Anyone who has ever been pregnant is familiar with the barrage of advice and opinions that comes their way. Eat this, not that; try swimming or prenatal yoga to relieve backaches; go to this obstetrician or that pelvic-floor therapist. It could be your own sister or a stranger in the grocery store haranguing you about C-sections or water births. Everyone has a story to share, either their own or that of someone they love.

During my pregnancy, I was fortunate to have excellent sources of information: my mom, a couple of friends, a great OB-GYN practice, What to Expect When You’re Expecting. I tried to keep the circle of advice tight. I was pregnant in 2022, by which time many people had begun getting pregnancy advice from social-media accounts, many of which espoused “natural birth.” While definitions vary, this tends to mean unmedicated vaginal birth with as few medical interventions as possible. Natural-birth advocates are often skeptical of obstetrics, pediatricians, hospitals, and the health-care industry in general, which they accuse of being profit-hungry, anti-woman, and technocratic. They lament the “medicalization” of childbirth, which has turned a natural process into an illness in need of specialized treatment. Above all, they encourage women to “trust their bodies.” Women’s bodies, they say, are well-designed to give birth safely with only a rare need for C-sections or inductions; indeed, interventions are often the cause of complications in childbirth. Some say giving birth is the pinnacle of feminine purpose and identity; it should be a transformative, empowering, even orgasmic experience, and interfering with it robs women of their right to feel such a transformation.

“Trust your body” is meant to be encouraging advice. It’s an appealing message, and it’s compatible with many different belief systems. Influencers tailor their messages to various audiences: To a Christian, God made his creation lovingly and made it to be good, so women’s bodies are well-made to fulfill a purpose. To someone with different spiritual commitments, the thought of the wisdom of women ancestors flowing through our bodies is a comforting one, or maybe it’s the idea that the Mother Goddess is watching over us. To feminists, it’s empowering to believe that our bodies are competent, purposeful, and life-giving.

But is this the right advice to give women? If women’s bodies are designed to give birth, does that imply that we should avoid medical interventions as much as possible? In wealthy societies today, most women have perfectly healthy pregnancies and deliveries, but some do not; does this mean their bodies are somehow defective? The exhortation “trust your body” can shame women into thinking that their bodies have failed if something goes wrong, or, even if things go well, it can leave them disappointed if they don’t have the transcendent experience they were promised. Discouraging women from taking pain medication suggests that it’s appropriate for women to suffer.

The way we understand pregnancy and childbirth is important because it influences the choices we make—which have real consequences on women’s and babies’ health. Women’s bodies—especially pregnant ones—symbolize and signify so much. As natural-birth advocate Cynthia Gabriel writes, “I find it virtually impossible to witness life’s portals opening without contemplating all the Big Questions that spiritual traditions address: Who am I? Where did I come from? Why am I here?” Personally, I was amazed when I was pregnant that my body “knew” how to grow another life without my conscious help; it felt like the most natural thing I could do. Because my life, a baby’s life, and so much meaning are on the line, small choices speak volumes about what we believe is happening in pregnancy and birth and have huge consequences for everyone involved. I’m worried that women and their children are ill-served by the natural-birth movement gaining traction today.

The natural-birth movement is not new. It emerged out of women’s fight for agency in their medical decisions. Second-wave feminists saw childbirth in particular as something to be reclaimed from a predominantly male, technocratic medical establishment that viewed women and their bodies as problems to be solved. Barbara Ehrenreich and Deirdre English’s 1972 manifesto Witches, Midwives, and Nurses captures the spirit of the moment, criticizing the dominant obstetric practices that dehumanized and harmed women. Throughout most of history, they write, predominantly female midwives were recognized as authorities on women’s bodies; they used wisdom that had been accumulated through millennia of practical experience to keep women healthy and were respectful of their bodies’ natural processes. But in the nineteenth and early twentieth centuries, a professionalizing, exclusively male medical establishment adopted new technologies and pharmaceuticals, turning away from human—especially female—experience. Women, Ehrenreich and English write, “were not supposed to know anything about our own bodies or to participate in decision-making about our own care.” 

