The pressure on women to have the 'perfect' birth

Many women strive for a "beautiful" birth experience without medical intervention. It works for some women, yet this ideal can be damaging if plans don't materialise.

Warning: This story includes details of traumatic birth that some readers may find distressing

When Emma Carr fell pregnant in 2021, she had a vision for her ideal birth. At the most basic level, she wanted to feel empowered, listened to and in control. But, like many women, Carr’s vision went further than that. In particular, she hoped for a 'natural birth' – generally described as a vaginal delivery with as little medical intervention and pharmacological pain relief as possible.

She followed two courses, including one popular approach known as 'hypnobirthing', which taught relaxation and breathing to help ease pain and help stay present during delivery. And, as her instructors recommended, she watched videos of healthy, happy, non-traumatic births to get her into the right mindset.

"You watch all these videos of these babies being born, and it's so beautiful," says Carr, 36, who lives in London. “They come out really easily, and the woman grabs them, and you're just like, 'That's what'll happen to me'."

But when Carr's water broke, the fluid contained meconium – the foetus' stool, which can be dangerous for mother and child. After she rushed to hospital, doctors told her they had to get the baby out immediately. Two hours later, she lay on the operating table under bright lights. Far from her ideal, intervention-free vaginal birth, her baby was born by caesarean section. Worst of all, she says, was how unprepared she felt for this kind of outcome, given how focused she had been – and had been encouraged to be in the courses she followed – on creating a positive mindset.

"If I hadn't had in my head how it 'should' have gone, then I wouldn't feel like it was a failure," she says. "I just wish [my instructors] were a bit more open about how these births happen. That it doesn't always go right, just because you did hypnobirthing." 

While she was pregnant, Carr says friends tried to warn her she might not have the labour she was hoping for. But she dismissed them, thinking they probably hadn't gone in with the mindset or techniques she would.

"People that you would normally listen to, you stop listening to, because you've got these other people in your head telling you birth should be natural and magical, and that your body is just perfectly designed to do it," she says. "But I don't think mine was."

Many women do benefit from this approach to birth. Some even experience the ideal scenario that they hoped for. With the right techniques – like breathing, listening to affirmations or massage – some advocates say birth can be enjoyable, even orgasmic. But others, like Carr, are left reeling, and not only from a traumatic birth – they feel as if having been fixated on that vision, and not preparing for the many ways in which it might not happen, made their experience even worse.

Birth of a movement

For much of history, women frequently died in labour – as often as in one in every 100 births in the 1600s and 1700s. Scientific advances including antibiotics mean that the maternal mortality rate has plummeted. As the medical community expanded its focus beyond safety, narcotic pain reduction techniques like the epidural became common in many countries. Even today, maternal mortality is highest in countries where there might not be adequate medical care for complications more easily treated elsewhere.

Many birthing parents choose modern pain-management as the right choice for them, and many doctors also recommend it. But other women and health practitioners believe the birthing process has gone too far in this direction, saying that an over-reliance on medical interventions can be unnecessary, risky, even dehumanising. In the 1960s, for example, women in wealthy countries often gave birth while sedated with general anaesthesia. They may not have felt pain, but they couldn't feel present or make in-the-moment decisions regarding their care, either. 

Today, many women now strive for – and idealise – what is often referred to as a 'positive birth'. Coined by UK birth campaigner and Positive Birth Movement founder Milli Hill, the term 'positive birth' wasn't, originally, meant to describe any particular kind of labour. It has broadened.

"A positive birth does not have to be 'natural' or 'drug free' – it simply has to be informed from a place of positivity as opposed to fear," the association's website reads. "You can birth with positivity in hospital or at home, with or without medical intervention." Rather, the website outlines, it is an experience where a woman feels she has "freedom of choice, access to accurate information, and that she is in control, powerful and respected" as well as one that she "goes on to enjoy, and later with warmth and pride". 

Still, many women who follow positive birth courses say they feel an undercurrent of idealising 'natural' births in particular. For some instructors, a big part in emphasising how birth can be 'positive' comes with talking about how a woman's body is 'designed' to give birth – and the subtext can be that medical interventions impede, rather than assist, this process.

A main tenet of many of these approaches, for example, is that fear and anxiety increase the body's production of hormones like adrenaline, which can slow down labour and make contractions feel worse. With techniques including making one's birth space feel homey and comfortable; being ed by a birth partner (or team); using breathing or meditation techniques; and, above all, going into labour feeling relaxed and confident, the idea is that you can encourage the production of oxytocin instead, making labour faster and less painful.   

