Home Births and Body Horror

When I was six and a half, my mother gave birth to my sister in our apartment. The home birth was planned, a midwife was in attendance. I was terrified.

Home births weren’t legal at that time — at least in the state we lived in. I didn’t exactly understand the question of legality. I knew I was supposed to tell people that my mother had intended to go to the hospital, but the baby came too fast. That rapid 10+ hour labor just didn’t give her time to get to the hospital, I guess.

By the time I was ten, I’d seen three home births — friends of my mother’s who followed her example. I’d sat on the floor, watching people labor through delivery, drip bodily fluids, scream in pain. I knew I wasn’t supposed to talk about these experiences, so I read books and watched TV about pregnancy to try to understand, but very little matched such a graphic experience or my emotions.

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Body horror, at least in terms of media, is an intentionally graphic depiction of violations of the human body. It’s meant to be intimate: all audience members can relate to physical suffering. Creators of body horror have long considered pregnancy, labor, and birth techniques to frame and amp up storylines, to the point that pregnancy horror is its own subgenre. Pregnancies provided a particularly visceral experience of fear and pain, all the more so for being a common experience. Pregnancies in horror tend to fall into a few categories:

  • Ahhh, I’m carrying the Anti-Christ (or some other evil). I’ll probably die giving birth. (Think Rosemary’s Baby, Devil’s Due, and Alien.)
  • Ahhh, I must live through this terror for my baby’s sake. I might survive, but it’s going to be bloody. (Movies like Children of Men use this approach.)
  • Ahhh, I must preserve my baby as a memorial to an already deceased character, usually the kid’s other parent. As long as the baby survives, my survival doesn’t matter. (Examples include Inside and Planet Terror.)

In any of these scenarios, a pregnant parent’s life is not valuable. For many stories relying on these tropes, the parent’s death is necessary for the story to proceed.

Pregnancy storylines have also served as a way to bring horrific moments to other types of media, sneaking body horror into prime time television. While many people deliver babies smoothly, pregnant characters in media are routinely symbols of trauma to come. In Grey’s Anatomy, main characters’ pregnancies are fraught with peril. In Season 2, Dr. Miranda Bailey was pregnant, as well as on the job. Emergencies abound throughout her pregnancy, with her delivery taking place while her husband underwent brain surgery (after being in a car accident) and while the hospital is under a code black due to a live bomb in one of the operating rooms. In the same show, miscarriages, pregnancies, and deliveries are used to increase the stakes for main characters, offering up enough medicalized body horror to scare anyone considering pregnancy.

Terrifying as the depictions of hospital deliveries are, media showing labor outside of hospitals emphasize a lack of safety compared to medical facilities. While I don’t remember being scared during most of the home births I witnessed as a child, seeing movies and television shows portraying dangerous births made me fearful. At the age of 6, I didn’t understand the risks of any pregnancy or birth, but by the time I graduated from high school, I’d realized all of the things that could have gone wrong at my sister’s birth.

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700 people die per year during pregnancy and deliveries in the US, routinely from preventable issues. 50,000 additional people are severely injured during their pregnancies and deliveries. That number is rising. The US is the most dangerous developed world to give birth in. The most common cause of maternal death in the US is eclampsia (including pre-eclampsia), which is preventable. Over a three-year period in the UK, exactly two people died due to eclampsia during their pregnancies.

Horror’s typical disinterest in the survival of a pregnant person after they’ve delivered a baby is mirrored in the rates of maternal death and injury during pregnancy. While medical facilities in the U.S. trumpet their ever-increasing ability to save infants in early and emergency deliveries, they don’t put similar resources toward saving the parents of those infants. Furthermore, medical facilities invest even less in the survival of people of color. Black women are three times more likely to die during pregnancy or delivery as White women.

Body horror, as well as other media, treat pregnant people as disposable. Violation is the norm: a woman may become magically pregnant without consent (or sex), give birth to a baby, and then be forced to hand that baby over to someone else immediately. Sometimes the parent may even die before giving birth, usually with their body kept on life support long enough to deliver the baby. That’s basically Mad Max: Fury Road’s plot: antagonist Immortan Joe holds five women captive for forcible impregnation and they escape. Two of the women are pregnant, including a very visibly pregnant Angharad, when they attempt to escape. Angharad dies during the pursuit, after which Immortan Joe has her body cut open in a failed emergency C-section.

These practices are permissible in media because they’re considered permissible in our own experience. Nonconsensual pregnancy is a very real fear: from rape to lack of abortion access, the chance of a pregnant person having true control over their own body is far lower than it should be. In Rosemary’s Baby, considered a classic of the body horror genre, the titular character is raped by a demonic presence, with the consent of her husband, which results in a pregnancy. Rosemary is even told to be grateful for the honor — a particularly grating suggestion considering the director, Roman Polanski, and the number of sexual assault and rape charges he faces.

In the film, Rosemary’s choices are limited. Even her selection of an obstetrician is ignored, forcing her to see a doctor selected by people invested only in her child’s survival. When she attempts to confide in another doctor, he ignores her concerns and turns Rosemary back over to the questionable care of a doctor proven willing to lie to her.