In her book Natural Causes, Ehrenreich elaborates on standard obstetric practices designed to make women feel “powerless, demeaned, and dirty.” For much of the twentieth century, it was common to fully sedate a mother for labor, rendering her an inert obstacle to the birth of her child rather than an active, necessary participant in the process. Doctors required women to give birth in the lithotomy position (lying on one’s back, with legs spread apart), not because it was an effective position in which to push, Ehrenreich charges, but because it was the most convenient position for the doctor. Women’s pubic areas were routinely shaved, supposedly to prevent infection. On top of being disrespectful, such practices can be harmful. Shaving actually increases the risk of infection, and sedation is very dangerous for a baby. Ultimately, Ehrenreich writes, women were passive recipients of their doctors’ expertise; their bodies and the way they functioned were the exclusive province of the male doctor. Ehrenreich recalls that, during her own labor, she asked her obstetrician how much her cervix had dilated. “Where did a nice girl like this learn to talk like that?” he responded.

To reclaim their rightful role in childbirth, feminists of the women’s-health movement advocated natural-birth methods, like the Lamaze method, for handling birth pain without drugs. They encouraged women to educate themselves on how their bodies work and to make scientifically informed decisions. Ehrenreich and English are careful to note that their problem isn’t with medical science per se but with a system that wields it to oppress women. “In our frustration, we are sometimes tempted to reject science, rather than to challenge the men who hoard it. But medical science could be a liberating force, giving us real control over our own bodies and power in our lives as health workers.”

When it came time for me to decide how I would give birth, I was inspired by those in the women’s-health movement who had fought, educated, and resisted. I didn’t agree with them on everything, especially some of their beliefs about abortion and their advocacy of homebirth, but I was encouraged by their confidence in women’s agency and their insistence on analyzing health care as a system that can be at odds with a patient’s—especially a female patient’s—needs. 

The natural-birth movement of today shares a lot of common ground with the women’s-health movement and borrows its concepts. As I investigated it, though, I didn’t like what I found. In podcasts, doula blogs, and Instagram accounts, the overwhelming message was “trust your body.” Anyone suggesting “interference” with childbirth—through epidurals, electronic fetal monitoring, Pitocin drips, C-sections, cervical exams—has an ulterior motive. Instead, women should rely on their body’s inherent wisdom and “natural” methods—massage, aromatherapy, hypnosis—to create a beautiful, empowering birthing experience and to manage pain. Accepting medical interventions means that you don’t trust your body, and that can only result in a lesser experience that also endangers both mother and baby. 

Perhaps the first use of the term “natural birth” was in 1933 by Grantly Dick-Read, a British doctor who believed that decreasing fertility rates in London were due to women being “overcivilized” to fear pain. Instead, they should be more like their “primitive” counterparts in other parts of the world, who, he claimed, do not experience pain in childbirth. (For the record, this is false.) In other words, it’s women’s fear of childbirth, not childbirth itself, that makes it painful and causes complications. 

I would wager that few natural-birth advocates know Dick-Read’s name, but they definitely know Ina May Gaskin’s. Gaskin became famous with her 1975 book Spiritual Midwifery; in that book and subsequent ones, she writes about her experience as a self-trained midwife at The Farm, a commune in Tennessee that she and her husband founded and where she still practices today. Gaskin and other women assist pregnant women at the commune’s birthing center and also attend home births in the community. She is widely respected by a variety of groups and has received accolades from Planned Parenthood and Lamaze International. As of this writing, Ina May’s Guide to Childbirth (2003) is ranked #11 on Amazon in the Pregnancy & Childbirth category and #2 in Health, Mind & Body. When I was pregnant, a friend lent me a copy of it, and when I checked the book out of the library to research this article, the librarian commented on how popular it was.

Gaskin’s fundamental message is that women’s bodies are completely adequate to give birth, but the medical establishment has deceived women into thinking that they need medical intervention to do so. “Pregnancy is not an illness in need of treatment, and nature’s design of women is not considered flawed,” she writes in Birth Matters. We have been taught to fear birth, but our fear gets in the way of a natural process. Echoing Dick-Read, Gaskin insists that part of her work is teaching “civilized,” “educated” women “how to behave like indigenous people—actually, like any other mammal.” They need to surrender to the experience rather than overthink it, to release their “inner ape” or “wild woman” while laboring. Women should focus not on the potential for pain but on how pleasurable giving birth can be, and use massage or breathing techniques to stay calm and keep the oxytocin flowing. “One of the best-kept secrets in North American culture is that birth can be ecstatic and strengthening,” she claims. “Ecstatic birth gives inner power and wisdom to the woman who experiences it,” she writes in Ina May’s Guide to Childbirth, and can sometimes involve feelings of intense intimacy with a partner and even orgasm. Women enter a sacred state of bliss, a higher plane of femininity, “when they are able to trust the wisdom of their bodies to labor and give birth in a way that is undisturbed.” This “mystic beauty” came upon “women who were not frightened,” Gaskin writes, and in these cases “complications are rare, and babies are born clean, rarely having any blood on them.” 

