As a global maternal health researcher and the leader of the nonprofit Nurturely, I unintentionally spent the past decade preparing for the moment I would become a mother. I read every book on birth and postpartum. I took — and even taught — every class. I read every “I was an OBGYN and even I didn’t know…” article written by professionals who thought they were prepared then ended up anything but.
I knew the stats, the physiology, the history.
I prepped my partner for the possibility of postpartum depression, anxiety or even psychosis.
I was ready to bleed, poop and puke.
Cognitive preparation, however, is one thing. The experience itself is another.
My love of control is obvious from one glance at my aggressively color-coded Google calendar, and letting go of the reins is not my strong suit. Yet those rare, occasional experiences of surrender — complete loss of control during a naked mushroom-induced frolic in the woods, for example — were actually my best preparations for the journey of giving birth. Birth requires a complete fall away from reality, a surrender to whatever physical and emotional feelings arise. No meticulous birth plan (ask me how many pages mine was…) could change that.
Why is it so hard for our society to grasp the realness of birth? We use every euphemism in the book to gloss over the pain, the unpredictability. “Surges” or “waves” instead of crushing pain. “Back labor” instead of rocket-ship-blasting-out-of-my-butt. We create clean, linear protocols to predict an unpredictable process: the dilation wheel, for example, spiraling from 0 to 10 and suggesting a neat, orderly path toward delivery. Yet birth is anything but linear.
We practice slow, measured breathing and share videos of meditative humming, but not the tremors of uncontrollable screaming that often follow. We sanitize the experience, posting photos of clean, swaddled babies while erasing the messy in-between moments like my husband wiping poop as it actively emerged from my body. (I will cherish that video forever.)
This denial goes beyond the use of Instagram filters. It’s a societal unwillingness to confront the messy, visceral truths of a life-altering ordeal.
Birth is unpredictable. It is full of gore, fluids, wetness and screams. It flirts with death. Even today, with modern medicine, the memory of death’s risk is embedded in our brainstems, triggering uncontrollable fight-or-flight responses as the baby gets closer to the outside world.
For too many in the U.S., the risk of death as part of birth is not just a distant memory. The U.S. is the only industrialized nation where maternal mortality is increasing. It is estimated that over 80% of maternal deaths are preventable. Black families are disproportionately affected — in my state, Oregon, Black babies are twice as likely to die in their first year of life as white babies.
My birth was steeped in privilege. It was a privilege to have the time and education and career that allowed me to read all the books and take all the classes. It was a privilege to have a tight and committed network of support. It was a privilege to be close friends with the queen of all doulas. It was a privilege to bypass my private insurance and instead choose to pay $5,000 out of pocket for holistic homebirth midwifery care. It was a privilege to know the importance of midwifery care — care that decreases the risk of cesarean, reduces postpartum depression and increases lactation.
Photo Courtesy Of Emily Little
Within our current systems and structures that are steeped in racism, whiteness supersedes other privileges in the United States. A Black woman with a PhD and a decent income still has a higher risk of facing death in childbirth than a white parent with a high school diploma. None of the usual protective factors like education or income are powerful enough to override racism to protect Black babies or parents. Let that sink in.
Why is it that in the wealthiest country in the world, the color of your skin remains the most significant determinant of your birth outcome? Why does maternal mortality and morbidity continue to be brushed under the rug?
We need more midwives. We need more Black midwives. We need birth locations that foster safety amid all the messiness, whether at home, in a birth center, or in a hospital. And we need these locations to be accessible, affordable, intersectional, and culturally inclusive.
My birth story is one of privilege, but it also underscores the urgency of this work. I had access to care that aligned with my values and supported my autonomy. I had a care team who respected my culture and honored my experience. But this should not be a privilege. It should be a right.
In psychedelic circles, there is a phrase: “Buy the ticket, take the ride.” Once you begin a trip, the only way out is through. I was ready to journey through — so the messiness, the realness and the pain is not what shocked me about birth. What shocked me is that we as a society continue to try to erase and control this power.
What if we looked at birth with awe and wonder rather than fear and control? Perhaps then we could see birth not as a sanitized photo op but as the messy, sacred, transformative experience it is — one that has the power to heal, connect and bring forth equity in its rawest form.
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To truly embrace this change, we need to celebrate the messy middle: the fluids, the screams, the surrender. We need to elevate the voices of Black birthing people and invest in community-based solutions that center their expertise. We need to ensure that midwifery care is accessible to all, regardless of race, income or geography.
If we recognized the power of birth and embraced the human connectedness that birth represents, I believe we could create a world where every parent is safe, supported, and celebrated.
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