The 98 Percent Problem: When Birth Became a Medical Emergency

Jennifer Margulis and Suzanne Arms on why America has the worst maternal mortality in the developed world—and how home birth could save both mothers and babies"

We make love at home. We conceive at home. Yet somehow, in the span of just two generations, we've been convinced that the culmination of this most intimate act—birth itself—requires a sterile room, strangers in masks, and machines that beep. The absurdity of this migration from bedroom to operating room rarely strikes us anymore. We've accepted that birth, which humans managed quite successfully for hundreds of thousands of years without medical degrees or fetal monitors, suddenly became impossibly dangerous sometime around 1950. Jennifer Margulis and Suzanne Arms see through this peculiar fiction. They recognize that when over 98 percent of American women now give birth in hospitals—institutions originally designed for the sick and dying—something has gone profoundly wrong with our understanding of what birth actually is.

The numbers tell a story the medical establishment would prefer remained untold. America spends more on maternity care than any other nation, yet maintains the highest maternal mortality rate in the industrialized world. One in three babies arrives via cesarean section—major abdominal surgery that would have been unthinkable for healthy women just decades ago. Hospital-acquired infections affect one in thirty-one patients. Fifteen thousand people die annually from infections they contracted in the very places meant to heal them. These aren't anomalies or unfortunate accidents; they're the predictable outcomes of treating birth as a medical emergency rather than a physiological process. As Dr. Robert Mendelsohn observed after decades in practice, hospitals have become temples where the god that resides is Death itself. The ritual separation of mothers and babies, the restriction of movement during labor, the insistence that women birth on their backs against gravity—these aren't medical necessities but institutional conveniences that transform birth from an act of power into an exercise in submission.

The women who've seen behind the curtain share remarkably similar revelations. Dr. Christiane Northrup, who began her medical career in a family where doctors "weren't gods" and mistakes were witnessed firsthand, learned that our bodies possess an innate wisdom that medical intervention often disrupts rather than supports. Hannah Kelesis, armed with knowledge from Margulis's earlier work, walked into The Royal Women's Hospital and refused every unnecessary intervention—from the NIPT test to the Vitamin K shot—delivering her daughter naturally despite constant pressure to comply. Laura Shanley went further still, choosing to birth completely unassisted, understanding that fear itself—not the absence of medical personnel—creates complications. Each story reinforces what midwife Ina May Gaskin's statistics prove: when women birth in environments where they feel safe and undisturbed, her 2 percent cesarean rate shows what's possible, compared to the 33 percent rate in American hospitals where fear and intervention reign.

The alternative isn't radical—it's ancient. In countries with the best birth outcomes—Japan, Iceland, Sweden, Holland, Norway—midwives attend the majority of births. Women labor freely, eat when hungry, move as their bodies direct them. The cascade of interventions that defines American hospital birth—continuous fetal monitoring that increases cesarean rates without improving outcomes, IV drips that tether women to beds, arbitrary time limits that pathologize normal labor—simply doesn't exist. A 2009 Canadian study found that planned home births attended by midwives had better outcomes than hospital births attended by either midwives or physicians. This isn't alternative medicine; it's evidence-based care that recognizes birth as a normal function that rarely requires medical intervention. The home birth that Montgomery wrote "consecrates" a house, that Margulis and Arms advocate for, isn't a return to primitive conditions but an embrace of what the research actually shows: for healthy women, home is not only as safe as the hospital, it's often safer.

What Margulis and Arms are really discussing isn't just where babies should be born but who controls the narrative around birth itself. Every unnecessary intervention, every coerced procedure, every assumption that women's bodies are broken machines requiring medical management represents a theft—of autonomy, of power, of the fundamental human experience of bringing life into the world on one's own terms. The medical establishment's response to the growing home birth movement—creating "birthing rooms" that simulate home while maintaining hospital control, offering "choices" that aren't really choices—reveals how desperately they need to maintain their monopoly on birth. But knowledge, as Hannah's story demonstrates, is power. When women understand that their bodies already know how to birth, that love and trust facilitate labor better than pitocin and epidurals, that hospitals profit from intervention while home birth midwives profit from patience, the choice becomes clear. This isn't about rejecting all medical care—it's about recognizing that for the vast majority of women, birth is not a medical event requiring treatment but a profound human experience requiring only support, patience, and trust in the process that has sustained our species since the beginning of time.

With thanks to Jennifer Margulis and Suzanne Arms.

Birth, Every Home Should Have One - by Jennifer Margulis

Birth, Every Home Should Have One

Jennifer Margulis

by Jennifer Margulis and Suzanne Arms

Babies are most often conceived out of lovemaking, a wonderful and fun activity (as long as it’s mutually consensual) that may take place at home, in a hotel room, or in a private corner off the trail at Mount Overlook in Inverness, California.

We humans don’t make love in the hospital.

Even the idea, except for those nurse-doctor late-night supply room trysts, is absurd.

Lovemaking is not something for which we need medication or supervision.

But, in America, as well as most countries across the world today, the majority of pregnant women—over 98 percent in the U.S.—now give birth to the fruit of that love in a hospital.

We’re told over and over again that a hospital is the safest place for a baby to be born. In a highly sanitized windowless room surrounded by a bevy of strangers and a highly trained medical doctor that a woman and her partner may or may not have met before.

We disagree.

We believe that the best, safest, and most empowering place to have a baby is at home.

Hospitals are for sick people

Hospitals are places where people who are sick or require emergency care or surgery go.

They are full of germs and infections, to say nothing of hospital-acquired illnesses, which affect 1 out of every 31 hospitalized patients.

