Joy Szabo of Page, Arizona, was told by her local hospital that she wouldn’t be allowed to give birth vaginally there. She even met with the hospital CEO to discuss their policy of forcing repeat C-sections — a policy she equated with physical assualt — and the hospital responded by threatening to get a court order for the surgery. When the local paper headlined Szabo’s plight, the hospital backed off, but it still told her “No VBAC.” Instead of agreeing to the major surgery, Szabo pushed back. She found a willing hospital and provider in Phoenix, a six hour journey by car from her home, and made the decision to move there and await labor. She and her husband Jeff had to live apart beginning in mid-November, with Jeff remaining in Page with their three children (one already born by VBAC at Page Hospital!).

Finally, this week, CNN reports a happy ending: Szabo gave birth to her fourth son, Marcus Anthony (7 lbs, 13 oz) on December 5th: “It was such an easy birth,” Szabo said. “I was in the pains of labor for about four or five hours, then I pushed once, and he popped out.”

Congratulations, Joy. You are a hero and an inspiration to the hundreds of thousands of U.S. women facing the same coercive policies each year.

Women denied health insurance because they’ve been raped, because of domestic violence, because they’ve had a C-section… Insurers telling women who’ve given birth by cesarean, “Alright, we’ll cover you–but only if you get sterilized.” Parents denied coverage for their children because they’re too big, too small, because they hold their breath …(?!?) It sounds too outrageous/absurd/illegal to believe, but listen to the testimony of Peggy Robertson (courtesy of the Service Employees International Union’s campaign for healthcare reform):







Here Robertson illustrates the awful bind so many women are in: No hospital will take her for VBAC, she doesn’t want another cesarean, she feels she has no choice but to have one, yet she can’t afford it. Her health insurer’s answer to this? Don’t have any more children. So much for reproductive choice.

RH Reality Check’s Jodi Jacobson has a novel idea: “I say the insurance industry as currently constructed is too sick to function and should be declared a national ‘pre-existing’ condition of which we should rid ourselves permanently.”

With the historic news that a majority of the U.S. workforce is now female, it’s clear that American women have more power than ever before, says OB/GYN and bestselling author Christiane Northrup, MD. But is that power reflected in the healthcare available to women? No, she writes in an essay for Huffington Post, especially when it comes to childbirth:

“Our so-called healthcare system, which is a direct reflection of the beliefs of our culture, sees the female body and its processes (like labor) as an accident waiting to happen…The truth is that labor and birth need not be the emergencies we think they are. And the medicalization of birth actually does more harm than good.”

Northrup criticizes the rising rates of cesarean section and labor induction, and cites the rising maternal death rate. “Studies have repeatedly shown that in healthy mothers with no risk factors, home birth is as safe as hospital birth. Increasingly, savvy women who trust their ability to birth normally [and, we should add, who have the resources] are opting to avoid the hospital altogether.”

Northrup concludes the essay with a call to action: “When it comes to pregnancy and birth, we as a culture and as individuals need to wake up and claim our right to literally birth right!”

In the latest example of a woman reclaiming her birth rights, Joy Szabo (left) of Page, Arizona, is refusing to have the cesarean section that Page Hospital is ordering. Szabo had her 1st child vaginally. Her 2nd child was delivered via emergency cesarean at Page — and she was very thankful for it. She had her 3rd vaginally (VBAC) on the same L&D ward. But now, because the hospital has changed its “policy,” it has told Szabo that VBAC is no longer allowed, and that her only option is a cesarean. Page Hospital’s CEO Sandy Haryasz (sandy.haryasz@bannerhealth.com, 928-645-2424) even threatened legal action. “I asked Sandy what would happen if I just showed up refusing a C-section and she said they would obtain a court order,” Szabo told the Lake Powell Chronicle. “They don’t want to allow VBACs because she said they aren’t equipped for emergency C-sections, but if they can’t do emergency C-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies — in case there is an emergency.”

