Allison Yarrow wants to hear your birth story

On childbirth, consent, coercion, and power

Post publication note:

I’ve heard from a few of you who said this piece didn’t land for them, and first of all, thank you for taking the time to reach out and share your thoughts. I’m grateful for you writing with care and thoughtfulness, and am always eager to expand my perspective and do better.

Birth is not one-size-fits-all, and for many reasons, it’s an incredibly personal, sensitive experience to consider in a public space. Those of you who wrote me were right to point out that I should’ve been clearer in emphasizing that there’s no right way to give birth, and I should’ve been more precise with my language. My point in bringing up “natural” childbirth, for example, was not to imply that there is some sort of gender essentialist way to bring children into the world. This negates the experience of folks who don’t deliver vaginally, people coping with infertility, and queer parents.

There is no definitive way to approach birth, or any ideal way to deliver a baby. All people should have access to the kinds of births they want and need. Whether that be a hospital birth, a birth center birth, a back of the car on the side of the road birth, or a home birth. Whether it be a birth that adheres precisely to every letter of your birth plan or whether circumstances compel you to throw your birth plan out the window entirely. Whether you deliver vaginally, via Caesarian, and whether you utilized epidurals or not. Whether you birth without medical intervention or whether you do, we should all expect to be cared for and listened to.

Thank you again for everyone who reached out. I appreciate you helping me to see where I missed the mark, and appreciate you giving me the opportunity to learn and grow. Most of all, thank for being in conversation with me. That’s what community is all about.

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One of the first times I felt like a writer was when I wrote about childbirth.

I was at my first ever writer’s workshop and we were instructed to write a flash piece, which is basically just a short piece of prose. Think under a page. Here’s a passage from that piece.

My body is flooded with chemicals: oxytocin, beta-endorphin, catecholamines, prolactin. These chemicals have other names. The sparks of periwinkle that bloom through winter-washed grasses are forget-me-nots, not myosotis. The hormone of love, the flight or flight hormones, the mothering hormone – these are the drugs that subvert my brain in service to my body. An acid trip of crystalline sensations, each feeling ebbing as soon as it crests, each moment existing in a vacuum, each minute the only minute there is.

In the darkness of a New Hampshire morning, early, I raise my head limply, eyes tightly closed, and click my sandpaper tongue against the roof of my mouth to demonstrate the word “parched,” and a straw is inserted between my dry lips. I drink long and deep.

My body is something bigger than me, bigger than conscious thought, more dynamic than any intention. More full of life and color and sound than a book or a song or a wish.

I trust my body out of necessity. It knows more than I know.

I wrote about my first birth because it was easily the biggest thing I had ever done; the biggest thing to ever happen to me. This is not to diminish any of my professional achievements or personal triumphs. It is simply a fact.

Through a combination of geographical access (I live near a wonderful birth center), luck, and support, I had three empowering birth experiences. It sounds weird to think about childbirth with nostalgia, but I do because it’s the most powerful and capable I’ve ever felt.

Allison Yarrow wants all people to have access to births that honor their humanity, their bodily autonomy, and their needs. In her new book, Birth Control: The Insidious Power of Men over Motherhood, Allison explores the (often harrowing) history of birth in the United States, exposing how sexism, misogyny, and racism have shaped standards, practices, and expectations. She illustrates how the ways in which we approach birth mirror the ways our culture denigrates, disenfranchises, and ignores mothers. And while this book will assuredly make you mad, it will also arm readers with knowledge, energy, and most of all, hope.

Photo credit: Beowulf Sheehan

Sara: I (like you) am riveted by birth stories. I carry my own within me like three epics in which I produced, directed, and starred. Did you start thinking about this book as soon as you experienced your first birth? Or did the impetus to write it occur later?

