Dear Friend,

If you’re reading this, it’s because I care about you, and I want you to rock your birth. I believe you deserve the best. If “rocking your birth” sounds like something other people do and you just want to “get through it” with a healthy babygirl, raise your expectations. You’re both too valuable to whiff on this one. If this is your first baby, it’s even more important, because it will set the tone for your future births and may determine your options for the rest of your life.

Please don’t feel judged that I’m sending this to you or like I’m trying to tell you how to do things. In fact, I don’t care how you give birth — that’s your business. But because I care about you and this incredible journey you are on, you have to know you’re facing a system where great maternity care is a gamble for most women. Nine in ten women lose that gamble.

I’m not trying to scare you — I’m trying to power you up. I want you to learn from my experience and from what I’ve picked up from other women who have gone through this — good, bad, and ugly. I don’t ever ever want you to say, “If only I’d known….!” about your pregnancy and birth.

I’m going to lay it out for you here, so get ready.

. . .

#1 You Are in Charge


Now is not the time to “wing it” or let anyone else take over, including your care provider. This is Step #1 to becoming a mother, when you will be making all kinds of decisions and will be asked to do all kinds of things that are outside your comfort zone and that you may feel completely unprepared or unqualified for. That’s okay.  Put on your Game Face, because this is one of life’s all-time best learning and growing opportunities.

When I switched care providers at 41 weeks, 6 days pregnant, I believe that’s when I became a mother. Until then, I’d been floating along, doing my best to advocate for myself while also getting along with my care provider, who I actually really liked. When I decided to switch from her to someone else, I was choosing my baby over everyone else: over that provider, who had been so sweet and nice to me; over my family, who would surely call me “high maintenance” behind my back; and over my friends, who already thought I was crazy for wanting a natural birth. But I didn’t feel 100% safe with her, and I knew that’s what my baby and I deserved.

I can’t say this enough: this is your show. It’s your body. It’s your baby. You are responsible for the decisions you make, and you will bear the consequences – good or bad – for any decisions made about your care. There are a few ways this can go: it can be traumatic and life-changing in a bad way; you can “get through it” just to get to the other side with some minor complications; or you can grab the bull by the horns and do everything possible to make it the safest, most positive, most life-affirming experience you’ve ever had, and something that will make you love and respect your own body in a profound new way.

Childbirth is unpredictable, but that is all the more reason to prepare for it and embrace it.  You will never have another chance to give birth to this child.


Photo Credit: DFW Birth Photographer /

. . .

#2 Education


“Unlearning” about birth is almost as important as learning about it. There’s so much inaccurate, outdated information and so many negative messages out there, you kind of have to start from scratch. Accept that a lot of what you think you know is simply not true. We live in a country where 1 out of 3 births is by surgery, and many of those surgeries are “emergency,” even though optimal care says that the majority of women could give birth safely without medical interventions and without complications. We create a lot of emergencies in the U.S. (How many of your friends have had unplanned c-sections?)

Do not waste your time on What to Expect and general pregnancy websites. Most are full of outdated and conflicting information. Don’t even think about taking the “childbirth class” at the hospital.

Do start with Birth Book by Steve and Sarah Blight. It’s easy to read and high quality.

Do get over and watch The Business of Being Born. Today. Right now. (It’s on Netflix, too.)

Finally, get in a good, reputable childbirth class outside of a hospital. This is an amazing process and the more you know, the less there is to fear.  Education is power.

. . .

#3 The Thing About Routine Birth


I’m going to skip you ahead a few steps here.  When you start researching and really learning how awesome birth can be–and not some emergency horror show like you see in the movies–and when you start formulating a plan for how to make birth the safest it can be, you’re going to find that what most places provide for care doesn’t match up to what your research shows as most beneficial and least risky for you and your baby.

Here’s a (really long) example:

>  Evidence-based care for you means freedom of movement, freedom to eat and drink as you like, intermittent auscultation to monitor your baby’s heart rate during labor, one-to-one continuous support by someone who is educated in childbirth, water immersion for pain management, privacy so you can focus, no vaginal exams during labor unless there is a specific reason for it or you want to know your dilation, and freedom to push in whatever position feels comfortable to you.  It includes interventions when medically necessary and not before, and, if medical interventions are recommended, full and accurate information on their risks, benefits, and alternatives, and support of whatever decision you make.  It also means that labor and pushing go as long as you feel comfortable and you and baby are doing fine.

