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. 🎈

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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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  1. Thursday, this is excellent. Lovely, nuanced, well researched and comprehensive. Thank you!

  2. I had a homebirth planned and all my prenatal care through a midwife. I also had to transfer to a hospital while 8 cm dilated, after 2 days of labor.

    While I often compared pregnancy and birth (and now breastfeeding) to body horror tropes, I am so lucky to live in an area where midwifery is regulated, legal, and accepted within my local hospital. My prenatal care was fantastic and my midwives were/are more supportive through my pregnancy, birth, and postpartum than any doctor or nurse I’ve seen, and the treatment administered equal to or better than that I would’ve received under an OB-GYN.

    My labor at home lasted 2 days, as contractions progressed and then repeatedly stalled due to the angle of my baby’s head against my cervix. My wife, my mom, my midwives and I tried everything to keep labor advancing and my and the baby’s health monitored throughout, but labor stalled completely at 8 cm. My midwives took us to the hospital of my choice, and seamlessly transferred care to the nurse-midwives practicing there, who gave me an epidural and allowed my body to rest 7 more hours until I felt ready to push. My baby and I were blessedly never in danger and are happy and healthy 1 month later.
    After we were discharged, my midwives picked up where they left off and have overseen my postpartum and breastfeeding care.

    Both home and hospital birth were challenging in different ways and the right support made all the difference in keeping my birth from being a frightening and traumatic experience. After my birth, I vowed I would never judge the birth choices a pregnant person makes but think it’s imperative that they have the choices and knowledge and support available.

    • Hey! I can’t believe this but I have a nearly identical story. While it’s still in a legal gray area in my state, my midwives have a great relationship with the admitting hospital and my OB was excellent at listening to me. My epidural facilitated nap was about 6 hours and I keep saying I had never needed a nap that badly in my life, after weeks of prodromal labor and then a day and a half of active labor. So glad I was under the care of midwives and was able to labor so long at home.

  3. I enjoyed this!

    But I thought it a little bizarre that (perhaps in an effort to be inclusive) there was no mention of why giving birth is so heavily policed.

    Namely…misogyny! It isn’t that (overwhelmingly male) lawmakers think that pregnant *people* can’t make their own decisions, it’s that they think that *women* cannot make their own decisions.Even though of course people of many genders give birth. We can absolutely acknowledge that not only women give birth without masking the structural misogyny that makes it so fraught.

  4. Eclampsia is not the number one cause of death. Not even close. The data you linked to there says cardiovascular/hemorrhage. Did that not fit well with your narrative or did you just not read the data you linked? I know this isn’t a peer reviewed publication or anything but I am disappointed.

    • It’s pretty close. It’s listed as the third most common cause of maternal mortality. A cause almost eliminated in the UK. I think you might be the one with the narrative.

  5. Hello! I just wanted to state that planned home birth with a registered midwife does not increase risk; Here are the results of a 2009 study done by McMaster University here in Canada:

    The study compared 6,692 home birth women with 6,692 hospital birth women. Both groups were at low risk for complications. The researchers found that the risk of death was very low for mother and child in both the hospital and home settings. In both instances, the mortality rate was one per 1,000 live births. There were no maternal deaths in either group.
    The study found serious complications — death, the need for medical care immediately after birth, neonatal resuscitation, admission to a pediatric intensive care unit and low birth weight — were lower in the home birth group (2.3 per cent) compared to the hospital group (2.8 per cent), as were rates for all interventions (5.2 per cent home birth vs. 8.1 per cent hospital), including cesarean section.

    Also, I can understand how scary it must have been to witness your sister`s birth and to feel afraid before she started to breathe, but it’s pretty normal for breathing to take 30 or 40 seconds to begin, which can feel like ages under those circumstances.

    I agree with what you`re trying to say here, but I do not believe that increased medicalization of birth is the only way forward.

    • Registered being the key word here Dara. The midwife the author described was a CPM, not a registered nurse. And I’m a bit confused by your point re medicalisation – registered midwives, in the UK at least, are medical professionals, often with prescribing privileges.

  6. I honestly just feel like this had a confusing thesis. It sounds like you want to make a connection between *all* homebirths and the underlying mechanisms of body horror: a lack of choice and negation of personhood. But you still included that midwifery care reduces disparities in maternal health outcomes amongst marginalized people due to the simple fact of being listened to?

    And you included the statistic that risk for newborns is 3x higher in an out of hospital setting while also making it a large part of your presentation of body horror that maternal personhood is seen as expendable when compared to the infant, that pulling out all the stops to save a newborn while ignoring the mother is wrong, that it’s horrifying how hospitals will tout a low infant mortality rate while allowing birth givers to die. I feel like you undercut your point when you reiterate the hospital PR line of significantly greater safety over the actual numbers of 1 less death per 1000 births (per the ACOG paper linked in the article).

    There are a few misconceptions about the differences in quality of care that I will decline to address because that’s not really the focus of your article. But what *is* the focus of your article?? How traumatizing witnessing homebirths was for you as a child? How maternity care in this country is frequently informed by fear? Those are good points worth exploring, but I don’t feel like you got there. I don’t feel like you made a journey or had an informed point of view on what is normal for birth versus what is frightening.

