“Empowered Birth”: Home Birth, Hospital Birth and Informed Consent

The Rhetoric of Natural Birth and Empowered Birth

Having a child is a hugely significant and powerful experience for expectant mothers, fathers and families. Many awareness days have rightly sprung up over the years celebrating the processes of pregnancy, childbirth and maternal well-being. One trend known as the ”empowered birthing” movement has gained momentum in recent years. The Reiter & Walsh team would like to address some of the movement’s principles, as well as some trends associated with the movement.

The empowered birthing movement stems from mothers feeling alienated from their own medical decisions. This alienation is often due to the feeling that they lack the information needed for informed decision-making regarding their pregnancies and childbirth. In many cases, this has led to some degree of distrust of ”the medical establishment,” leading women to attempt home births, water births, hypnobirthing and other ”alternative” birthing practices.

Options for Birth Abound but Require Careful Risk Assessment

Many low-risk pregnancies proceed without complications or the need for a C-section. Women can choose to give birth in a hospital setting, in a freestanding birthing center, or in a home birth setting accompanied by a midwife or doula. The American Congress of Obstetricians and Gynecologists (ACOG) urges women to consider the advantages and disadvantages of different birth settings, as each comes with attendant advantages and risks. Specifically, they recommend birthing care that places women within reach of medical attention if needed, as even low-risk pregnancies can become high-risk suddenly. They also recommend that women with high-risk pregnancies do not attempt home births, as it is far likelier that high-risk pregnancies will require medical services (such as resuscitation) that are not available in a home environment.

Considering Home Birth as Part of the “Empowered Birth'” Movement: Safety

Some women opt out of having medical assistance on hand when giving birth due to a desire to plan a delivery more in line with ”natural birthing” trends and practices. Instead of giving birth in a hospital or birth center environment, they rely on midwives and doulas at home. While midwives and doulas do have birth-specific training, not all midwives and doulas are necessarily equipped to handle high-risk pregnancies or certain delivery complications. Indeed, women with high-risk pregnancies – such as those with prior C-sections – are advised against having a home birth at all. If complications arise, these mothers must be rushed to hospitals for emergency medical care in a situation where time is of the essence.

There are certainly cases where home births are an option for mothers, but – contrary to popular belief –  there is little to no evidence to support the concept that home births are in some way safer than hospital births. Indeed, research in the New England Journal of Medicine and the American Journal of Obstetrics and Gynecology found that planned out-of-hospital births are associated with higher rates of perinatal death than planned in-hospital births. Home births are also associated with a higher risk of neonatal seizures, and higher odds for a baby being admitted to the NICU.  

While home births are associated with a lower chance of the mother having a C-section, in some cases, C-sections and other interventions are necessary to ensure that babies are delivered safely. Comparisons of hospital births and home births found that giving birth in a hospital reduced risk by 26%; this statistic is significant, as time spent rushing to a hospital for emergency procedures if complications arise can be critical to outcomes.

Empowered Birth as a Synonym for Informed Decision-Making

Medical professionals emphasize that, in the end, it is the mother’s choice regarding the setting in which she would like to give birth, but mothers must be aware that unforeseen risks can occur. ”Natural childbirth” is, to many, an appealing label, but it is a label often conflated with ”empowered” birth. The empowered birthing movement advocates that a ‘natural birth’ is not, however, the only kind of ’empowered birth’ a woman can have. The movement stresses that an empowered birth can be vaginal or C-section; a mother can use pain medication or may not. Nor are hospital births in conflict with safe, empowering birthing experiences.

We encourage support for and awareness of the definition of empowered birth that is rooted in consent from and respect for the safety or both mother and child – essentially, a definition stemming from informed decision-making. When mothers are fully informed of their options (as well as the relative benefits and risks) by trained staff, their births can be empowering, fulfilling and free from undue risk. Empowered birth, therefore, should not be a controversial label.

Natural Birth Rhetoric and the Risk of Misinformation

Much ”natural” birth discourse pits home births against hospital births, misrepresenting hospital births as part of a system of ”industrialized” or ”disturbed” childbirth. This heated discussion can sacrifice evidence-based methodologies to support an ”alternative” paradigm of birthing.

While alternative birthing practices are not necessarily harmful (and, indeed, many mothers report that alternative birthing practices improve the emotional and psychological experience of delivery), they can become a point of contention when their advocates pit ”natural” birth against mainstream medicine’s evidence-based standards of care. The standards of care established by medical practice help to ensure that mothers and their babies receive proper care throughout pregnancy and birth.

Because empowered birthing supports deliberate delivery choices and clear communication with medical personnel, expectant families planning for an empowered delivery should work to thoroughly research, understand, and communicate with medical personnel about all delivery techniques. This incorporates research into the pros and cons of traditional and non-traditional birthing practices.

Recently, trends show that mothers have been gaining interest in certain techniques such as water birth and hypnobirthing, techniques that many ”empowered birth” proponents recommend. However, rigorous studies show that there are no significant medical advantages to these methods in large studies despite the insistence otherwise.

Empowered Birth Within the Medical Context

Women can have an empowered birth by selecting a licensed medical provider who will work with them to create a birthing plan and keep a clear and consistent line of communication open. Many expectant families can distrust traditional medical practices, while others distrust new “alternative” methods. Selecting an experienced and trusted medical provider can help relieve some of the anxiety surrounding birthing options and help provide parents with the information they need to create an empowering, evidence-based birthing plan.

If you are interested in learning how selecting a medical professional for your pregnancy can be an empowering decision, please read this mother’s account of switching doctors during her pregnancy.

  1. http://www.ajog.org/article/S0002-9378%2814%2900275-0/abstract

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