>  BUT Routine hospital care usually looks more like: strapped into bed with belts for continuous monitoring of your baby (this kind of monitoring has an over 99% false positive rate), no food or drink allowed (they might give you ice chips), no one-to-one support, maybe a tub for water immersion, but you can’t get in if you’re on monitoring belts, an automatic IV into your hand that hurts and makes it hard to move, lots of interruptions by people wanting to give you vaginal exams (that usually serve absolutely no medical purpose, but increase your odds of infection down there), and constant pressure to “hurry things along” with medication or “give you a break” with an epidural.  It’s unlikely that anyone will tell you the significant risks of medications that speed things up (Pitocin causes fetal distress, which is a #2 cause of C-sections) or the downsides of an epidural (primarily, that you won’t be able to move around to get baby positioned better, which makes it much harder for him or her to descend through the birth canal and can result in a need for episiotomy/forceps or vacuum or even surgery!).

You are free to choose any of these things!  There is no judgment here.  The thing is that most women don’t choose these things–they’re just done to them–or they “consent” without all the information about what’s being done.  I don’t want that to happen to you.

So what’s a girl to do?

. . .

#4 Get a Damn Doula


Have you ever cut your hair yourself?  It might turn out okay, but then you get it done at the salon with the hypnotizing head massage and the mysterious, magical products and the blow-out-you-can-never-replicate and you realize, yeah, that was better with professionals.  That’s kind of what doulas are to birth.

Doulas are trained to support women in continuous, one-to-one support throughout pregnancy and childbirth, and their use is strongly supported by science, including new guidelines from the nation’s obstetricians that call doulas “one of the most effective tools to improve labor and delivery outcomes.”  They will answer your questions if you’re having heartburn at 28 weeks or refer you to a great chiropractor if your hips hurt, and help you create a birth plan; during labor, they will gently help you get in different positions, encourage you, inform you about what is going on, bring you snacks, and let your partner have bathroom breaks so s/he can stay comfortably by your side when you want her/him.  If you or your partner is wondering what a doula does, read this.

But they are so much more than just a luxury.  They really, truly, are a safety measure. Look at these stats!  Look at the decrease in the risk of C-section!


More at:

More at:

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Doulas can also help you with #5 “Best Provider Ever” because they work together with many different providers and see how they practice!  They know if Dr. A tends to be more patient with first-time moms, or Dr. B’s bedside manner sucks during birth even after being so laid-back during pregnancy, or that the nurses at Hospital C are exceptional.  Hospital cultures are VERY different, and doulas can help you figure out where you’ll have the best shot at the safest, best birth possible.

. . .

#5 Best Provider Ever


Every provider is different, and research shows that the #1 determinant of whether or not you end up with a C-section isn’t you–it’s your provider!  That’s saying something.

Know that your options include obstetricians, family doctors, and midwives.  This is significant, because the U.S. is unusual in that we send low-risk, uncomplicated pregnancies to surgeons rather than normal childbirth experts: midwives.  Midwives specialize in preventing complications, including surgerySpeaking of, don’t be shy about vetting your provider.  What is his or her rate for Cesarean section?  What about episiotomy and other common but usually unnecessary interventions?  This is your vagina we’re talking about.  You have a right to know.

Know that whomever you pick owes you the best.  If you’ve done your research, you have an idea of what to look for.  If you hear things like, “You’re not allowed” or “We can’t let you,” — if you are getting any of these “red flags” — please, take your business elsewhere, to someone who will treat you like a competent adult.

(Remember that your local birth professionals are a GREAT resource for insider info on how providers practice!)

. . .

#6 You don’t have to go to a hospital


If you’re a healthy, low-risk woman, birth centers are a stellar option: comfortable, high-quality, family-centered care with a Cesarean rate of approximately 6% and a less-than-2% urgent transfer rate (for either mother or baby) with no adverse health consequences compared to hospitals. More here.

Home birth is another option that more and more women are taking advantage of, as they recognize the benefits of truly supportive one-to-one, individualized care and avoiding the routine risks of a hospital.  The acceptance of home birth as a legitimate health choice makes it more safe in some places than others.  If you’re open to this possibility, do some homework and see if it’s a fit!

. . .

#7 Know Your Rights


Most women are totally unaware about what their rights are or why they’d ever need to know them.  Pregnant women have the same rights as everyone else, but women are very often treated as if they’re in a special category because they’re pregnant.  Legally, you are entitled to informed consent and refusal: a full discussion with your care provider about the risks and potential benefits of anything they are suggesting, and about your alternatives, with the right to say “no” to anything.  You’ve got to know your rights if you’re going to use them!

. . .

Once again…

Birth doesn’t have to suck.  Keep your expectations high and do the work to have those expectations met.  Don’t let anybody convince you that you need to step aside for your baby.  You need to step up for your baby. 

