In the birthing world, it was big news: After a 15-year decline, home births in the U.S. rose 20 percent between 2004-2008. Though the actual numbers remain tiny — out of about 4 million births, 28,357 happened at home in 2008 — the reversal of the long downward trend is notable. So are the demographics: much of the increase was driven by highly educated white women. A full 1 percent of them decided to forgo the hospital and give birth at home, according to the new report published Friday in the journal Birth: Issues in Perinatal Care.

I’m not sure I’d call it a trend, yet:  even with the increase, fewer than 1% of American women give birth at home. But what’s interesting about the data is that he biggest increase in home-birthing women is among white, highly educated women.  Home-birth is no longer just a “crunchy” option; increasingly, women who don’t even wear Birkenstocks are doing it.

Some folks have suggested that this proves more American women want “natural birth.”  If you’ve taken my childbirth class, you know I don’t like the word “natural” (in food labeling and in childbirth, it’s somehow both too-charged and unspecific).  Becoming a parent is quintessentially natural, though not everyone does it.  It’s natural, irrespective of how you cope with pain. 

To me, though, what’s even more natural is the desire for control and dignity when you face a challenge.   For some women, pain medication gives the sense of control they need, to cope with labor.  For other women, control means a familiar setting, not dealing with strangers, and avoiding hospitals’ institutional protocols that are designed for litigation-avoidance and not always for safety.   Part of the trend towards home-birth may be that more educated women, considering their options, choose a setting that gives them the sense of command they need in order to cope.  Hospitals wishing to draw women back might do well to consider what changes might let women feel more control.

For all women, control involves respect and dignity.  And one area where home-birth is unbeatable is customer satisfaction.  Women who give birth at home tend to describe a relationship of trust and respect with their caregivers.  I don’t mean in a soft-focus-let’s-all-gather-round-the-bonfire-and-talk-about-our-vaginas way.  What I mean is that their midwives treat them as competent adults and consumers, and remind them that birth is not only about the dilating cervix and the fetal heart tones.  It’s certainly more convenient to ignore the woman attached to the cervix – she might have questions!  She might want to tell you everything about her mother and her sex life!  She might need you to talk her down after she’s read all manner of horror stories on the internet!  She might want every single thing to be explained, or she might be so visibly scared that she says she is afraid of any information at all, to her detriment! – all of these things are complicated to deal with.  But it doesn’t compromise safety to take the time to meet her where she is and treat her as a human being so that she can feel respected and dignified.

Not everyone needs an intimate relationship with her doctor or midwife, but no one – not the Granola Birkenstock Mom, and not the Type A Wall Street Mom – can feel dignified if she is shamed, rushed or disrespected.  I meet several hundred pregnant women and new moms per year and the overwhelming majority are college educated women who give birth with an OB in a major hospital.  I hear many, many complaints about being rushed, chastised or even bullied, from moms who simply had questions.   It is upsetting to hear and it’s demoralizing how many of my clients don’t object because they despair that there is “no other option,” or that objecting would just make it worse.   Women planning a home-birth with a competent, professional midwife do not report being rushed, chastised or bullied – to the contrary, they typically report that they are treated like competent adults and human beings, and that being treated properly increases their self-confidence.  In this day and age, shouldn’t that be something we can all expect, anywhere?  

My hope is that the trend of highly educated women choosing home birth is a sign that women are voting with their feet.  And I hope that hospitals and OBs take note:  customer satisfaction is part of maternity care.  

(Full text of quote here).