Since coverage in the Chronicle and on CNN, the hospital has backed off the court bullying, but it is still deferring to its “No VBAC” policy. Szabo’s doctor supports VBAC, in theory, but told her he’s powerless. “He was wringing his hands, and said he would have to do [a cesarean] if the hospital told him he had to,” Szabo wrote in an ICAN blog post. “He told me he would lose his licence if he didn’t. I have looked into it and have yet to find where doctors lose their licence for having ethics. But it was clear to me that I was not safe in this hospital, and if I step foot in the building, I would have a cesarean, and my doctor would do it while I scream in protest.”

The closest hospital Szabo can find to support her choice is in Phoenix, 350 miles away. In order to avoid surgery, she will leave her family in mid-November and rent an apartment in Phoenix until she goes into labor. Her husband probably won’t make the birth. In the United States, it is illegal, unconstitutional, and medically unethical to force a competent adult to have surgery for any reason. And yet, some 800 hospitals officially “ban” VBAC and another 600 don’t have a single provider willing to attend, forcing hundreds of thousands of women into this situation every year.

“Mention that you are planning a home birth and it might be as if you had just brought up Sarah Palin or Palestine: brace for family feuds, public denunciations, and offhand remarks that imply you are selfish and stupid, your midwife is a quack, and your unborn child is a victim already in need of social services…Such is the pitch of the ‘home birth debate’ in the United States. And yet, the the research evidence suggests a more nuanced conversation.”

Read more on Babble.com.

Last time the New York Times reported on home birth it was in the “Home & Garden” section. Here’s another story, about the rise in birth video viewership on YouTube, in “Fashion & Style.” (Sigh. When will physiological birth get a page in the “Health” section??) Most of the thousands of birth videos are shot at home — as of today there are 10,900 results to the search terms “home birth” — because taping is rarely permitted in hospitals. It’s mindblowing to think that 30, 40 years ago, women didn’t have access to books or even photographs showing the normal birth process. Now you can spend a whole afternoon birth-surfing.

Here’s a favorite. Here’s encouragement for those carrying multiples. Here’s one of several women singing in labor. And check out this absolutely gorgeous birth shown in a Spanish ad for a bed! And look, a brand new video about midwives and health reform — perhaps the birth of a movement?

ADDENDUM: “The Birth of Amerlyn Grace” — a beautiful, intimate slide show shot in black and white by Austin photographer Lyndsay Stradtner.

The Big Push for Midwives campaign — 10,000 Facebook members strong — is taking their message to Congress this week with a Capitol Hill Issue briefing “on how out-of-hospital maternity care reduces costs and improves outcomes,” writes the group. “Studies show low-risk women who plan their births with out-of-hospital midwives have outcomes equal to low-risk women who deliver in the hospital, but with far fewer costly and preventable interventions.” Not to mention unnecessary and harmful interventions! Increasing women’s access to midwives and birth centers should be a no-brainer, but so far, nobody at the healm of health care reform is talking about the need for maternity care reform, which could save the country billions of dollars a year. (Read more about the potential cost savings in the L.A. Times.)

You can help out the Big Push by spreading the word about the briefing, scheduled for this Thursday, May 21, and urging your representatives to attend.

“The worldwide ‘Baby Friendly Hospital Initiative‘ is a great campaign — get the baby skin-to-skin with mom first thing after birth, leave them be for an hour to start nursing, and basically phase out the nursery. A centerpiece of the initiative is to ban formula companies from giving out free samples in maternity wards. But perhaps calling it ‘baby friendly’ was a bad idea. Perhaps it sends the message that breastfeeding is somehow not ‘mother friendly.’

That’s essentially what Hannah Rosin argues in an article in this month’s Atlantic, ‘The Case Against Breastfeeding’…”

[Read more and add your $.02 on Babble.com]

You’d think that between Erykah Badu’s home-birth twitter and Ricki Lake’s film success and the New York Times coverage that we’d moved beyond dissing home birth as fringe — “extreme.” Apparently not. The current New York magazine titles a feature about it “Extreme Birth.” The piece, by Andrew Goldman, tries to be a character study of Cara Muhlhahn, the home-birth midwife and now memoirist featured in Lake’s film The Business of Being Born. But after raising her to a teetering pedestal, crowning her “the fearless — some say too fearless — new leader of the home-birth movement,” Goldman shoots her down. It feels more like a character assassination — of both her and the movement.

