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More Like a Wedding Than an Illness

“As a patient and the daughter of a patient, I was amazed by how precise surgery had become and how fast healing could be. I was struck, too, by how kind many of the nurses were; how smart and involved some of the doctors we met were. But I was also startled by the profound discomfort I always felt in hospitals. Physicians at times were brusque and even hostile to us (or was I imagining it?). The lighting was harsh, the food terrible, the rooms loud. Weren’t people trying to heal? That didn’t matter. What mattered was the whole busy apparatus of care—the beeping monitors and the hourly check-ins and the forced wakings, the elaborate (and frequently futile) interventions painstakingly performed on the terminally ill. In the hospital, I always felt like Alice at the Mad Hatter’s tea party: I had woken up in a world that seemed utterly logical to its inhabitants, but quite mad to me.

– Meghan O’Rourke, The Atlantic (emphasis added).


The things modern medicine can do when you’re sick are pretty impressive. I am weak with gratitude to the surgeon who skillfully removed my appendix (and my mother’s) before it burst; for the antibiotic that probably saved my husband’s life when his foot became dangerously infected; for the medical professionals who took tender care of my son when he broke bones. Hospitals are marvels of health care delivery.

But a hospital is not necessarily the best place to have a baby.

I work with women who desire natural birth – that is, to give birth without interventions that interfere with the body’s innate process. Yet most of them do not question giving birth in hospital.

We should question it. I don’t mean chuck medicine altogether, but rather soften its influence by placing birth away from “the whole busy apparatus of care” and into the settings where the focus is not on the “inhabitants” – hospital employees and the tech they wield – but on the family: in independent birth centers and at home.

It’s time to think differently about birth. It may help if we notice that, instead of being like a chronic illness cured by medicine, birth is like a wedding: an intimate and celebratory once-in-a-life time moment of social and spiritual significance for the whole family.

Here are some parallels to consider.

Both are a rite of passage. Though our current moment interprets birth as a medical event, it has historically been understood to be a rite of passage: a time out of ordinary life in which initiates physically and symbolically shed the old life and enter a new one. The rite introduces initiates to guides and orients them to their new life. (My new course, Becoming A Mother, restores birth to this context. Look for it in the New Year!)

Out of hospital, birth has retained this context and power. In hospital, however, birth is stripped of most of its significance and instructional value. The mother’s intuitive and community guidance is replaced by the clinical assessments of strangers.

Both have an officiant to guide the couple through the rite of passage. In birth, the officiant is the birth attendant. In the US, obstetrician, surgical specialists, attend 92% of births and midwives, the experts in physiologic birth, attend the rest.  It would be like bishops officiating 92% of weddings, instead of the parish priest.

A marrying couple doesn’t simply take whomever they get. They choose carefully based on the officiant’s experience and on how well their philosophy and practice style align with the couple’s. They notice how they feel with the officiant. They respect the officiant’s expertise, but they also continue to trust themselves and their own judgment. Choose your birth attendant similarly.

Both take place in a special location. Again, the couple doesn’t just pick the location nearest to where they live, or the place where their friends have married/birthed, let alone the place their parents/insurance will pay fully for. They choose the space carefully based on how it suits their unique needs and how they feel in it.

Some people choose to get married at home because it’s where they feel best. Similarly, home birth may be the right birthing location for the healthy moms and babies who choose it. It is important to know that although home birth is still rare in the U.S., it is not rare in the countries of the developed world which have better maternal/fetal outcomes. Out-of-hospital birth attendants also manage to keep Cesarians to about 5%, compared to a rate of 33% for hospital births.

Expect to pay to get what you want. Parents traditionally pitch in generously for a wedding, but if there isn’t agreement between parents and the couple, the couple usually finds a way to make up the difference.

It’s time we started to become willing to pay for birth, too – for the experience, not just the layette. Find out what your insurer pays for out-of-hospital birth. You may find they cover birth center birth and home birth, at least partially. Out-of-hospital fees are also much less than hospital fees. (According to “Evidence-Based Maternity Care,” in 2003 a birth center birth averaged $1,624, and an uncomplicated vaginal hospital birth averaged $6,239.) You may find that hospital birth, even with insurance coverage, costs more than a birth center or home birth you pay for entirely out of pocket.

By voting with your wallet, you are influencing trends in maternity care much more than with a birth plan. Think of it as paving the way for your siblings as well as investing in memories you will treasure for a lifetime.

Plan a special time for after. A honeymoon is a special time of adjustment and celebration set aside for just the couple after the wedding. It is time we started to plan “babymoons,” too – 28 days (or so) for everyone to adjust to their new life.

In traditional societies, the women of a mother’s village stepped in to do her work so that the new mother could rest with her baby for four-to-six weeks. That is no longer traditional in modern society, but we can resurrect the practice. (I detail how in Five Keys to Thriving Postpartum, which you can receive as a thank you for signing up for my newsletter!)

By reframing it in this way, birth is restored to wholeness and its natural context within the family. Parents and child are restored to their place at the center of the event, and risk management and medicine in their place: still present but on the sidelines.


I’d love to hear your experiences comparing in-hospital and out-of-hospital birth. Please share your stories in the comments!

Join the discussion 2 Comments

  • Kara says:

    Allison, lovely post! I can second your advice in regards to home birth (something I’m looking forward to doing in the next week or two!) I was surprised, after much digging, that our insurance DOES cover partial cost, and it will be more affordable than a standard hospital birth. Also, the care from my CPM’s has been so personal, respectful, evidence-based, and peaceful. I’ve seen them every week for the last two months, and they always spend a full hour with me! I know when I give birth they will surround me with respect, compassion, skill, and care.

    • Allison Evans says:

      Kara, thank you so much for sharing your experience! First, it is encouraging to know that insurers will at least pitch in for out-of-hospital birth. That should give interested couples the heart to investigate it! Second, I am so thrilled with the care you are receiving from you midwives. You are in my thoughts now every day, and I look forward to hearing the story of your baby’s birth!

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