Approaching birth in the most natural, primal way possible not only facilitates a beautiful experience; it also, Gaskin claims, is safer for mother and baby. Medical interventions are to be avoided unless absolutely necessary, otherwise the mother risks the dreaded “cascade of interventions,” in which one procedure leads to more and more invasive procedures. For this reason, Gaskin and other natural-birth advocates are particularly opposed to epidurals. An epidural immobilizes the mother, which means she must labor on her back. Labor could stall when the mother can’t move around; doctors will then recommend the use of Pitocin to speed the process along. This could end up requiring a forceps or vacuum delivery, or even a C-section. If the mother had avoided the epidural in the first place, she would have been able to give birth naturally and unproblematically.

When my husband and I were making plans for our son to be born, we wanted to look at all of our options. Initially, I contemplated a birthing center—a facility in which nurses and midwives are available to assist with birth, but which is meant to be more comfortable and less emotionally sterile than a hospital. Some less invasive procedures may be available there, but epidural pain relief and major procedures like C-sections are not. For low-risk pregnancies like mine, birthing-center deliveries are considered as safe as hospital births. This appealed to me. A cascade of interventions sounded pretty scary; aromatherapy and soothing music seemed a lot more humane than a sterile hospital. 

As I did more research, I saw Gaskin’s vision of natural birth everywhere I looked. I was surprised that sources with very different ideological, religious, and even political commitments found something to like about natural birth. They tended to posit some kind of Creator, and to insist that a woman should trust her body and its maker—the Christian God, the Divine Feminine, or some other power. One Christian natural-birth blogger (who has almost a quarter-million followers on Instagram) writes:

God designed women perfectly. He gave us the ability to birth our babies without any intervention. It’s a process as natural and normal as breathing…. Trust yourself + your baby. Trust that you were created for this. There is purpose in experiencing it just as God intended.

On the less institutionally religious side, the introduction to Gaskin’s Birth Matters was penned by folk musician Ani DiFranco, who rhapsodizes that “[t]he pains associated with menstruation and childbirth (even the emotional pain) are the price of having agency with the bloody, pulsing, volcanic divinity of creation, and they lie at the core of feminine wisdom.” Women giving birth naturally tap into a kind of universal femininity, a “wisdom” that sustains all life. Some natural-birth advocates reflect on how the experience unites us with our female ancestors. Cynthia Gabriel writes that natural birth “connects our generation with the women in the hundreds of thousands of generations before us.” DiFranco insists that pregnancy and childbirth “are meant to be a time in women’s lives when they bond with other women and all of womanhood.”

As DiFranco implies, part of what it means to be a woman is to endure pain, and this belief is prevalent across the natural-birth movement. Birth pain is natural, so it must be good or beneficial in some way, and taking it away robs women of something fundamental to the process. “For many women…natural birth brings the greatest reward that any life experience can provide—a sense of joy, achievement, and satisfaction,” Gabriel claims. If women don’t meet this pain virtuously, they will only feel more pain: “When you feel overwhelmed by contractions, you have not yet surrendered. You are in pre-surrender. A miracle happens in the instant that you yield.” Gaskin writes that natural birth allows a woman to “give birth in ecstasy, with her full power evident,” and anesthetizing this experience decreases a woman’s power and denies her bodily wisdom. To be able to “stay strong” in the face of pain and reject the epidural, natural-birth advocates insist that pregnant women should consume as many stories of natural births as possible. One influencer encourages women to “fill [their] cup” with inspiring and encouraging birth stories so that they will have the fortitude to achieve an intervention-free birth. If a woman doesn’t get her head “in the right space for birth,” she might succumb to an epidural or another easy way out.

Moreover, a woman must work for the childbirth she wants, and this requires “designing” her birth experience as she wants it to be. Gabriel insists that you must “create a vision of birth for yourself,” discovering your “ideal birth.” As one blogger puts it, every decision you make should advance this goal—not merely a safe delivery for mom and baby, but an ecstatic, monumental experience. “I want you to have the empowering, magical, intoxicating and transformative experience that you and your baby were intended to have,” one influencer writes. “You owe it to yourself to explore every option, every alternative, to take ownership of your experience. This is your first step in your journey as a deliberate Mother.”