I’m rooting for you in this once-in-a-lifetime process.  I know you can rock this thing.

Author Cristen Pascucci is the former Vice President of ImprovingBirth and is the founder of Birth Monopoly, co-creator of the Exposing the Silence Project, and executive producer of Mother May I?, a documentary film on birth trauma and obstetric violence.  She is dedicated to promoting the rights of women in childbirth.

Want more must-know info like this from Cristen Pascucci?  Check out The Empowered Consumer: 3 Things Every Parent Needs to Know About Hospital Birth.  It’s a compact 30-minutes course for any parent planning a hospital birth–covering the basics of routine care in hospitals, consent forms, birth plans, hospital policy, and the rights of patients–and it’s available in July 2015 only!  More here.

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  1. Kay says:

    Overall, this article is pretty good, but the whole “get a doula” thing…getting a doula costs money. I understand lot of mothers who are having and raising their child must have enough money to put aside for that but people like me who are literally only able to afford the things the adoption agency will cover for me simply do not have access. People giving birth who didn’t plan for pregnancy really need to be considered in these articles, as our situation has already taken away so much control from us.

  2. Emily says:

    Your link to learning about what a doula does go to 404 page not found – can you update? Great article, thank you!

    1. Improving Birth says:

      Thanks, Emily! Here is the updated link:

  3. Patricia says:

    Is it possible for this to be a handout that we could share? A .pdf file maybe? I am very impressed with the information and tone of the article and would love to share it with other doulas and mothers-to-be.

  4. Emily says:

    I feel like this is more of the “you have options- but you should pick a doula.” “You should enjoy your birth experience- but hospitals/doctors/c-sections/epidurals.etc will be a bad experience.” I know this article is not outright saying this- but there’s just this tone that like doctors/hospitals/epidurals/etc are bad and less-than. To share more personally, with my first son, I had a doctor/hospital/took the birth classes that you say not to take/ got the epidural/used vacuum for delivery/had an episiotomy/etc. I had an AMAZING experience. It was wonderful- loved my doc, adored the hospital and nursing staff, worshiped the epidural (haha! ) and look back on my whole hospital stay/delivery as totally euphoric. with my second son, I had an emergency c-section. I feel like when reading articles like this or having talked to some people before along those lines, my joy from my first birth experience feels questioned- like, was I stupid for having that experience? For loving it?? And then with my second, I’ve really struggled with insecurity over the c-section/feeling like I didn’t “really” give birth/etc. And those insecurities haven’t come from thinking it was unnecessary- I’m very glad I got the c-section and avoided the risks of a vaginal delivery that my lil guy had. The insecurities come from articles like these, and from women I’ve talked to along these lines, that have this tone about c-sections that it’s like the worst thing that could happen in your birth experience. Heavens, it’s not. I actually personally know a couple women who LOVED their c-sections experiences. And I personally know a couple women who had home births/doulas that resulted in serious complications for the babies, one of whom had to be rushed to the hospital. I guess I just feel like this article and some other I’ve read, ignore that- they ignore that maybe your choice IS to go the more medical route- maybe your choice IS to hand it all over to the doc and say “you call the shots”- and that’s OK! I know you says she’s not judging that, but really? Aren’t you? It’s like saying something offensive and then saying “no offense!” C’mon. You’re also and that home births/doulas don’t always go right and result in a magical birth story. Can’t both sides be just as equally valid? This post claims to be about options but it’s totally one-sided and leaves those of us on the other side feeling nothing but judged.

  5. Danielle says:

    I wish I had read something like this 7 years ago before my first son was born. The only reason that I did not end up with a csection is that my OB did not push for it. My son’s birth should not have been complicated and I believe if I had a doula I could have avoided an unecessary epidural, episiotomy, and a forceps delivery after 3 hrs of pushing followed by being separated from my son for 2 hours and weeks of difficulty breast feeding and bonding. I don’t know if having a doula would have avoided all of those issues but I think it definitely would have helped. Luckily the birth of my second son was complete different!

  6. Jessica says:

    Hope you don’t mind, but I’m borrowing your paragraph on what evidence-based care actually looks like to create a birth plan. I had an awesome second birth after a particularly traumatic first, but part of what made it awesome was I ended up forgoing doctors altogether and had him at home, just me and my husband. I’m hopeful that I can find a midwife or even a doctor who will treat me with the respect and care I deserve this time around, but it’s difficult for me to even consider since I have such bad whitecoat syndrome. Really all I want is some basic prenatal care and for everyone to leave me alone while I give birth, but I don’t know if that’s feasible even with the best of medical professionals.

