My first baby is now 15 years old, my second is 11.  And it was probably only five years ago that I finally stopped asking every midwife I met, what could I have done differently to have the delivery I wanted. I don’t mean in the lit candles, music playing, holding-hands-in-a circle kind of way—just in a regular, vaginal delivery kind of way.  I desperately wanted to deliver vaginally—I went to all the classes, I was not a high risk pregnancy, no complications, I waited some time and continued walking the mall even after my water broke knowing that could help. But ultimately, after several hours of my obstetrician (who I love) sitting by my bed, I just didn’t dilate beyond 6 centimeters, he said and that it was time for a C-section. Four years later, when I had my son, I was hopeful for a VBAC—the spacing of my children indicated that I was a decent candidate. Again, no pregnancy complications. But yet another C-section. And quite honestly, I don’t know why. Options were never offered.  Instead there was fear and threats of me possibly doing harm to my baby to coerce me to agree. Ultimately, I have never had the birth experience I wanted and I still can’t fully explain why that did not happen. Perhaps it is one thing when your baby is premature or you have an emergency situation, but I had two full-term, 8 pound plus babies and still ended up with C-sections. And for years, I’ve suffered from what I call Post Traumatic Birth Syndrome–a feeling of trauma and sadness around my birth experience. Time to let go, I know.

But when I travel the country I meet so many women who still have similar stories. Similar birth regret. Women traumatized by medical interventions that weren’t explained to them, episiotomies that they didn’t consent to and “urgent” C-sections despite no emergency other than needing more time to labor.  I was hoping things may have changed in the decade since I delivered but instead the problem of Post Traumatic Birth Syndrome or simple birth regret is real. Too many women enter motherhood with feelings of being disrespected, that their wishes were not met, and that their questions were not appropriately answered or their options made clear before something happened to their bodies that they still cannot fully explain.  To this I say, how we birth matters. Motherhood is a life-changing journey and how you enter it sticks. Good or bad. What’s troubling is that too many women are not having the birth experience they want—and I don’t mean waterfall sound effects or Andrea Bocelli , I mean they want respect and dignity and shared or informed decision-making.

Unfortunately, ever since birth was medicalized we have been on a slippery slope of losing our maternal authority in birth. With doctors taking over a normal biological activity that women used to tend to. (Check out my football-shaped belly moments before I was wheeled in for C-section!)

In order to transform the birth experience, we must transform maternity care and that includes moving away from a highly medicalized model to looking at birth as a normal life event. Most developed countries use midwifery as the standard of care for normal, non-high risk pregnancies. In England a 1902 law put midwives in charge of maternity care, while the U.S. enacted 1894 legislation in Massachusetts that made it illegal for midwives to practice without a medical license. From that point on, obstetricians have delivered most U.S. babies. Yet, studies show midwife attended births have just as safe outcomes and significantly reduced C-section rates compared to hospital births.  And birth centers provide this option, several with doctor supervision and hospital access if needed. Transforming the maternity care system means transforming how and where we birth. How we birth impacts pregnancy outcomes, the sky high C-section rate, breastfeeding duration and the high maternal mortality rate (mostly related to complications from excess C-sections).

That’s why I’m honored to join the Board of Governors of the Commission for the Accreditation of Birth Centers. Moving all birth centers to a high quality standard of care means more trusted options for families. Looking at CABC as the gold standard for birth center care is a health imperative and I’m honored to be a part of the movement as we also work to improve access and to better understand the role of birth centers in reducing health disparities.   And birth regret.