Natural childbirth is much, much more than a Brooklyn fad

It's not just about home births. Midwives in hospitals can reduce costs and save lives.

(Image credit: (Ian Hooton/Science Photo Library/Corbis))

If you thought watching Ricki Lake give birth in a bathtub was too tame for television, Lifetime has the show for you. Born in the Wild is a forthcoming reality series that will follow a handful of women who claim to be giving birth in the most "natural" way possible — alone, in a forest.

In the couple of weeks since Lifetime announced its new lineup, a clear consensus has emerged: Only the producers of Born in the Wild think their show is a good idea.

But there's less agreement about whether Lifetime is merely capitalizing on the success of a YouTube video showing a woman delivering a baby beside a creek, or whether the show is, in the words of Elissa Strauss here at The Week, the "natural extension of a culture that has turned labor into a defining moment in women's lives." Strauss blames the "Brooklyn birthing culture," the province of wealthy women who demand midwives and birthing tubs in lieu of the good old-fashioned epidural, for shaming women who want painkillers during delivery or shudder at the idea of developing a "birth plan." She's not alone. At RH Reality Check, Martha Kempner worries that the show "will perpetuate the idea that 'real' women give birth without modern medicine."

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When the movement for "natural childbirth" — essentially, the push for fewer medical interventions during labor and delivery — makes its way into the media, it's usually because a celebrity has decided to talk about it. Or we hear about "natural childbirth" after a home birth goes terribly wrong. This skews the way we think and talk about the movement for reforming birth, which is ultimately about giving women more choices and improving their health. Last week, The Lancet, a leading medical journal, published a series of papers on the need for global investment in midwifery. This is especially true in the United States, where maternal care is the most expensive in the world.

Midwives are trained to attend and deliver low-risk births, where the chances of complications are low. They offer prenatal and postpartum care, and are often accompanied by birth doulas, non-medical assistants who serve as a kind of labor coach, providing support to mothers throughout labor and delivery. (Full disclosure: I am trained as a birth doula.) If there's confusion about what a midwife's role in birth should be, that's partially because there are several different kinds of midwives. Certified nurse-midwives are registered nurses with an extra two years of midwifery training who rarely deliver babies at home. Certified professional midwives, by contrast, aren't required to have medical training. Many are unlicensed, and they almost exclusively attend home births. It's the latter category of midwife that's attracted most of the negative press; after a baby delivered by a certified professional midwife in Oregon died last year, the state cracked down with new licensing requirements for home birth midwives.

Demand for both kinds of care is rising rapidly. Between 1990 and 2009, the number of births attended by a certified nurse-midwife doubled, from 3.3 percent of all births to 7.6 percent. Home birth is still quite rare (less than one percent of women will give birth outside a hospital), but the numbers are also increasing. Between 2004 and 2009, home births increased by 29 percent.

Home birth may be trendy among the New York elite, but most midwives work in hospitals, where painkillers are readily available. The women who choose these midwives aren't engaging in some kind of childbirth competition; they're justifiably worried about entering a medical system where induced labor, vaginal cutting, and cesarean sections are common.

Often, such interventions aren't medically necessary. The number of c-sections in the U.S. is twice as high as the World Health Organization's recommended rate. Far from improving mothers' health, there's evidence that doctors' reliance on c-sections is part of the reason why the U.S. has the highest maternal mortality rate in the developed world. Sometimes women request c-sections, but other times, they're performed because they're convenient for the doctor. There's a reason why the number of surgical births rises sharply just before holidays, and why Sunday is the slowest day for deliveries: doctors turn to c-sections when they want to end their shift. Obstetricians also make more money when they deliver a baby by c-section — one of the perverse incentives of a reimbursement system that compensates doctors for surgeries.

In other countries, like Britain and the Netherlands, midwives perform most prenatal exams and attend low-risk deliveries. Obstetricians are seen as specialists who intervene when complications arise. The result? Fewer tests and surgeries, and a lower bill.

But although the Affordable Care Act mandates that all insurance plans include maternity care coverage — a huge step, considering that only 12 percent of plans covered it previously — they won't be required to cover midwives. Nor will they be compelled to pay for birth doulas, nonmedical birth assistants who have been shown to substantially reduce the risk of complications. If wealthy white women are the ones who are primarily taking advantage of midwives' care, it's not because lower-income women couldn't benefit. It's because our insurance system doesn't let them.

Strauss and others argue that Born in the Wild is the extension of a dangerous myth — that giving birth unassisted is somehow more "natural" than a hospital. But kooky reality TV programs like My Strange Addiction or Bridalplasty aren't known for inspiring legions of copycats, nor do they necessarily reflect broader social trends. There's no reason to take Born in the Wild more seriously than any of Lifetime's other offerings. We're talking about a network that just greenlit a dental makeover show that aims to "fix people's lives by fixing their teeth." We shouldn't be worried about whether women will reject modern medicine when they give birth — the danger is that our medical system is making harmful decisions for them.

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