  7. Bethany says:

    Lovely, Humorous & to the point. Articles like this balance the birthing community as a whole. Some mothers need to look themselves in the eye & KNOW they can DO this! This article is great for any Mama looking to find a supportive article to tell her what she already knows, she CAN have this baby how SHE wants to. As doulas & educators, we must accept however a mother chooses to birth, & for Mama’s that are not ready for this advice, we are there for you.. but for Mama’s that ARE ready for this.. here it is, live and real! And let’s be honest, Birth Professionals, ANY birth that leaves a Mama feeling CONFIDENT & SATISFIED with her birth, HOWEVER it went down, IS A BEAUTIFUL THING! That confident satisfaction, is why I do this! keep it up, Cristen, love this, xo~Bethany Wright

  8. Lauren Stapp says:

    I loved your article! Just remember there are some awesome nurses in the hospital setting who are patient advocates. I do not always get to practice my philosophy of childbirth. But when I have patients who want to eat, want to walk or bounce on a ball, want to be in a different position or to have intermittent auscultation. I make it happen. Lauren

    1. Cristen Pascucci says:


  9. Cristen, This is a wonderful and very helpful article. Thank you for sharing your thoughts! I am posting this to my facebook page. Thank you for your positive comments about doulas. As a birth doula with 15 years experience, I could not agree more that a good doula is an invaluable asset towards achieving a gentle, peaceful birth.
    The oft repeated line, ” healthy mother, healthy baby is all that counts”, is completely untrue. The overall quality of the childbirth experience is of great importance as well. A difficult, intervention laden, or traumatic birth can a have long lasting negative impact on the mother’s ability to breastfeed, bond with and mother her baby, with the relationship between parents, the birth of a healthy new family, and epigenetically, it can affect the babys health well into adulthood, and even subsequent generations. It is of paramount importance that expectant parents read, research, ask questions, become educated, prepare, practice and take time to ready themselves for thier birth. Blessings to all the expectant mamas who read your blog post, and I wish for them a blessed, joyful and ecstatic birth and transition into thier new lives as mothers!
    Allison Harris NCTMB,LMT,CD
    Kairos Holistic Healing Arts Birth Support Services

  10. Laura says:

    I saw this blog a few days back when a friend posted it on her news feed. I think a lot of the contention stems from the tone that the information is presented in on this particular article and on many sites in general. If the information were presented more positively and charitably toward the woman making the best choice for her and her pregnancy instead of demonizing common medical practices (as opposed to too-common medical negligence), then I think these birthing options would be considered with far less angst from those who have had success in hospitals and medicated birth experiences.

    Had my husband and I not had to walk the tough walk of infertility for 3+ years, I think I would have been more likely to go down the natural route because of all of the doom-and-gloom tone I found out there about customary medical treatments in hospitals. After getting away from baby blogs on ALL sides, I chose the options that were best and ultimately necessary for me.

  11. S says:

    I watched The Business of Being Born a few years before I became pregnant. I knew I wanted as natural a birth as possible as well as a midwife and/or doula. I had my baby this year at a well known and respected hospital and not once was I pressured into something I didn’t want or pushed into having a routine birth. I know women of various ages and in several different states who had a similar experience regarding a wonderful birth team. That movie, as well as your description of a “routine birth”, GROSSLY exaggerates and makes doctors seem like heartless people who want to pump you full of drugs then push you out the door as soon as possible. Do I think no one should ever watch that video? No, there’s useful information in it. But I think it should be taken with a large grain of salt. (Not to mention it’s ironic the woman who was involved in the making of the movie ended up having her baby in the hospital.)

    I know it doesn’t sound like it but I’m glad this article was written. Women should know their options, but I don’t think it’s fair to the medical professionals to make it sound as if they don’t care about the opinion of their patients.

    1. S says:

      I should have added that while I was able to have the birth I had hoped and ended up with a csection, it was not for lack of effort on the part of my midwife or the hospital staff.

  12. Having had both my children at home, *applause*!

    Though in the going-off-on-a-tangent department, I did kind of do a double-take at the “Have you ever cut your hair yourself?” bit, because I always do it myself. 🙂

  13. Rose says:

    This article is incredibly misleading. I did every one of these things. I prepared so much for my home birth. Had a doula, took Bradley, read all the hippie natural birthing books that existed. Hired an educated midwife who supports a woman’s right to choose and be the decision maker in her birthing experience. Worshipped Ina May.

    I was ready.

    Or so I thought. To say that a woman should never say “I wish I had known…” is so ridiculous. You’ve put birth in a box, just like the “system” that you criticize. We now have this huge “anti-system” birth movement that hypes women up to think that birth is this beautiful, perfect, empowering thing. It’s simply not true for every woman.

