Ilana Stanger-Ross is a registered midwife in Victoria, B.C. and the author of A is for Advice (The Reassuring Kind): Wisdom for Pregnancy
Royal watchers are anxiously awaiting the arrival of a new royal baby. The Duke and Duchess of Sussex, Prince Harry and Meghan Markle, are expecting their first child apparently any day now.
Details about the pregnancy have been trickling out for months, but one piece of speculation has some news outlets south of the border freaking out: that Meghan is allegedly considering a home birth. ABC News, for example, worries that the American royal’s choice to birth at home might triple the risk of serious complications for her baby.
While judging the birth choices of others has unfortunately become the standard of our time, Meghan’s pregnancy is an opportune time for intelligent reflection on the dysfunction of the U.S. maternity system and why we need to stop policing women’s bodies.
There’s likely not a commoner-mother among us who hasn’t faced the proverbial firing squad or flood of opinions about how one chooses to bring a child into the world. While pregnant with my first, I actually dove into the frigid waters of a Nova Scotia lake – a lake I’d been refusing to swim in all summer – to escape the particularly vehement “advice" of a stranger who’d ambushed me while I’d sat reading on my beach blanket.
One can only pity the Royal Family, which is forced to live under the tabloid microscope. But Meghan is American born and bred. And the United States, as evidenced by the recent “heartbeat bills” in Georgia, Ohio and Mississippi, which ban abortions after a fetal heartbeat is detectable on ultrasound (often as early as six weeks gestation), has a particularly horrifying tradition of controlling women’s bodies.
At the same time: When it comes to labour and delivery, the United States holds the title for both the costliest maternity system and the highest rate of maternal mortality in the developed world.
Meghan is biracial, and is likely aware that the American maternity system especially fails black women. According to the Centers for Disease Control and Prevention “The risk of pregnancy-related deaths for black women is 3 to 4 times higher than those of white women.” Last week, while tabloids scrambled for the latest updates on the Duchess’s “bump,” congresswoman Alma Adams and Senator Kamala Harris introduced legislation to designate April 11 to 17 as Black Maternal Health Week (BMHW). For the past two years, the Black Mamas Matter Alliance has convened a major BMHW campaign, providing education and inspiring advocacy to improve maternal outcomes for black women. If we really cared about the health of the newest royal-to-be, that is the conversation we should all be tuning into.
Would home birth be an outrageous choice for Meghan? The evidence says no. While marginalized in the United States, home birth can be a safe choice for low-risk women. In fact, home birth is integrated into the maternity-care system in Britain, the Netherlands, New Zealand and here in Canada, where maternal and fetal mortality rates are much lower than those in the United States. In Canada, all registered midwives are required to hold both hospital and home-birth privileges. After two decades of careful data collection on outcomes of planned home birth, this February the Society of Obstetricians and Gynecologists of Canada issued a position statement in support of home birth for low-risk women.
Regardless of choice of birth place, strong evidence suggests that midwifery care improves maternal and fetal health outcomes. (The Royal Family knows this: Catherine, Duchess of Cambridge’s babies were caught by midwives, as is standard in Britain.)
Meghan deserves what all pregnant people deserve: the ability to make her own choices about her body and her baby, and to be able to access excellent, evidence-based care.
I wish her a safe and supported birth and postpartum period. And I wish for her home country a national strategy to improve maternity care for all Americans.