How much choice does a woman have when giving birth in the USA?

Before I begin, I want to be clear that I am writing this based on my own personal experience. I am part of an HMO plan in California and working with an OBGYN, and people who are on other insurance plans, live in different states or have a midwife may have had completely different experiences.

When I first started planning for my baby’s birth way back in early March, I thought that I would need to be in Canada for the end of October (I’m due early October), and of course I would want to take the baby with me. This meant I would need to expedite the birth certificate in order to receive it in time to cross the border. Obviously COVID-19 has changed things and I will no longer be traveling in October, but at the time this was a real concern. I couldn’t risk her arriving later than her due date, or there was a chance she wouldn’t have her birth certificate in time to cross the border.

I began to look at various birth options. Of course ideally she would arrive on time and everything would be fine, but most first born babies tend to arrive later rather than earlier or on time.

Another option was an elective c-section. Most of the information on the web is about emergency c-sections, so at first read it sounded quite risky, but once I was able to find info about elective it actually seemed almost preferable to a vaginal birth. It has a longer recovery period in both the hospital and once you’re at home and of course there are the usual surgical risks (bleeding, scars, infection, etc.), but the pain is considerably less during the procedure itself, you’re less likely to have pelvic issues and bladder incontinence, labor is not as long, and perhaps the most exciting: your vagina stays in tact. You can also schedule a c-section at 39 weeks vs. 40 weeks, and so most women feel more prepared and in control of their delivery rather than being surprised when they suddenly go into labor.

I asked my doctor about elective c-section, and it turns out I would have to pay full price for my elective c-section – the insurance wouldn’t cover a dime. If there’s any reason to call it an emergency or required c-section things would be different, but an elective c-section could cost from $15,000 to $27,000!!! So c-section, it would seem, is not a “choice” that most women can make.

Continuing to look into options, I then discovered that a woman can be induced at 39 weeks, though there’s a 75% chance that the cervix will not be ready at that point and you’ll be sent home to wait another week or so. Labor is also longer if you’re induced vs. if you naturally go into labor. The benefits, however, seemed amazing to me. It has all the same benefits as if you were to wait for natural labor, but overall women report less pain and that they felt more in control of their birth experience. There is also a reduced risk of the baby needing to go on respiratory support, a reduced risk of needing a c-section, and a lower risk of having hypertensive disease in pregnancy.

It’s important to note that induction before 40 weeks has been considered a big “no-no” up until the last couple of years, when a study by the National Institute of Health showed that as long as you waited until 39 weeks (NOT before!) there were actually more benefits vs. risks.

When I spoke to my doctor about this, she kept harping on the negatives of inducing before 39 weeks (which is not what I had asked about) but never actually responded to whether it’d be okay to be induced at 39 weeks. She kept saying “well, it’s a bit early to discuss this” and “let’s wait and see what happens.” Clearly, this is not something that she was terribly excited about. I had planned to bring it up again with her, but now with COVID-19 taking away my need to get to Canada in October it doesn’t seem necessary. I’m fine with waiting for natural labor (although we’ll see if that’s still the case when the due date gets closer!).

So what choices does a woman have when giving birth?

  • You can choose if you’d like to work with an obstetrician or a midwife.
  • You can choose if you’d like to give birth at a hospital or at home. If you give birth at home, you may be rushed to the hospital if there’s an emergency but otherwise you have more options when it comes to where and in what position you’d like to give birth.
  • You can choose whether or not you want pain management, and what type of pain management method to use (i.e. epidural, nitrous oxide, etc.).
  • You can choose what position you’d like to give birth in, but only if you have opted not to have an epidural. Once you select an epidural, you are pretty much resigned to a bed.
  • You can choose who you’d like in the room with you. This is mostly when it comes to family and friends, and not doctors and nurses.

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