    I wish I’d known that birth sometimes, no matter how well you’ve prepared, does indeed suck. It sucks very much. Nothing about my birth left me feeling empowered. And part of it is due to the fact that dumbed down lists and blogs and birth stories like this hide how hard birth can be. And make it out to seem that all you have to do is X, Y and Z and then somehow your birth will not suck.

    I “got through my birth” as you mentioned. And for months (and months and months) I felt guilty that that’s ALL I did, because I was in the mindset that this article is written in. I thought I should have done MORE than just “get through it” – I truly felt like I let down myself, my husband and my daughter. I felt less of a woman because i thought birth was awful. I hated the experience. I finally know that that’s ok. Because birth DOES indeed suck sometimes.

    There are other ways to empower women than to build them up with false expectations. This is belittling and offensive.

    1. Dawn says:

      We appreciate your comment. I feel your pain and I’m so very sorry that this was your experience. I also want to say that I had a similar experience of birth. I was as prepared as I felt I could have been. I was a doula for 8 years, helped many families through VBAC and knew that my previous births weren’t necessary c-sections. I went in feeling confident. After 19 hours of horrific back labor, pain in my scar, being in transition at 8 cms for hours, I felt like I was being tortured. I was transferred and given another c-section. I was devastated. I’m sharing this so you know that I know how you feel. We would never intentionally set false intentions and certainly weren’t trying to belittle or offend anyone.

      I must stand strong on the post, as the founder of this organization and a women who didn’t enjoy birth at all. I would still share this over and over again because I believe information is power and the first step towards a better birth is the information presented here. No video, letter, blog post or article can guarantee an easy birth with a perfect outcome.

      I hope you are loved and supported through processing your birth trauma. There is a facebook group by that name where you can get support with other mothers who have had similar experience. Sincerely, Dawn Thompson

  14. Shana says:

    Eh. My last birth was the best one of 3. In a hospital. Epidural. Absolutely no pain and completely peaceful. I would deliver 50 babies if they could all be like that 🙂

  15. Nicole says:

    Articles like this bother me to the extreme, not because they are inaccurate, but because they leave out a very important consideration: insurance, or lack thereof. My insurance company dictated which pool of doctors I had to work with, which facilities I had to go to, and I was left with few options. I would not have been able to afford the cost of giving birth without my insurance, and it didn’t cover the services of a midwife. Midwifes aren’t free or inexpensive (not that I’d expect or want them to be) but if you are stuck with less-than-stellar insurance, what choice do you have? Home birth without a midwife for my first childbirth was not an option I wanted to explore.

    Basically, I was left feeling bullied by my providers with nowhere to turn. I felt my doctors used scare tactics and pressured me into all sorts of interventions, up to and including my resulting c-section, performed 70 hours after I was checked in to have an induction I didn’t even want, but was told was necessary because I had gestational diabetes.

    My point is, no matter how armed and ready a person thinks they are going in, after hours and hours of being strapped into a very uncomfortable hospital bed (I had 3 IVs, a blood pressure cuff, and constant fetal monitoring), being woken up every 3 hours for painful pelvic exams, blood tests, needing to adjust position because of decels, etc., you just kind of give up and go with whatever needs to be done to end the trauma. I can’t agree with you more that a doula is an absolute necessity, and I only wish I would’ve known more about them when I got pregnant.

    Thank you for your candid article. Thank you for the opportunity to share my experience. But please don’t continue to leave out the financial implications of giving birth and the horrible state of HMOs and “preferred” providers. All of these issues contribute to a person’s birth experience.

    1. Cristen Pascucci says:

      Nicole, I agree with you a million times over. This article is just a starting point and certainly can’t cover all the contingencies and nuances. The issues you raise are very real. We work with women on a regular basis in these kinds of circumstances, including a woman who was told she had to have a repeat C-section because her insurance company didn’t think vaginal birth was a “medical necessity” (!) and a woman whose insurance company wouldn’t pay for a home birth but had no problem paying for her repeat Cesarean. Both of these women went to the mat with their insurance companies, and only one prevailed. It was ridiculous! Unfortunately, part of the problem is NOT ENOUGH WOMEN FIGHTING BACK BECAUSE THEY DON’T KNOW BIRTH DOESN’T HAVE TO SUCK. I’m so sorry for your experience. It shouldn’t have happened that way. We need more access to midwives, birth centers, and safer, more humane, more evidence-based birth options. A lot of that starts with issues of human rights around childbirth ( and even legal issues related to providers telling women they “have to” have any medical intervention. It’s going to take time to change. Thank you for commenting and please stay in touch.

