Dr. Isis wrote a post on how having a home birth is not a feminist choice, cited some papers to support her contention that home births are unsafe, and described the decision to birth at home as “utter nonsense,” warning readers that she will “judge you” should you choose to have a home birth, and compared these women to those who choose not to vaccinate their kids. The comment section contained a number of comments denigrating those who choose or advocate home birth.

Phew. It was a lot to take in, and hard not to take personally.

The thing is, I don’t necessarily advocate home birth. I advocate better information about the impact of hospital interventions on maternal and infant morbidity and mortality, their impact on breastfeeding success, and their impact on maternal-infant bonding and postpartum depression. I also think it’s important to question the motivations of hospitals, who have a lot of money at stake were women to start choosing birth centers or home births at a higher rate. It also seems like I need to be advocating for better information about home birth, as Dr. Isis and Dr. Tuteur have recently shared statistics suggesting that homebirth in the Netherlands is not the utopia most of us have assumed.

That said, I empathize strongly with those who advocate home birth, and I am not completely against it. And I think that comes from a number of places. For now, I just want to briefly share the emotional reasons why, because I think a better understanding of this population of women would make it easier for clinicians and those who are against home birth to have a more productive conversation with them. I’m happy to debate the evidence-based reasons another time. But when I see this population of women denigrated, called “homebirthers,” essentialized, and conflated with anti-vaxxers, I feel like something needs to be said.

Women have been historically understudied and misunderstood within medical science. Of course things are improving now, but the fact that everyone owns at least one pink thing that is supposed to support breast cancer research demonstrates, to me, how women’s health still needs better advocates. There are still people out there, publishing as late as 2003, who think menstruation happens because women need to get toxins out of their systems every month, and until at least 1977 this menotoxin was thought to wilt flowers (I PROMISE to write a post about the history of the study of menstruation soon!). Many treatments for women, like hormonal contraception and assisted reproductive technologies, are not only understudied but are not necessarily designed to understand the contexts that influence an individual’s physiology – since things like exercise and diet composition affect your hormone levels, and stress affects your fertility, this is pretty important.

Add to this the politics of reproduction. Women’s bodies often feel like a warzone – we are not in control of them, because they are a political tool. Other people get to make decisions about our bodies all the time – by making birth control more or less affordable, by making abortions legal or not, or harder or easier to get, they impact our decisions. When groups physically threaten abortion providers, and the number of abortion providers goes down, that is someone else controlling our decisions. Pregnant patients don’t even have the same rights as nonpregnant ones.

When you combine this broader lack of control, with the lack of control one feels both while pregnant and while in labor, and compound all this with how it can feel to give birth in a hospital, you can get an uncomfortable situation. Home birth represents women trying to figure out, to the best of their abilities, how to take some of that control back. Is it the best possible way to do it? Perhaps not. But perhaps this means that the people that demand that births happen in a hospital (because I tend to see people advocate only one or the other, hospital or home, and rarely do we even talk about freestanding birth centers) need to figure out how to reach out to these women.

Hospitals don’t need birth suites with more iPod docks or to promise to give you a CD full of digital photos of your infant when you are pushed via wheelchair out the door. These are the main advertisements I see for hospital birth centers these days, as though making it homey, or having a photographer, makes one hospital a better choice than another. Instead, hospitals and their staff need to convey more understanding and be ready to explain procedures to women. They have to be willing to produce birth plans with the patient that they then read and enforce as much as they can. They need to have good relationships with the people who want to support the mother, rather than antagonistic ones.

As Isis herself says at the end of her post, “We should be continuing to ask how can we make women feel empowered in an environment that offers the best chance of survival for their offspring.” My worry is that, since hospitals – at least the ones I have visited or witnessed births at myself – are not exactly prioritizing this, we’ve already lost a huge number of women. And with so few states making it legally and financially feasible for midwives to set up stand-alone birth centers that work with hospitals, women will continue to feel stuck between a rock and a hard place.

All of this is to say, I know that Dr. Isis and some of her commenters feel like this is a no-brainer, based on their read of the evidence. But many women calculate their trade-offs differently, so we need to figure out how to gently change how they make those calculations, or change what it means to give birth in a hospital.