Allison: I love that—birth is epic! I didn’t really go into my first birth thinking I would write about it. I went in with my reporter lens, doing the thing I do as a journalist for almost two decades and human, I guess, which is try to learn enough about a thing I fear to not fear it anymore. I spent my first pregnancy gathering resources and just experiencing. But my husband and I did take a Bradley Method class in partner-coached childbirth. And we spent 8 weeks intensively preparing for birth and learning how to defend me against my provider and the hospital. That piqued my journalistic interest because I thought I had chosen my provider and birth setting because that was where the care I wanted and needed would happen. It took longer, through reporting and writing the book, really, for me to learn that managed care in the hospital isn’t evidence-based, that it is not rooted in what’s best for birthing people, but in what is the most cost-generating (read: fast). I had to do a lot of reporting and interviewing to understand that “bad” birth stories weren’t rampant because birth itself and the people doing it were inherently problematic, which is what we’re told, but rather because birth is controlled and manipulated into a risky procedure unnecessarily.  

Sara: While you were writing the book, were you wary about it having the unintended effect of making people who have given birth in hospital settings or who have embraced epidurals, for example, feel judged for their choices or feel somehow less than for not having chosen to forgo many of the interventions this book implicitly argues are often unnecessary or even (sometimes) an impediment to health, wellbeing, and empowerment? 

Allison: Too wary, I think, now. This fear tied me in knots during early phases of writing the book. Everyone who births deserves to have their experience be validated. But that’s also ultimately why it’s so important to understand the evidence of what birth is actually like in this country—that the routine care is failing women. When I surveyed 1300 people about their birth experiences I learned that many internalized birth trauma, or even a birth that wasn’t like what they had imagined, as their own fault. For this to change, we need to examine what’s actually happening. 

Birth is an individual experience and needs to be cared for by individuals, but in our system of managed care many women in labor are cared for by a few people. That’s why the cascade of intervention occurs. This means that the things hospitals offer and do to women from giving (or coercing or forcing) a pelvic exam to gain entry to the hospital, to Pitocin to speed up or start contractions, to electronic fetal monitoring to watch a labor from a remote location, to an epidural if contractions are unbearable (Pitocin makes them much more painful) to a cesarean if time’s up or your doctor wants to peace out for dinner to whatever—none of this is based in good evidence. The purpose is to rush people giving birth, to control them. 

Still, if people want any of these things for whatever the reason, they should have them. But my reporting shows that almost no one is actually choosing. If you’re accepting an intervention because you’ve been misled about what it is and what it does, that’s not really choosing.  

Sara: You write that many experts you spoke to for the book refer to menstruation as the “fifth vital sign, equal in importance to your blood pressure, heart rate, temperature, and respiratory rate.” The older I get, the more horrified I am about how little I was taught about menstruation, and how little I still understand about how it impacts my every waking moment. Were you similarly shocked at how little we culturally and medically understand about menstruation?

Allison: Completely shocked. I grew up in Georgia and received abstinence-only sex education that was also shaped by the AIDS epidemic. During my reporting, I spent time with three 10-year-old girls to understand what sex and menstrual health education looked like today, and I ended up opening the first chapter, “Welcome to Pregnancy,” with our conversation. I went in thinking whatever they were getting in progressive Brooklyn had to be much improved. Still, their basic takeaway was that puberty meant that “stuff comes out”—semen for boys and blood for girls. For the boys, this was exciting and felt good. For the girls, they were now saddled with something gross and embarrassing to clean up. Some 350 people I surveyed didn’t know how their menstrual cycle worked before trying to become pregnant (I had the same experience) and it’s clear that this not knowing matters, and that we’re deliberately being kept in the dark. If we don’t learn how our own bodies work, and what they need when we’re young, it’s tough to play catch up and advocate for ourselves in a healthcare system that misunderstands and devalues them routinely. 

Sara: This book contains many horrific incidents of men interfering with childbirth in harmful, dystopian ways [TWILIGHT SLEEP]. What were some of the nastiest surprises for you in researching the book? I went into reading it with a vague belief that episiotomies, for example, weren’t great, but had no clue just how not great they were until after reading. 

Allison: The best research on episiotomies essentially concludes that ending them is key to humane childbirth. They are grisly. They are done unnecessarily constantly and a frightening number—more than half of people who get them aren’t consenting to them, which is medical battery. It’s really hard to get figures on this. Hospitals must report their own numbers, as episiotomy is a surgical procedure, but they conceal them from the public. But I grew up believing they were necessary because women in my own family had them and were told by their doctors that cutting the perineum made it easier to heal than tearing naturally. Which of course now sounds awfully socially and patriarchally contrived doesn’t it? But they believed that and I believed that. Until I looked at the research. There are so many elements of hospital birth that hew to this formula—they seem perfunctory, recommended, necessary, but they’re based in tradition, not evidence.

