When is the first time you realized you had true choice and autonomy in birth?

Are you on the threshold of just now realizing this?

Below are some of the ways in which women are often surprised to know that THEY (in conjunction with their womb babies)  have the ultimate say in their birth experience.   Note:  This doesn’t mean that we get to choose the outcome, but we DO get to influence the overall experience.  Similar to how when we go on a hike, we can choose different trails and the general pace but the summit is the same.

Barring evidence-based medical necessity, healthy women who are pregnant and/or in labor:

• Don’t need an IV in labor or even a hep-lock (unless you choose pain medication)
• Don’t have to head to the hospital/birth center immediately after their water breaks (always check for signs of meconium)
• Do not require induction prior to 42 weeks
• Can choose to birth at home, in a hospital, a birth center, on any other wild wonderful place on Earth
• Do not require ultrasounds during pregnancy
• May decline any routine testing/procedures for themselves and their newborn
• Do not need vaginal exams prior to or during labor (generally a hospital does have a policy for requiring a certain cervical dilation before they admit a patient).
• May labor and push in any position she desires (mamas/dads/partners, midwives and ob’s can catch/deliver a baby in just about any position)
• Does not require continual fetal monitoring (some providers do have protocol around VBAC’s but even these can be discussed prenatally with your midwife/OB)
• Can ask if the hospital has wireless fetal monitors (many do and some are even submersible in water)
• Does not have to receive Pitocin to “speed up” a natural labor (there are so many other natural alternatives as well as the good ol’ “Wait and See”)
• May eat and drink in labor (most women only want small bites of food but hydration is very important)
• May wear her own clothing or none at all (don’t have to wear the hospital gown)
• Don’t always follow a standard “pattern” for labor contractions and progress
• Can labor in water even after her water has released (water broken)
• Can be in charge of her ambient environment; ask to have lights dimmed, music on, temperature adjusted, etc.
• Doesn’t have to follow “coached pushing” if birthing unmedicated (can follow her own body cues)
• May feel her baby as he/she is crowning
• Can decline an episiotomy in favor of allowing her body to tear
• Has options even when a C-section is chosen:  can request that sleep medications not be added to her IV, may apply essential oils to pulse points to help calm and ease her, can have partner take photos/videos, may ask for immediate and continual skin-to-skin contact, etc).
• May ask for her or her partner to help catch the baby
• May delay cord clamping until the cord has stopped pulsing
• Does not require routine intravenous or intramuscular Pitocin immediately following birth
• May view and/or keep her placenta
• May keep her baby skin-to-skin, with her, at all times and until she is ready for the newborn exam
• Can choose not to have her baby bathed, circumcised, vaccinated, eye-ointment, sent to nursery, etc

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Share with me some of the other ways in which women have choices in their beautiful birth experience!

I wrote this a few years ago for a prior website related to how design and architecture impacts each of us.

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The light of a singular candle flickers, its sea-inspired aroma lingering.  Silky tapestries dappled with soothing pastels move fluidly with the breeze from the fan.   The air is humid and warm, full of anticipation and ancient memory.  A bed, littered purposely with pillows of various sizes and thickness, awaits with freshly smoothed and laundered sheets.    Like a protective lioness, low moans emanate in harmony with quietly sung chants, and the occasional sound of water being swirled by fingertips; the soundscape of birth.  Breath, deep and intentional, becomes the new song.

In this protective cocoon, there are no strangers.    As the sun peers through the curtain, a new life emerges into this space.  This is the space of my youngest daughter’s birth.

Growing up around litters of cats and dogs, I was always intrigued to notice how the females seemed to retreat to a place of quiet and solitude when it was time to give birth:$   Under the bed with dust and old magazines, in the closet amongst the stash of winter clothes, or beneath the evergreen bushes.  This migration to a safe refuge signaled the imminent addition of babies to our clan of animal companions.  Noticing this, my family would often respectfully help the animal create an optimal birthing space by fluffing a cozy pallet of blankets, keeping water and food near, and providing protection from the elements.