I ultimately chose to give birth in a hospital rather than a birthing center because I wanted at least the option of an epidural. This decision came with some shame, especially because several other women I knew were opting for a birthing center. Was I not brave enough, not virtuous enough, to confront the pain that was my apparent inheritance as a woman? Would I succumb to the cascade of interventions? Ultimately, did I not trust my body?

The more I thought about this final question, the more I realized how many problems there are with it. Are women’s bodies really so well-designed to give birth? The record of human history suggests otherwise. Maternal-mortality rates are difficult to ascertain and vary by time and place. In colonial America, for example, historians estimate that 1 to 1.5 percent of pregnancies resulted in the mother’s death. Since a woman often had many children, her lifetime risk of dying in childbirth was about 4 percent. Today, in high-income countries, it’s less than 0.02 percent.

In her 2023 book Eve: How the Female Body Drove 200 Million Years of Evolution, Cat Bohannon argues that humans are really bad at giving birth. “We often forget how buggy human reproduction actually is,” she writes. “We’re not like rabbits. Our reproductive systems aren’t even as reliable as most other primates’.” One of the reasons is that human heads evolved to be bigger to house a larger brain, but human birth canals did not evolve to be wide enough to accommodate them easily. 

In fact, Bohannon argues, midwifery came about in early human societies only because of how difficult, and sometimes impossible, it is for a woman to labor on her own. She characterizes midwifery as a kind of technology—perhaps even an intervention—not found elsewhere in nature. What’s “natural” or “unnatural” in the history of human reproduction may not be so obvious. 

If Bohannon is right and natural-birth advocates are wrong, and our bodies are not exceptionally well-designed to deliver babies when compared to other creatures, what are we to believe about nature? Christians, for example, believe that God created all things to be fundamentally good, and that each being is equipped to flourish by performing its characteristic activities well. But what would it mean if something essential about our bodies isn’t well equipped to flourish, or tends to malfunction? Would a high maternal-mortality rate resulting from our own physiology suggest that God designed something badly? Would Christian natural-birth advocates be wrong to say that God designed our bodies well to give birth, and would pregnant women actually be wrong to trust their bodies and accept what’s natural? (As Michelle Goldberg recently wrote in TheNew York Times, “Having a baby without medical help may be natural, but so is obstetric fistula and hemorrhaging to death.”) What would it mean for a being’s essential functions—for what’s “natural”—to be dangerous for it? If pregnancy isn’t a disease or a malfunction, why does it sometimes act like one?

Such questions go beyond pregnancy. What would it mean, for example, for a cancer patient to trust his body? Or a diabetic? Their bodies are malfunctioning, failing at a particular task, and are ill-equipped to do the thing required of them, as sometimes happens in childbirth. Are some bodies designed well and some poorly? If some things are designed badly, is God not the all-powerful, all-loving creator we think he is? In Natural Causes, Ehrenreich, certainly no theist, questions the idea that bodies should be expected to work well at all. Our dominant image of the body is a well-running machine, with organs coordinating, cells regenerating, hormones regulating, and the immune system protecting, all teleologically oriented toward sustaining our lives—maybe even divinely designed to do so. She posits instead that a body is “at best a confederation of parts” temporarily in alignment but which can be easily set against each other; Ehrenreich discusses the shock she experienced upon learning from a Scientific American article that sometimes our immune system helps cancer cells grow at the expense of healthy cells. 

Even pregnancy might not be what we think. Bohannon and Ehrenreich both argue that it involves less cooperation and more competition between mother and baby. Pregnancy, Bohannon writes, is a tense stalemate in which the baby tries to draw as much nutrition from the mother’s body as possible while the mother’s body tries to retain it; for both to live, it’s imperative that neither side “wins.” Pregnancy is so draining to a mother’s body, Ehrenreich writes, that we evolved to menstruate—creating a thick uterine lining not as a friendly home in which an embryo can embed but as a fortress wall, protection from all but the strongest embryos. In fact, she points out, there is a lot about the experiences of menstruation, pregnancy, and labor that actually does look like an autoimmune response to a foreign invader. 

This idea of pregnancy as combat makes me deeply uncomfortable—it’s a far cry from the way I preferred to consider my pregnancy, as a loving gift of nourishment. But it’s impossible to avoid the truth that nature can be pretty unpleasant. Throughout Christian history, philosophers and theologians have posited many explanations for the decay, disease, competition, and death that abound in nature and our own bodies—original sin being a primary one. I can’t say I fully subscribe to Ehrenreich’s dystopian vision of the body or to its attendant interpretation of pregnancy; I think if I did, I couldn’t call myself a Christian. But I agree that the image of our bodies as well-tuned machines, sites of perfect cooperation, is demonstrably false—and that fully “trusting” this complicated, maybe even contradictory thing to perform its functions flawlessly isn’t wise at all. 

