There are a number of reasons that a pregnant person may choose to give birth with a midwife and at home rather than in a hospital or birth center. Some choose a home birth in order to remain more in control of the birth experience, believing that hospital births can be pushed too rapidly towards medical interventions like induction and c-sections. Others want to be able to feel more comfortable, conducting the entire labor in one convenient and familiar place, with the added benefit of moving straight to real life after the birth is complete. Even finances can play a role, as the average hospital birth grows more and more expensive even with insurance.
For many, an assisted home birth with a qualified midwife poses no more risk than a standard uncomplicated hospital labor and delivery. Yet there is a growing movement to regulate both midwives and home births, just like many other issues in reproductive health care, using the rationale that potential life always outranks the desires or beliefs of the person carrying that pregnancy, and that the pregnant person is not capable of making fully informed decisions about her own medical health.
That’s the situation in Arizona, where an “emergency” proposal is being introduced in the legislature to undo new advances when it comes to allowing assisted home births in the state. The bill, SB 1157, would forbid licensed midwives from taking on medically complicated pregnancies, such as a breech, the birth of multiples or when a pregnant person is having a VBAC (vaginal birth after cesarean section).
Midwives, on the other hand, say that they have been trained for just such complicated deliveries, and that there is no reason to have a blanket ban on all of these scenarios, which should instead be taken up on a case by case basis with the decision made by the patient and her midwife. “Women and mothers are smart, informed and educated. We have a right to choose our patient care. We have a right to do our own research and make our own choices for our birth,” testified Tori Anderson, of the Right for Homebirth consumer group, in opposition to the bill.
Lawmakers proposing the ban disagree, and believe that the pregnant people in question either aren’t intelligent enough to weigh risks, or are selfish enough to put the health of their future child in jeopardy in order to stay out of a hospital. Sen. Kelli Ward (R-Lake Havasu City), the bill’s sponsor, says that it’s up to the legislature to care for the life of the fetus since the mother is obviously incapable. “I’m a pro-life legislator. I see the mom and the baby as two separate entities,” Ward said, according to the Arizona Republic. “I would love to preserve the choice of the mother for their home birth, but that child also needs to have a choice … the choice not to die.”
The idea that lawmakers, and not a patient, should be inserted into care decisions in order to represent what they see as the state’s interest in that fetal life is nothing new to Arizona, which also passed a bill saying that doctors could not be punished for withholding medical information from a pregnant person if the information may make her choose to terminate a pregnancy. In this case, however, legislators are once more making a case while manipulating facts.
Although medical best practices used to believe that once a person had a c-section, the risk of a future uterine rupture was too great to do anything but a second surgery for the next birth, opinions on that have changed. Risk of rupture now is placed at less than 1 percent — yet many health practitioners still insist that a VBAC should only be attempted in a hospital where there is a team that can immediately provide care in the case of that 1 in 100 complication. For comparison’s sake, in-hospital births that end in emergency c-sections continue to rise, in some states to as much as one in three births.
If a pregnant person who had a c-section shouldn’t be allowed to give birth at home because she has a 1 in 100 chance of a rupture that would turn into a medical emergency, shouldn’t it logically follow that if 1 in 3 labors end in c-section all births should be required by law to be in a hospital?
Sen. Ward’s argument that the state must protect the baby from harm, in this case used against midwifery, is really in essence a declaration that pregnant people do not have the right to make a medical decision without approval of the legislature, who will weigh her opinions against their beliefs in what is the best action a “mother” should take at any given moment. From birth control to abortion to pregnancy and birth, from the moment of conception, the Arizona legislature now gets to judge and modify a pregnant person’s behavior.
All for the sake of the baby.