  7. You wrote

    “Someone in labor has to cede at least some control and autonomy.”

    As a registered midwife, I vehemently disagree with that statement, and I am saddened that this is your current impression of birth.

    We aim to empower clients with evidence-based information about their choices so they can make the best possible decisions for themselves and for their families; autonomy and informed choice are among the core principles that guide how we practice, both at home and in the hospital.

    Yes, there is so much to be done to improve obstetrics in our hospitals, but midwifery and home birth have been proven to be beneficial to individuals and communities. The inuit midwives returning birth to their remote northern Quebec communities have not only ended the practice of mandatory evacuation (approximately 92% of pregnant people now remain in their community to give birth – high risk pregnancies are still evacuated to southern hospitals) but they have also achieved better maternal and neonatal outcomes than the overall province of Quebec.

    Access to equipment does not automatically equal safety.

    The choice of care provider or of birthplace should never be made out of fear.

    • As a birth/postpartum doula, I came here to say the same thing re: ceding autonomy during labor but @DaraM did so super well! My goal as a doula is to assist with patient advocacy – in this case, advocacy is defined as supporting the birthing person in their right to make decisions about their own body and baby.
      As a doula, I ensure that nobody’s autonomy is in jeopardy at any time during the birth experience, and that the birthing person/their support partner/any other involved family members feel as if they have the information they need to make decisions with informed consent. I essentially assist the family with feeling emotionally secure in their choices and outcomes during labor, birth, and postpartum.

      Do people need to have a doula in order for the experience to be positive and non-traumatic? Absolutely not, but in one Cochrane review, people who received continuous labor support from a doula were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans. In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth. There is a smaller amount of evidence that doula support in labor can lower postpartum depression. There is no evidence for negative consequences to continuous labor support. My personal experiences have further led me to believe that positive birth outcomes are tied more to having wishes respected and heard, having a practitioner that listens to you, and receiving emotional support when desired – rather than hospital vs. home, ob vs. midwife, epidural vs. unmedicated.

      I also just wanted to add that a majority of available studies we have regarding birthing at home vs. birthing in a hospital facility in the United States have been funded and produced by organizations looking for increased medicalization of birth, and the research doesn’t typically consider a bio/psycho/social framework of care (i.e. overall patient satisfaction, PPD occurrences, etc.) and are only considering a bodily medical outcome (in this case, bodily healthy birthing parent/bodily healthy baby = success). They often also fail to factor in quality of prenatal/postpartum care, breastfeeding experiences if applicable, and family bonding, in addition to other considerations that we now know are really important to examine the big picture of birth in our country.

      For more info I suggest taking a look at the Transforming Birth Fund, whose vision is to fund research with an aim of improving birth care in the United States.

      For more info on research regarding continuous labor support: (https://evidencebasedbirth.com/the-evidence-for-doulas/)

      • I’m interested to know why you think pain relief is a bad thing? Especially given that people have different pain tolerances, and that the pain experienced during childbirth can be so extreme it can cause PTSD.

  8. Definitely not qualified to comment on the home births vs hospital births debate, but just wanted to add another example of pregnancy horror where the pregnant person’s life is not valued. Netflix’s new series The Umbrella Academy opens with the spontaneous pregnancy and labour of forty-three women, shows one birth in enough detail to sufficiently horrify and intrigue the audience, and then, as far as I could tell (I stopped watching after one episode), never mentions the women again. What happened to them?? How did they cope with the trauma of suddenly becoming pregnant and giving birth in one day??

    I’ve got so used to seeing pregnancy used as a form of horror that it was a shock when I started watching Call the Midwife and saw depictions of labour where it wasn’t just a super painful, mysterious, and unmanageable ordeal.

  9. I’ve seen a few articles recently glorifying midwives and home birth as some kind of feminist utopia that never, ever goes wrong. The author doesn’t go that far. But I find this trend immensely disturbing. The majority of the midwives in America are, indeed, CPMS, or direct entry midwives. Which means they have no nursing qualification, no prescribing ability and usually, no university degree. Home births in the UK are with midwives who have studied biology, psychology and sociology. People who have extensive qualifications and experience.

    And yes, there are fewer obstetric interventions. For two main reasons; one, CPMS aren’t qualified to do them (even if necessary) and two, high risk births, i.e. ones more likely to require obstetric interventions, happen in hospitals. The UK only recommend home birth for women likely to have uncomplicated pregnancies, and that’s with a qualified and experienced midwife – not someone who’s done a correspondence course and attended a few births.

    This isn’t innocent either, or always limited to unqualified midwives – this obsession with intervention free birth kills pregnant people and babies. One UK hospital had to scrap it’s midwifery department after what was described as their ‘mania’ for ‘natural’ birth killed three mothers and 16 babies before they were finally stopped. It’s worth remembering that interventions can save lives. Not every doctor – plus, can we please remember women can be doctors – is a cackling, megalomaniacal tool of the patriarchy, and not every midwife is a saint.

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