Sara: You write: “Like school or the office, birth is another societal opportunity for women to perform, to prove they’re good girls. We can participate willingly or unwittingly in our own subjugation.” I’ll never forget, after my first birth, a kind nurse checking on me and telling me that my “uterus was shrinking beautifully.” And of course, that was something I had no control over, but I couldn’t help but feel proud. I also think there’s so much opportunity to feel pride in childbirth that has nothing to do with performance. Thinking back to my first birth, which was, I suppose, the most frightening for me in the lead-up only because it was the first, I still feel proud of my ability to retreat deep within myself and conjure up an otherworldly level of focus. The strength and empowerment I felt during my birth was a stark contrast to my postpartum experience, during which I felt so inept and small. This is a long question (? lol), but I’m so interested in how we can divest of performance while also moving through childbirth and the postpartum period in ways that open us up to our own power.

Allison: I love that you’re asking this question. We should be proud of birth. We can create and grow human beings in our bodies and give birth to them. Humanity continues and prospers because of us. It’s ultimate power. It’s magical, spiritual, godlike. That women and people who do this aren’t utterly revered, and are instead disrespected and even abused during this time, is a horrendous modern tragedy. We don’t even ask people to share their birth stories. We lack the centering of this foundational narrative in our culture. Perhaps the idea of “doing birth well” that can seem or feel performative comes from our deep understanding as women and birthing people that no one is giving us the kind of validation we deserve for doing this incredible thing. It’s incredible no matter how it gets done. And we are entitled to praise and validation for birthing even if it’s only ourselves who can give that to us. 

Sara: Can you explain what” obstetrical dilemma thinking” is, and how it’s important to considerations of autonomy, patriarchy, and agency within childbirth?

Allison: The obstetrical dilemma is an anthropological theory that female hips are inherently flawed because when we give birth our babies’ brains aren’t developed enough for them to live independently from us (horses can run after birth, etc.) and that this flaw in our bones requires men to intervene in birth with tools and drugs. The OD scaffolds the modern birth industry. It has seeded the idea and practice that birth requires intervention to work. The OD has not only excused but invited episiotomy, C-section, forceps, etc. in birth because it views a mom as a weapon designed to thwart the baby she creates. That interpretation is pretty ridiculous. But anthropologists like Holly Dunsworth are working to change that. Obviously just looking at bones doesn’t give us a full picture of birth—we must look at hormones, muscles, tissues, energetic and metabolic needs, etc. 

Sara: So many facets of medicalized childbirth have been impacted by race and class. You explain, for example, that the “average” labor time was calculated by studying five hundred subjects who were all white and who all gave birth in the same hospital. The Black maternal mortality rate continues to be unconscionable. How else has race impacted how women give birth in the US? And how else has shitty science and inconclusive data impacted the way we birth?

Allison: In the book I write about the ways large and small that systemic racism shapes birth in the US. One example is how the obstetrical dilemma theory impacted Black and white women differently. Journal articles and text books from the turn of the century through the midcentury suppose that Black and white birthing bodies have different inherent flaws. It was believed that white women had fragile pelvises (and constitutions!) that required the tools, arts, and drugs of doctors to give birth successfully. It’s part of why the twilight sleep, episiotomy, forceps deliveries became de rigueur. Knock her out, give birth for her. Meanwhile, Black women’s pelvises and bodies were believed to heartier and more pain-tolerant, thus less deserving of what medical arts could offer. This is rooted in slavery and early obstetrical experimentation on Black women. Black women’s pain not being believed, which we know from good evidence is still common today, is rooted in these outlandishly bigoted theories and practices. The belief persists in hospitals systems that higher rates of pathology can be caused by non-whiteness. Black women are 3 to 4 times more likely to die from childbirth than white women. Today. That kind of says it all, doesn’t it?