I find it no coincidence that humans seek to create similar birth spaces, ones that sustain the biological, emotional, and physical needs of birth.  From a biological perspective, scientists and midwives alike recognize the critical innate need for a birthing woman to feel “safe” during the experience of labor and birth.   This understanding is based on “the hormonal orchestration of labor and birth”, as described by childbirth educator Judith Lothian, or rather the physiologic process of birth that involves the stress hormone catecholamine.

Lothian continues:  “In nature, when a laboring animal feels threatened or disturbed, the stress hormone catecholamine shuts down labor. Similarly, when a laboring woman does not feel safe or protected or when the progress of her normal labor is altered, catecholamine levels rise and labor slows down or stops.”

As we venture into the emotional layer of birthing, we understand that “safety” takes on a new meaning; one of feeling loved, attended to, listened to, supported.  In this space a birthing woman is provided the expanse of freedom and fluidity.

Furthermore, we know that the design and ambiance of spaces and places are often an important component in cultural or social rites of passage.   These are the places we will venture to year after year, to feed our desire for ritual and remembrance.  The acoustics and grandness of a cathedral for a wedding, the chirping of crickets and hand-made fire surrounding a summer camp, and the perfect combination of vehicle and seclusion for a lover’s lookout point.

With birth as the ultimate rite of passage, the concept of appropriate space is paramount.  Let us not forget that not only will a woman be doing the work of a lifetime in this space, but a child will marks its arrival there as well.   In terms of sustainable design (that which sustains the spirit and the earth), how can we accommodate the creation of safe, respectful places for women to birth?

Like many women, I chose to birth at home because I felt safe in its familiar territory.  I could handpick my birth team – thereby eliminating strangers in my birth space – and arrange my space to fit my very my comfort level.   The germs were my own.  The music my own.  The blankets, the clothing, the food, the timeline, and the rhythm were all my own.

But for the majority of women who choose to birth in hospital or birthing centers, the same level of comfort and security is deserved.  A space full of humanity instead of institution.

If the word “sustainable” means “To support the spirits, vitality, or resolution of; encourage” then I propose that designers of health care facilities and consumers alike ask the following conscientious and holistic questions regarding birth spaces:

Is there natural light in each room?   Private access to a shower or a roomy bathtub?  Rounded, gentle corners to walls and sturdy counters to lean against?  The ability to dim the lights?  Equipment for music?  A cabinet with a stock of rice socks, birth balls, massagers, fans, and other comfort measures? Soft surfaces like cork – which is naturally antimicrobial, renewable, mold and mildew resistant, and non-allergenic – to pad tired, heavy pregnant feet upon or rest weary knees upon?  Unique temperature controls for each room?  Warm slippers and a decadent robe hanging from hooks? Soft curtains and fabrics adorning the room?

Photos of strength, depictions of goddesses, images of nature? A double sized bed for a partner or support person (and eventually a newborn)  to rest alongside the laboring woman?  Wonder Woman cups to sip from? An interactive, cozy, playful, safe waiting room for children and loved ones?  Furniture scaled for pregnant women and soothing colors on the wall?  The greeting of fresh flowers in each room? A private patio with a porch swing and a drift of breeze?  A walking path filled with blooming flowers and a koi pond?

I won’t deny that this collective effort to provide “birth-sustainable” design may cost more or require more thoughtful planning.  I admit that some of these requests come at the worthy price of a culture shift; from a “birth for the masses” mentality to a “birth for the individual” approach.   Because I don’t know any birthing woman who loves the tiny, hard beds, glaring lights, and cold floors of a hospital.

Isn’t the environment in which we are born worth the extra cost and extra attention?  Must women sacrifice the need to birth in an intentional, provocative space?  Are there architect and administrations willing to forgo convention in an effort to bring about a revolution in the spaces in which first breaths are taken?
As Alastair Faud Luke stated, “We have failed to put the individual in the middle of the sustainable design debate”. –

Let us not continue to fail.