The options around giving birth are fairly limited, even without the intercession of demonic forces: there are hospitals and birthing facilities which are committed to a status quo approach. There are free births, where parents don’t hire any help (including midwives). There are home births, which are overseen by midwives.

In 2017, around 35,000 people gave birth at home, which is just under 1 percent of the total deliveries in the US. Very little research has been done on home births, but observational data suggests some conclusions:

  • Home births result in fewer vaginal and perineal tears
  • Home births result in fewer infections.
  • Home births require fewer medical interventions.

However, home births also increase risks, especially to newborns needing more intensive care. The Journal of Medical Ethics estimates neonatal risks triple in home births, due to delays in diagnosing hypoxia, acidosis, and aphysxia.

Those very real risks make pregnancy even more of a body horror show: In an article, Davey Davis offered a description of successful body horror: “The body horror genre is not just for those of us whose sensibility is tickled by the grotesque. Far more than being merely stomach-turning, it runs fantastically and viciously rampant with the anxieties we all have about our own physical vulnerability.”

My sister was almost in those statistics. When she was born, she didn’t breathe right away. The midwife managed to get her breathing, but was just a moment away from calling an ambulance. My sister could have become a statistic more easily than anyone likes to think about. The circumstances around her birth only increased that risk, because calling an ambulance could have resulted in more trouble.

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During the 1980s and 1990s, the American Medical Association and the American Academy of Family Physicians lobbied against “independent non-physician health care workers.” While much of the rhetoric focused on the safety of both parents and infants, their recommended legislation focused more on money. Their efforts, in part, were to ensure that all payments for medical care flow through doctors, rather than any other health care workers.

States enacted laws against “direct-entry midwives,” as midwives acting outside of hospital systems are described. By the early 1990s, home births were illegal throughout the US. The first state to re-legalize the practice, was New York, in 1992, but there are still more than 20 states with laws against direct-entry midwifery on the books.

When my sister was born at home, her birth was essentially illegal. My mother’s midwife was not legally permitted to oversee births. I didn’t know that at the time and only realized the questionable legality of my sister’s birth around the time she was twelve. That was the year our state celebrated the ten-year anniversary of the re-legalization of home births.

I developed my own paranoia about pregnancy then. I swore uphill and down that if I ever got pregnant, I’d go to a hospital. I wouldn’t follow my mother’s bad example. I wouldn’t take risks with my health or an infant’s. I was vehement as only a teenager can be. My stance has softened and shifted since then: I’ve recognized that choosing medical care is a far more complicated question than just what equipment and medical professionals are available to provide care.

While many pregnant people look to minimize the risks they face during delivery, the necessary calculus includes so many factors. There will never be one true way to give birth. There are health factors, cultural factors, and, absurdly, legal issues to consider: A person’s location and employment can dictate where they can get reproductive healthcare (and if a necessary procedure is even legal). People with disabilities may need specialized care. Some religious dogmas even dictate what sort of attendants are considered suitable during delivery. But there are some realities true for all births.

Someone in labor has to cede at least some control and autonomy. Right now, the options are doctors, who many pregnant people fear may ignore and override their requests, and direct-entry midwives, many pregnant people may feel are more likely to listen to the requests of people under their care. That difference alone is enough to convince many people that a home birth will be safer than a trip to the hospital.

Ultimately, for many, the unwillingness to give birth in a hospital is as much about survival as personal comfort: The odds of surviving a birth (as the parent) increase dramatically when that parent is listened to. With a trusted midwife, some parents have much better odds of survival.

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Pregnancy and delivery may never be an easy and clean process. But improving safety and survival is within reach if we can destroy the assumption that pregnancy should be a horrific experience. Seeing pregnant people as people, rather as vehicles for babies or sources of body horror, is the only way to make that change. Without that change, pregnancy and delivery will continue to be unnecessarily dangerous. Even now, there are solutions. Ariadne Labs, in partnership with the World Health Organization, has created a tool that has revolutionized eclampsia and pre-eclampsia care in Namibia, India, and other countries, but that is not yet standard in the United States. That tool is the Safe Childbirth Checklist, which lists steps to guarantee the safety of both parents and children during pregnancy and delivery. Just a page of reminders to check the parent’s vitals, check the availability of supplies and ask the parent and their companions questions.

Films like Rosemary’s Baby, where a doctor refuses to even consider listening to a person with concerns about her pregnancy, should be horror. That sort of heavy-handed foreshadowing is terrifying. But actually having to choose between types of medical care based on whether or not you can get your caregivers to listen to you is a real life horror show, one that millions of people face during pregnancy. Only a fundamental change in the culture of medical care will reduce both risk and fear. 🎈

Thursday Bram is the editor of The Responsible Communication Style Guide and the creator of A Haggadah of Our Own. She writes about technology, media, culture, and even the occasional kitchen sink. Thursday can be found online at ThursdayBram.com.

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