Sara: I appreciated how many times you challenged some of my feminist assumptions in regards to childbirth. I cherish each of my unmedicated births, which took place in a birth center, and which all left me feeling embodied and in control, but throughout the years, despite believing that all people should have access to those types of birth, I’ve glibly told friends to approach childbirth without any expectations, or “be flexible” about birth plans, and while I do think a certain amount of flexibility is important, I think it can also leave folks vulnerable to external influences that might not be in their best interests. It’s a tough question, but how can folks prepare for birth with a good balance of surrender and desire for certain outcomes? 

Allison: Yes, this. Very excited to hear that you had unmedicated birth center births. Feeling what happened in my body during labor and birth was important to me, and I love talking to others who share this sense. It was also validating to find in the research that feeling labor and what happens in your body is central to birthing—closed eyes, darkness, physical comfort, relative privacy and feeling safe are all laboring needs in a birth, not preferences. You need these things to give birth. Knowing that is power when the traditional offering is bright lights, loud noises, strangers, all in a foreign place. 

Decades of birth trauma research have found that birth trauma isn’t caused by the kind of birth you have—vaginal, surgical, epidural, episiotomy, fast, slow, whatever. Birth trauma is more likely to occur when women are left in the dark and unsure what is happening to their bodies during birth. My first birth was traumatic in a sense because it happened in 2 and a half hours. That wasn’t what I was preparing for. My water broke and I thought labor was at the beginning when it was actually at the very end, like, baby crowning in the shower, in the Uber. In my chapter on C-sections, I share the story of Lis’s incredible, empowering gentle cesarean birth. She visited the operating theater ahead of time. She wasn’t strapped down, which is a typical protocol to protect doctors not women. Her doctor was supportive and communicative about what was happening. The team put the pulse oximeter on her toe instead of her finger and he told her to tie her hospital gown in a halter so she could easily pull a string to breastfeed after her baby was born. She calls it a healing birth. It wasn’t traumatic because, as the research tells us, she was the expert in the room and informed at every stage what was happening. So the key here is to trust yourself first. And to trust your provider. To choose a provider who believes you are the expert in your own body, your own birth. 

Sara: I think breastfeeding and formula feeding occupy a similarly gray zone in terms of feminism. Like, I don’t want a single person to suffer needlessly because “breast is best,” and formula stigma absolutely sucks, but also I think our country needs to better support breastfeeding parents. You write that “ours is not a breastfeeding culture.” What would a breastfeeding culture look like? Tellingly, you write that, “in 2007, the National Institutes of Health announced that it would dedicate $115 million and five years to studying three hundred human specimens—blood, skin, amniotic fluid, saliva, snot, feces, and more.” But breastmilk was not included. (!!!!!!!)

Allison: A breastfeeding culture would feature universal paid leave and subsidized child care. Not 25% of women going back to work two weeks after giving birth and maybe given a breast pump and a closet to pump in, if that. It would include holistic lactation support for all in perpetuity. It would banish stigma around nursing in public or extended breastfeeding. A breastfeeding culture would likely be one in which perhaps formula companies, like drug companies in Europe, were barred from direct-to-consumer advertising and aggressive tactics like sending new mothers home with formula or boxes showing up on their doorsteps (this happened to me). We would likely see a reduction in postpartum mental health conditions, in breast and ovarian cancers, and an increase in happiness, as the oxytocin hit you get each time is real. We’d also see more “extended” breastfeeding, which I am currently doing with my 4-year-old because he likes it and I like it the end.  

Sara: Related to the above question, when it comes to childbirth, the medical community is still so shamefully ignorant (and underfunded). What do you think the most appalling point of ignorance is? If you had all the money in the world, which aspect of childbirth would you throw the most money at?

Allison: The midwifery model of care, the core of which is that every person giving birth is the expert in her own body and should be treated as such throughout her perinatal experience, and that birth is a physiological process in the body, not a procedure in a hospital, is what should be the standard in the US. Tons of good evidence points to this model (which includes collaboration with doulas) as not only producing better outcomes for moms and babies, less trauma and surgery, and better experiences but it actually saves lives. The researchers who study maternal healthcare at the CDC state that this model and doulas are an inextricable part of reducing our country’s heinous maternal mortality rate, yet this method of care remains far from the norm. All the money should be thrown at making it the rule, not the exception. The majority of pregnancy and birth related deaths are preventable. So let’s prevent them. 

