternity care. Patients may prefer to have vaginal births, unmedicated births, or births without medical interventions such as pitocin augmentation or episiotomies. But this does not make them “natural”; nor are births that require interventions or cesarean section surgery “unnatural.” How should we judge what constitutes a “natural” birth? If a woman has an ultrasound? If she uses a fetal monitor, required in many U.S. hospitals? If she receives antibiotics because she is running a fever? If she needs treatment for gestational diabetes? If she takes a Tylenol?
Birth is a physiological event, but the term “natural,” meaning “derived from nature,” serves only to imply that a certain type of birth is superior.
This attitude is apparent from the opening of the New York Times article, where we learn about Lisa Binderow’s appalling childbirth experience at New York’s Mount Sinai Hospital. According to Satow’s reporting, Binderow was forced to labor in a tiny triage area on a bed with no mattress and before giving birth in a storage room. Placing this disturbing account at the beginning of an article about “natural” birth centers has a distinctly misleading effect. It equates Binderow’s traumatic experience with the fact that she was denied access to Mount Sinai’s birth center, where she had apparently planned to give birth “naturally.”
To be clear, Binderow’s experience was abusive and unacceptable. But it is medical negligence, unrelated to the type of birth Binderow preferred to have.
This false connection between “natural and fulfilling,” as opposed to “unnatural and traumatic,” effectively labels the growing movement for respectful, evidence-based maternity care as people who all want “natural” births, which is untrue. The evidence is clear: People are traumatized by how they are treated by hospitals and health-care personnel, not by the type of birth they have. The movement for human rights in childbirth is not a “natural birth” movement. Instead, it simply demands that birthing people should be treated like autonomous human beings with the ability to make informed choices about their health care.
The final quote in the article, “a natural birth should be every woman’s right,” is similarly misleading. “Natural birth” is not, in itself, a right. All birth preferences should be respected and supported. But the physical reality of labor, if accurately and truthfully assessed by medical staff, may require intervention, or those preferences may change. This should not be portrayed as a failure on a woman’s part or a violation of her rights.
Claiming the “right” to a certain type of birth is a bit like claiming the “right” to keep your appendix. Your appendix lives inside your body, and you alone should make decisions for it. If you and your appendix are healthy, attempting to interfere with it is unnecessary and possibly dangerous. If you are one of the approximately 280,000 people who develop appendicitis every year in the United States, keeping your appendix could be life threatening, and you would probably choose to have it surgically removed, although no one could legally force you to do so.
But what if you showed no evidence of appendicitis, and yet someone held you down and removed your appendix without your consent? What if they threatened that you would be charged with a crime unless you allowed them to take out your appendix, or obtained a court order to compel you? What if they insisted that by entering the hospital you had already relinquished your right to consent? What if they removed your appendix because it was convenient and then falsified your records to show a medical necessity? What if they performed the surgery and then ignored your urgent medical symptoms for hours until it was impossible to save your life? This is the reality that many, particularly women of color, face in U.S. maternity care every day. There are 700 to 900 maternal deaths every year and over 50,000 near-deaths, often with permanent health consequences. While it is difficult to link the data to specific procedures or interventions, researchers estimate that more than 60 percent of these deaths could have been prevented.
Before you shriek, “A baby is not an appendix!” let me be clear. For a laboring person, a baby’s life truly being at risk might outweigh all other considerations. I use this analogy simply to illustrate that a pregnant patient has not forfeited the rights that any other patient exercises without question.
As a pregnant person, you have rights in childbirth. They include human rights defined by the World Health Organization; civil “patient’s rights,” which can vary by state; and criminal assault and battery laws. You have the right to scientifically accurate, evidence-based health care. You have the right to informed consent and to refuse any medication or procedure. You have the right to equal treatment, without discrimination based on race, ethnicity, religion, age, weight, sexual and gender identity, socio-economic status, or marital status. And you have the right to basic human decency.
Sending pregnant people into hospitals believing that their rights begin and end with “natural birth” does them a great disservice. If a medical issue alters your plans for a specific type of birth, you still have options for your care. Decision-making power still rests with you, and there is still no excuse for abuse, disrespect, or medical malpractice. Failing to empower pregnant people with these facts can only delay the changes in our maternity care system that are desperately needed, the consumer-driven movement that will insist on ethics and accountability.
Let’s start by calling births what they are: vaginal or cesarean. Let’s present all pregnant people with factual, evidence-based, medical information on which to base their maternity care choices. Let’s provide options and support for every birthing person’s preferences, whatever those might be. And let’s stop using the phrase “natural birth.” However you bring your child into the world, you are entitled to be treated with respect, compassion, and dignity. If you were not, know that you are not alone. And I am listening.