This is unfortunate for many reasons. As Goldman himself admits, routine maternity ward monitoring, inducing, and anesthetizing have added up to millions of unnecessary cesarean sections (latest CDC rate: 31.8%) — a “hospital childbirth system gone insane.” Midwives who attend home birth provide a much needed, safe alternative. But Goldman can’t quite buy that (or manage to cite any research one way or another). He claims that Lake’s movie “de-radicalized home birth, conflating it with garden-variety natural childbirth and allowing Muhlhahn, largely unchallenged, to argue for its safety.”

Here’s the deal on safety: The American College of Obstetricians and Gynecologists claims that it isn’t safe; the American College of Nurse Midwives and the American Public Health Association claim that it is. The research evidence clearly demonstrates that birth outside the hospital with a trained midwife is not only as safe for the baby, but safer for the mother, provided she is considered “low risk” — a healthy woman carrying one full-term, head-down baby.

What does Goldman mean by “garden variety natural birth” and where can you get one? The “painful truth” is that it’s an uphill battle to avoid unnecessary intervention once you check yourself into a garden variety U.S. maternity ward (these “pushed births” are epidemic). In many places, like NYC, there is very little gray area between the extremes, if you will, of home and hospital. And freestanding birth centers are great if you can find one, but there’s no real clinical difference between there and at home: every piece of equipment at a birth center a midwife can bring to a home birth. If labor isn’t progressing normally or a complication develops in either location, you transfer care to the hospital.

This concept of transporting a birth from home to hospital is a toughy, especially for reporters — it looks like failure. The anonymous OBs quoted in New York magazine call transports “dumps” and “train wrecks.” In reality, transports are normal and appropriate. These are the women who actually need advanced medical intervention; most just need pain relief or antibiotics (the C-section rate for planned home birthers is under 5%). The option of transport to a fully equipped hospital is what keeps home birth safe. Supportive physicians embrace the role of providing appropriate medical intervention and emergency care, rather than demanding that every woman give birth in the hospital and be treated as if she’s an emergency.

Several times in the NY piece, Goldman thinks he’s catching Muhlhahn in flagrant malpractice, but this is because midwifery standards and obstetric standards differ so, and because Goldman is relying on a cultural bias that obstetrics is more scientific. But it’s not.

Yes, hospitals and physicians restrict women to 24 hours of labor after their waters have broken (many providers want you induced with Pitocin immediately after membrane rupture), but that’s just standard protocol, not science. The best, largest study actually showed that a woman can labor four days without risk to the baby. Goldman also sanctions Muhlhahn for underestimating a baby’s weight, and quotes an OB who claims she should have known the baby was “too big.” But again, the evidence shows that even the highest-tech ultrasounds can be off by two pounds, and that it’s impossible to predict which babies’ shoulders will get stuck. Even ACOG doesn’t recommend inducing or sectioning based on size guesstimates.

The truth is, standard maternity care is not evidence-based care (see this recent report.) And this is why more women are interested in giving birth at home. Not just so they can have candles and music and a better “experience,” but because they know that checking into a hospital means exposure to preventable risks.

Which is really the shame in all this. Because most Americans are skittish about home birth, and no woman should feel it is her only option for that garden variety, supported, physiological birth.

As for the higher-risk births (twins and breeches for instance), the ideal setting is a hospital in theory, but some midwives agree to attend them at home because they know that their clients have zero chance of a vaginal birth otherwise. They feel an obligation to support women’s choices and help them avoid unnecessary surgery. And they have the skills to do it (the current obstetric training for breech delivery is a cesarean section!). The system is shameful to an extreme.