Sara: My eyes were opened SEVERAL times throughout this book, but the research on postpartum onset PTSD really blew me away. Can you talk a bit about that? 

Allison: There is no universal postpartum (or perinatal for that matter) mental health screening. Conditions like depression, anxiety, and P-PTSD go undiagnosed. There is a lot more attention and focus on depression because it’s in the DSM. And there are women who are getting a depression diagnosis wrongly, who actually have P-PTSD. That matters because the treatments differ. P-PTSD sufferers can be thrust back into reliving trauma at any moment and are pretty powerless to stop that without specific therapies that I write about. A big reason we’ve long ignored PTSD in new moms and in women in general is because the discovery of it and subsequent treatment centered on men coming back from war. The screening test we all use today was developed by the military. And the military is still a big funder and supporter of efforts to diagnosis and treat PTSD. I also think that as a society we’re resistant to the idea that new motherhood could be traumatic, that women suffer during this time. 

Sara: Can you talk to me about Donald Winnicott’s “ordinary devoted mother?” Winnicott famously introduced the idea of the “good enough” mother, which I and many others have embraced. But, unsurprisingly, his work wasn’t without flaws, right?

Allison: The ordinary devoted mother is the idea that early mothering is a natural act, that you can’t teach it, and that no matter how women are doing it they are inherently doing it right. I took a lot of comfort in this idea when I was a new mom and it was hard. However, the idea is bound up the goddess myth and it flattens women into both a baby devotee and care machine. That’s especially problematic when our transitions to motherhood aren’t serene and goddess like—they’re ambivalent, flawed, hard. Made more so by our society. The ordinary devoted mother trope doesn’t account for the complexity and transition of actual mothers. Not to mention it was conceived by a man who wasn’t a mother. 

Sara: I study momfluencer culture, and one particularly noxious type of momfluencer is the “divine goddess free birth” momfluencer who sells essential oils for an MLM, espouses supposedly feminist beliefs about bodily autonomy, but also disseminates anti-trans rhetoric and conspiracy theories about “jabs” and misinformation about certain types of births permanently destroying mother-baby attachment. How can we advocate for “natural” childbirth (which means what, for you?) while also steering clear from harmful, reductive, gender essentialist arguments?

Allison: An important argument for natural childbirth is that interventions add risks that wouldn’t otherwise be there, even when they are needed, and providers routinely don’t explain that to women. C-sections account for a third of all births and the vast majority of them are unnecessary. They increase the risk of hypertension, sepsis, and hemorrhage, all leading causes of maternal mortality. There are rare instances of life-threatening conditions that require C-section (like placenta previa, when the placenta is blocking the baby’s exit) and it’s a good thing we have the technology to apply in a scenario like that, but again it’s very, very rare. Regardless, I think everyone should have the birth they want, whatever that means to them. For me, it meant birthing naturally, vaginally, and with as little to no intervention as possible because I believed in my body and my ability, and I feared adding in unnecessary risk. At my core, I also hate being told what to do. 

Sara: “We both expect and direct ourselves to sacrifice for our infants, only for society to despise and fear us for it, then sublimate and strip us of power. We too have internalized this fear of ourselves. We have shuttered the possibility of power, this ordinary ability not only to meet the needs of our offspring but also to create them, to grow them, godlike, from our own flesh. We internalize early motherhood as a sentence we serve, not power at all but sacrifice.” I MEAN. I’m fairly certain that I became convinced that patriarchy was conceptualized as a defensive strategy as soon as I pushed that last push to get my first baby out. We create life! We are magic! 

Allison: They know what we can do and it’s terrifying and perhaps we’ve been punished for it ever since. Imagine being the forever witness/sidekick to the magic human creators. When I talk about the book, men will often say a version of this: that if men were responsible for birth then humanity would have gone extinct a long time ago. Maybe that’s projection. But we who give birth have essential and godlike power that men simply cannot have. Let’s celebrate us.