The popularisation of 'natural' birth in particular has a long history: it dates back to at least the 1930s, interestingly around the same time that the first college of obstetrics and gynaecology was founded. And for many women, approaches like these have never held much weight: if you want to give birth as painlessly as possible, why not just use every modern medical intervention and drug available?

But for others, this image of the 'natural' ideal birth has stuck, amplified by a booming birth-education industry. On social media, beautiful stories of relaxed water births with soothing music and candles everywhere abound.

There are many benefits to these birth movements, not least their aims to put the decision-making back into the birthing parent's hands. But with both 'positive' and 'natural' increasing as common cultural ideals, for some women, there is a downside. No number of classes or relaxation techniques can always overcome the reality that the circumstances of every birth are different; that there are huge racial and ethnic disparities in quality of care; that maternity care can be subpar overall; or that women sometimes feel pressured to accept interventions. Even the simplest goals of feeling empowered during labour, or having fond memories of birth, can feel out of reach. (It's also worth noting that both the time and financial investment that some of these courses require make them out of reach for many – they can cost less than $50 (£41) online or upwards of $1,000 [£815] for private guidance, and usually require at least several hours of instruction).

Proponents of this approach say that medical providers need to step up to fix these problems, rather than mothers lowering their expectations. But in the meantime, for women whose labours don’t go as planned, having a highly specific – and often idealised – birth vision in mind can put undue pressure on what is, ultimately, an unpredictable experience. In the worst case, they can feel as if they have failed themselves – or their babies. 

An ideal – not a norm 

The 'natural' birth, in which everything unfolds perfectly and without a need for intervention, remains far from the norm. In the US in 2020, for example, CDC data shows nearly a third of all births included an induction of labour. In addition, a third were caesarean deliveries (C-sections). Home births, often held up as the ultimate 'natural' labour, ed for just 1% of all births.

But for many birthing parents who emphasise natural birth as the goal of their 'positive' approach, their labours don't always go to plan – and this can have ripple effects. Some mothers say that, by focusing only on their ideal birth, they were blindsided by the reality – and felt additional grief for not getting to experience the perfect birth they wanted. In one study, 15% of women who had an unplanned C-section reported that they felt as though they’d "failed".

In Toronto, Andie Perris, 38, wanted "as much of a natural experience as possible" before her first birth. She took a hypnobirthing course, listened to relaxation audio tracks and read Ina May Gaskin's On Childbirth, which was "full of stories of serene deliveries of women breathing down their babies and their body taking over", she says.

"I had seen and heard of these beautiful birth stories, and that's what I was expecting for myself because I had done all the work," she says. "I really believed that it would change the outcome of my delivery." Instead, Perris was in labour for almost 24 hours. Her pelvic floor was "completely destroyed". Her son, who wasn't descending properly, was ultimately delivered by vacuum. Perris had a postpartum haemorrhage.

Looking back, she says, she probably should have had a C-section. But she had been set against it. "Feeling like there was one 'right' way to have a baby, it made me laser focused on that right way," she says. "And of course, there's not one right way. But I was so wrapped up in this vision of how nature 'intended' you to have a baby."

Because she was so focused on maintaining a positive mindset going into her labour, Perris says, she didn’t prepare herself for the possibility that it might go differently. As a result, "when things started to go sideways, it was very hard for me to adapt".

For her second child, she tried to listen to the same relaxation audio tracks she'd used to prepare for her first. She found it so anxiety inducing that she had to stop.

Emiliana Hall is a UK-based doula and founder of The Mindful Birth Group, which helps women prepare for birth. Hall, who says her approach eschews idealising any form of labour and instead covers all potential outcomes, reports she is now seeing a wave of second-time mothers saying that, after doing a 'positive' birth approach, their first experience didn't go as they thought.

The problem, says Hall, isn't just that they had a negative experience. It's that they blame themselves for it. This can be the risk of an approach that focuses so much on mindset, she says: many courses recommend listening only to positive birth stories, or even replacing negative words like "contractions" with "surges", to keep fear and anxiety, and therefore stress hormones and, theoretically, pain, at bay. If a woman does wind up feeling pain or trauma, she might question if it was because she wasn't relaxed enough. 

"When it doesn't work, it feels like either they failed, or it was a complete waste of time," says Hall. "But there are so many things that you can't control." In her courses, says Hall, she is careful not to even use the phrase "positive birth" – because despite teaching techniques to make birth better, she's acutely aware that there's no guarantee things will go as planned. 

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