      1. Susan Jenkins says:

        I understand and empathize with your frustration that your health insurance plan would not cover the services of midwives. You may be glad to learn — and it may help other women who read this excellent letter (THANKS, Cristen, I love it!) — that the health plans in the new health insurance exchanges are required by federal law NOT to discriminate against any category of health provider so long as the category is licensed in that state. CNMs are licensed in all states and CPMs are now licensed in 28 states. Birth centers are licensed in 41 states plus DC. This law will gradually begin to apply to all health plans and all health insurance companies. It is called the Provider Nondiscrimination Law and is found at section 2706(a) of the federal Public Health Service Act (part of the U.S. Code of laws at 42 U.S.C. sec. 300gg-5(a)). Ladies, if your health insurance says it doesn’t cover midwives, write a letter to the head of the plan (find his name online) and to your state insurance commissioner and complain that the plan discriminates against licensed midwives or certified nurse-midwives in violation of the Provider Nondiscrimination law, and provide these code and section numbers. In fact, the U.S. Department of Health & Human Services, Department of Labor, and Department of the Treasury are presently accepting letters from people whose health plan has denied them access to any type of licensed health provider. They are doing this because they need to make rules on how to enforce this new law. They need to hear from real live people, from citizens I who were denied access. I will post the link for how to file your letter by email in a follow-up comment on this site. All letters are due by midnight June 10.

        1. Here’s the link to the Request for Information about the Provider Nondiscrimination law:

          The document will explain what’s going on and there is a button that says “How to Comment” that will tell you how to file your letter.

          Good luck,

  16. Shoshanna says:

    I like the sentiment and article, but, as a childbirth educator and nurse, I was put off by your recommendation that women “don’t even think about taking the childbirth class at the hospital.” I work, and teach, at a hospital-based birth center. Our birthing families are cared for mostly by midwives and family practice doctors, using evidence based practices. Our typical low risk moms are not continuously monitored, we offer water tubs for labor and even water birth, and food/drink is not restricted.
    I’m curious why you would brush off hospital based classes as being worthless.
    Sometimes a guided tour of our Birth Center may be the only “class” a woman gets during pregnancy–so I try to incorporate as much as possible including empowerment and ideas for “rocking her birth.”

  17. Ashley says:

    Great Article! Every part of it rings true. “If only I’d known….!” I say that all the time! Maybe in your next article you might forewarn against the “Med-Wife.” I had never heard that term until after my DD’s birth, but wish I had. I will share this as often as I can!

  18. Megan says:

    I agree with so much of what you say here. I had my four children in a birth center with the most amazing midwives I could have hoped for. I didn’t have a doula, but my husband was an AMAZING birth partner. And I was lucky that the few minor complications I did have were easily handled by the midwives. I chose that kind of birth because it was the best for me. However, as much as you state that there is no judgement, I feel that the tone throughout this article is nothing but judgement. If I were a mother choosing to have a hospital birth with an epidural and I read this, my take-away impression would be “You’re doing it all wrong. Here, let me tell you how you should do this.”.

    1. Elaine says:

      Well if you don’t think your birth sucked, you probably don’t need to read this – if you loved your epidural, docs will love you. If you’re like me though and hated every minute, felt pressured, unsupported and traumatized unnecessarily, even when you’ve HAD a natural birth before and KNOW there was no reason for all your emotional pain, how else do you warn people? So many people let it all happen because they think they are doing the best thing for the baby or because they’ve been laughed at for believing in natural birth. I’m sorry if some people get uppity because they had all the interventions and felt great about it, or because they are a nurse or doc that “doesn’t do that to people” but that is not who this post is for, and I think its great. I only hope some people will listen and start having faith in themselves and in birth because when we go into labor we become very VERY vulnerable, and you will never forget it.

  19. Regarding your Evidence For Doulas poster:
    Don’t forget, most statistics are based on what is the biological norm. It is NORMAL for a woman to have another woman she trusts, supporting her during labor. Hospital policy historically forbade outsiders… which means their methods actually CAUSED more problems. See this post for further explanation:

  20. Chantal says:

    THANK YOU for this!! I planned and planned for my birth, and while it didn’t go as I had hoped (natural birth to cesarean due to breech), I felt in control the whole time because of my knowledge and research. As a doula, I encourage everyone to become as informed as possible on the choices they might have to make. A healthy baby isn’t the be all, end all of every birth.

  21. Kathy says:

    I appreciate everything you have written. I gave birth to four children. If I had not been in a hospital setting I would have died giving birth to our first. If I had not been in a hospital setting our third child would most likely have been born with a lot of complications I am so grateful I was in a hospital when seconds mattered.