Instead of protecting birth as a normal, natural, healthy, loving activity, obstetrician-led birth is categorized by machines, bright lights, unnecessary interventions, and all things plastic and metal.

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Hospital birth is dangerous in America

According to the World Health Organization, the United States has one of the highest—if not the highest—maternal mortality rate of any country in the industrialized world.

Hospitals in America are largely unregulated, profit-driven institutions whose bottom lines include money, convenience, and liability risk reduction. Doctors are in charge, though nurses provide the vast majority of patient care.

Indeed, the entire system of medicalized birth is categorized by outdated, illogical, and unscientific practices that, for the most part are both unnecessary and unsafe.

These include such seemingly harmless practices as limiting freedom of movement and restricting a woman’s intake of food and drink during labor; limiting who she is allowed to have with her; and hooking her and her baby up to continuous fetal monitoring, which studies in the United States and other countries, has proven to result in increases rates of cesarean birth without improving the outcomes for moms or their babies.

Another still-routine practice in most U.S hospitals is to encourage or even require women to labor and birth on their backs.

Labor when lying on your back lengthens the duration of contractions, cause contractions to be more painful, and makes contractions less effective.

With her legs spread apart and her feet up in stirrups, a woman becomes a stranded beetle, positioned so that her body works against gravity as she and her baby are doing their best to birth.

Perhaps the worst intervention is the routine separation of most mothers and their babies in the first critical hours after birth. This has been shown to hinder both breastfeeding and bonding, making it much more difficult for the baby to feel safe, protected, and loved.

Less intervention a safer, more scientific way to birth

The most scientific birth is the least technological, as medical historian Alice Dreger so eloquently put it in an article for The Atlantic that explored the backward birthing practices in American hospitals.

Indeed, in countries with the best birth outcomes, midwives attend the majority of births, whether these births take place in a hospital, a stand-alone birth center, or at home.

Women in these countries are treated with respect, kindness and patience, encouraged to move around during labor, given water and food when requested, and helped to have unmedicated vaginal births.

In Japan, a country with among the best birth outcomes in the world, over 75 percent of births are attended by midwives.

Midwife-assisted birth in Nordic countries, including Iceland, Sweden, Holland, and Norway, has been shown to be the main reason why these countries are among the safest places in the world to give birth, where c-section rates remain low and birthing women are able to avoid the use of painful, dangerous, and often unnecessary drugs and other interventions, according to researchers.

When birthing women are in an environment where they are able to labor undisturbed, guided by the natural rhythm of their body and the baby, as we know from the outstanding birth outcomes tabulated by homebirth midwife Ina May Gaskin, there are rarely complications requiring medical interventions like drugs or surgery.

Only 2 percent of the births attended by Gaskin resulted in a C-section, despite her attending women deemed “high-risk” by the medical establishment, including women carried twins and moms of so-called “advanced maternal age.”

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What about the baby?

“But,” you might be wondering, “What about the baby?

Isn’t it safer for babies to be born in a hospital?”

The answer is no.

Homebirthed babies have as good or even better outcomes when the birth is planned and attended by a skilled midwife. In fact, a 2009 Canadian study comparing babies born at home with midwives with babies born in the hospital attended by midwives and babies born in the hospital attended by physicians found that the babies born at home attended by midwives had the best outcomes.

“Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician,” the researchers explained.

Home birth is cost effect, satisfying, and safe for women. In America, the vast majority of births take place in a hospital and we spend two to four times as much on healthcare as any other country, according to the Commonwealth Fund. Yet we have higher infant mortality rates than at least 54 other nations.

Home birth: a safe, peaceful, and woman-friendly option

Home birth, attended by skilled midwives, has been found to be as safe or safer than hospital birth in more than half a dozen international studies, including this one, this one, and this one.

But that’s not the only reason to birth at home.

A woman birthing at home is surrounded by patient attendants, undisturbed as she works through the difficult and sometimes protracted, often messy, process of cleaving herself in two, and held with love and kindness.

The baby born to her is welcomed into the world with love, given immediate skin-to-skin contact with the mother, and primed by this early calm to find the world a loving, peaceful, comfortable, and safe place.

If a woman wanting to birth at home runs into snags, for any reason, going to the hospital is always an option.

A homebirth transfer should not be seen as “failed” homebirth, rather, it is a healthy change of plans. In America, angry, uninformed, ego-driven medical doctors often punish women and their birth attendants for wanting to have a home birth.

Yet in Nordic countries, even though birthing at home is outside the norm, a homebirth woman coming to the hospital, for whatever reason, she is welcomed, not shamed.

It takes love to get the baby in. And love, which triggers a cascade of natural hormones that flow unimpeded when a laboring woman feels comfortable and trusts her body and the process, has been proven to be the best way for the vast majority of women to safely get the baby out.

Lucy Maud Montgomery wrote in her beloved novel, Anne of Green Gables, that a house is not a home until it has been consecrated by a birth, a wedding, and a death.

Home birth is not only a blessing for the home; it is a blessing for the birthing family—and for all of humanity.

Related articles:
They Told You You Needed a C-Section. They Lied
I Just Hope I Don’t Poop (During Childbirth)!
No, the HPV Vaccine Won’t Protect You Against Cancer. Here’s the proof…

About the authors:

Jennifer Margulis, Ph.D., is a science writer, homebirth mom, and the award-winning author of the 2015 Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family.

Suzanne Arms is an internationally known birth activist and the author of the 1975 bestseller Immaculate Deception: A New Look at Women and Childbirth in America.

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