The day my son was born, I woke up at 5 a.m. with severe abdominal pain. At first, it felt like an attack of my bowel disorder. But a few minutes later, I started shaking uncontrollably—not mere shivers but full-body spasms. My husband and I got in the car and headed to the hospital, thinking that I needed to be treated for food poisoning or worse. On the way, it occurred to me to time the strongest spasms—lo and behold, four minutes apart. I was in labor.

It was nothing like what I read, and nowhere had I heard about the possibility of severe shaking, which I learned later is a somewhat common response the body can have to an intense surge of hormones. Labor hurt, definitely, but the shaking was the biggest problem. I asked for an epidural and as soon as it kicked in, the shaking stopped and the pain subsided. I was able to focus on remaining calm, resting when I could, making good decisions for myself and my baby—and pushing. And then, wonderfully, giving birth. 

I came out of that experience both in awe of what my body was able to do and very grateful for medical science and the competent, compassionate people who practice it. It can certainly be practiced badly, and the medical and insurance industries sometimes sacrifice patient well-being for profits. Hospitals can promote unnecessary C-sections because they make about 50 percent more money on them than on vaginal deliveries. Private equity is buying up neonatal ICUs because they are very profitable, which can mean that babies who don’t really need to stay there end up being transferred into them. Doctors and nurses are often dealing with several women in labor at a time, which can lead to corner-cutting and distraction. At its best, the natural-birth movement points these things out and gives people the information and resources they need to advocate for themselves as they interact with a flawed system in the most stressful and dangerous moments of their lives.

But the problem with the natural-birth movement as it exists today is that it actually ends up keeping information from women. Instead of soberly presenting risks and benefits of interventions, it fearmongers about them. For example, Gaskin falsely insists that epidurals lead to an increased risk of C-section. Instagram influencers depict medical procedures like Pitocin drips as unnatural, foreign, and just icky compared to more wholesome techniques. Meanwhile, it downplays real risks and scary situations. Gaskin claims to have witnessed women who are so in tune with their bodies that when she has “told a mother to stop bleeding…she has done so.” When, after giving birth, I consulted these sources to see what I could have done in the moment to remedy the shaking, I found dismissals and denials. Gaskin does not mention the possibility in either book. Cynthia Gabriel insists that shaking is “what happens when women don’t release fear in other ways.” In other words, it wouldn’t have happened if I had purified myself of anxiety and surrendered to my body.

Why do so many women aspire to the natural-birth standard, despite all of these problems? I can think of a few reasons. First, there is a lot of distrust in the medical establishment and institutional authorities post-Covid; it’s no coincidence that many natural-birth influencers on Instagram are also antivax and push (and sometimes sell) unproven, potentially dangerous treatments. At the same time, we are having a national reckoning about maternal and infant mortality: the United States has the highest maternal-mortality rate among wealthy nations, and our infant-mortality rate has been rising. The “medicalization” of childbirth provides a ready, if incorrect, explanation—these trends are more likely due to inadequate access to health care and racial disparities in treatment.

But there’s more to it. In a world that can feel artificial, unstable, meaningless, and alienating, many of us are looking for something eternal, transcendent, and deeply meaningful. Childbirth is one of the last things that can feel constant. We would have to change everything about our lives to eat, work, or play the way our ancient ancestors or even our great-grandparents did, but with childbirth we can get pretty close to what they experienced. Drawing lines around what’s “natural” can be a way of protecting the experience from change—of claiming that maybe, at last, this experience is real, this experience is sacred.

But bringing a child into the world is sacred no matter how it happens. We don’t have to work to make it that way. We don’t have to strong-arm it into being meaningful. We just have to show up and recognize the meaning that’s already there, to experience the wonder of “life’s portals opening.”

We shouldn’t think of childbirth in terms of “success.” It has nothing to do with having an “experience,” whether mystical or pleasurable or Instagrammable. We don’t need to design, curate, or visualize our way to it. There is already too much pressure on women to make choices that stake a claim or make a statement. Our primary job, as mothers and people who love them, is simply to respond to that feeling of wonder by attending to the things that matter most—the well-being of mother and baby—and subordinate all other concerns to that. This means bringing love, respect, and knowledge to the process, as well as the amazing tools we have developed to care for each other.