    1. Dawn says:

      Kathy, thank you for your thoughts. I’d just like to be clear that we in no way are telling people in the article that they shouldn’t go to a hospital. We are only talking about options. Many women never consider that there might be another place of birth to choose. The entire letter is about encouraging her to know ALL the information and then choose what is best for her and her family.

  22. Kara Martin says:

    Wow. You have some excellent points, but I feel compelled to respond in hopes that pregnant women reading this (esp. first-time moms) have a somewhat balanced outlook. I gave birth 10 months ago to my first child in a hospital, and it was a fantastic experience! Super-helpful, friendly, non-pushy staff who made me feel relaxed. Both my SIL and close friend had healthy, low-risk pregnancies but would be dead today had they not been at a hospital during birth. My sister had her children naturally at a birthing center and had a fantastic experience. I read What To Expect and found it sooo helpful…my friend read it, and it made her freak out over every little thing. My husband and I watched a birthing dvd in the privacy of our home and could actually understand what the doctor/nurses were referring to during birth. We liked that. My point? Everyone has an opinion. Be informed. Find what works for you. What works for one person does not work for everyone.

    1. Cristen Pascucci says:

      Kara, I don’t disagree with anything you are saying here 🙂 I had a great experience in a hospital, too. I’m just talking about options here.

  23. Savannah says:

    And our epidurals still allow for leg movement, feeling pressure to know when to push and the ability to use the squat bar, etc to labor/give birth.

    1. Cristen Pascucci says:

      Savannah, I know there are a lot of awesome care providers out there and evidence-based care is practiced at some places. Thank you for doing what you do and advocating for moms and babies! Research is still showing, unfortunately, that the majority of women aren’t getting that kind of care. Check out Evidence Based Birth’s State of Maternity Care table:

  24. Savannah says:

    I am all about natural birth and plan to give birth to my daughter in a couple weeks naturally but I do take minor offense at some of the statements in this article. As an RN I make it part of my job to be current on ALL best practice and a lot of the things you mention (being “strapped” to a bed, an IV, Pitocin to “hurry things along”, not allowing movement or different positions) are not only not best practice anymore but rarely done, at least in my area. We do saline locks which do not leave you strapped to anything we have wireless tele monitors that allow for any position or movement you want and are waterproof so you can labor in the shower or tub with them. We allow birth in any position you like and is beneficial to baby. All of our practitioners are certified nurse midwives and there is alway one OB doctor on call 24 hours for consult, c section and high risk birth. Birth has come a long way and we as hospital employees are (for the most part) up with the times. And this is not a small town holistic clinic, this is a huge “brand name” hospital doing these things. Birth centers are great but if you choose to come to a hospital for your birth do no be scared or that you need to come in guns blazing ready to fight us on every little thing. If you step back you will realize for the most part we are probably on the same page and already put into practice a lot of the things you think you might have to fight us on. Babies and mamas are our passion and we don’t have pre concieved notions on how YOU should deliver. We work based on evidence based and best practice and a lot of it is in lone with everything you say above. This is long but all I’m saying is give us baby nurses, midwives, and doctors some credit – we do this because we love it and because we want to help you have the best birth possible.

    1. Sarah says:

      This!! I happen to work in a hospital that is keeping up with evidence-based practices very well. 90% of what I see on someone’s birth plan includes items we already implement. No, we won’t let you light a candle (fire hazard) but we will let you labor and move about and even EAT as you are able.I fear that posts like this and horrible documentaries like BOBB (which I LOVED when I was pregnant, before I realized how dangerous it is) will send the wrong message to moms about giving birth in a hospital, with or without an OB, midwife, FP.

      1. Cristen Pascucci says:

        Sarah, that’s awesome, and I WANT moms to go to wonderful hospitals like yours, and I wish more hospitals offered care like that. Most hospitals do not, and that’s why articles like this are important – when MOST women are not going to receive evidence-based care unless they ask for it, and even then, they may be denied. Please note, also, I’m not telling people not to go to hospitals, but to consider their options — and birth centers are fantastic, certainly not “dangerous,” options for many women (safer than hospitals, in many cases).

    2. Jena says:

      Sounds like you work in a great place! I wish that every birth center & hospital was like that (and nurses were all like you describe yourself & colleagues).

  25. Alexandra Rosero says:

    I loved this article and I am a natural birth advocate all the way..especially since I’ve had two! But I disagree about not going on sites like I’ve been on their mailing list and I love their emails updates. They are very informative and answer a lot of questions about my daughters’ developments.

  26. AP says:

    Just a plug for Family Medicine docs — I am one, and I consider myself a NATURAL childbirth expert. I work side-by-side with midwives and OB/Gyns, and I have been told many times over that my practice is much more similar to the midwives than the OB/Gyns. I was trained by both midwives and family medicine physicians. Family Medicine docs are typically not trained in C-sections, so will similarly do everything possible to facilitate a vaginal birth. After all, I don’t want to have to part with my patient & put her in the hands of someone else’s care!

    Family medicine doctors are also trained to take care of babies & children. It’s so incredible to take care of a whole FAMILY — just yesterday I did a well child check on a 2 year old AND mom’s prenatal visit with 2nd baby at the same time, in the same room.

    Amy, MD, Seattle.

    1. Allie says:

      I had an all natural VBAC with a Family Doc at the Naval Hospital in Bremerton, WA and it was fantastic. Family medicine is another great option that is needs to be talked about more 🙂

    2. Heather says:

      I think that still depends a lot on the individual doctors and isn’t across the board the norm for Family Docs. My first birth was under the care of a Family Doc. He ‘allowed’ my birth plan, but with a condescending attitude. He did a membrane sweep at a checkup without getting my consent, or even informing me before he did it. He made me deliver on my side, and gave me an episiotomy — a botched one, since he was using the wrong scissors at first and chewed me up pretty badly down there. When I had a 4th degree tear (I suspect at least partly due to the side-lying position) he sewed me up badly.

      After the birth, he gave me bad breastfeeding advice — no more than 10 minutes per side and not so often. Give cereal in a bottle to help him sleep through the night. And he told me to retract my intact son’s foreskin at every diaper change.

      It’s wonderful that you consider yourself an expert in natural birth. However, I am very skeptical that most, or even many, family doctors have any training at all from midwives. I suspect that you are a wonderful exception to an unfortunate rule.

    3. Cristen Pascucci says:

      Thank you, Amy!!!

      1. Robin says:

        Wow, a REAL Dr. Amy who cares about women. : )

  27. Jewel Hernandez says:

    Great article. Kudos for encouraging the use of midwives. Frustrated once again that you didn’t go far enough in defining midwives (CPMs and CNMs) and also mentioning the option of home birth. It is a valid option.
    “the first intervention in birth that a healthy woman takes is when she walks out the front door of her home in labor. from that first intervention, all others will follow.”
    Michael Rosenthal, OB/GYN
    While I have no doubt that IB supports home birth, I really wish they would include it more in the conversation and thus normalizing the choice. Thanks

    1. Cristen Pascucci says:

      Hi, Jewel! This article was originally a letter to a friend who would never consider an out-of-hospital birth in a million years, and it was “risque” of me to even suggest a birth center. I updated it to apply more broadly to folks, and linked out to the MANA site. I think we do talk about home birth a lot, but the fact is, when we are talking to the average woman, she’s not even going to be interested until she starts doing her research and gets through the Business of Being Born. That’s where I was coming from. Thanks for your comments!!

      1. Lauren says:

        Having had a NCB outside of a hospital, I love this article as well, but I am disappointed that you support The Business of Being a Born so strongly. I feel a lot of the facts are misleading and even fear mongering. For example, discussing the infant mortality rate (death in the first year of life), which isn’t great, rather than the perinatal mortality rate (death around time of labor up to the first 28 days), which is one of the highest. I feel there are enough reasons to support alternative birthing options without leaning on this documentary.

        1. Cristen Pascucci says:

          Thanks, Lauren. Out of all the resources we point women towards, BOBB is consistently one – and maybe the only one – that “gets through” to mainstream women. All the statistics in the world don’t matter if someone isn’t open to the possibility of something different!

          1. Christina says:

            Hello, I too urge you to reconsider tour support for BOBB. It’s a dangerous documentary. It fooled me hard. Check out this article by a doula:

  28. WOW! This is poignant; thank you!

  29. Em says:

    Dear Cristen,

    THANK YOU for this article. Thank you thank you thank you. It’s funny and honest and straightforward and important.

    I will definitely share this on my blog and twitter (@Whatisadoula). I was wondering if it would be okay to print and share at our monthly Meet the Doulas and Midwives Gatherings and with my childbirth ed clients. I will keep any and all credit clearly visible and make sure to reference your organizations.

    Thank you again and best wishes,

    1. Cristen Pascucci says:

      Go for it, Em! Thanks for sharing!

  30. This article is fantastic, open and honest! It helps expecting women know what to look for and to start asking questions. Birthing a baby is a beautiful and natural occurrence. Yes, sometimes, things happen and intervention must be used, but majority of the time our bodies know what to do. Great article!!!

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