“Yes, it can be sad and messy and powerful and 
hard and normal and absurd and 
everything in between.”- Zen Hospice Project website

I’ve always felt that birth and death were very similar in many ways. If you believe in the concept of a soul or spirit, the idea that birth is a type of death and death is a type of birth applies, since leaving one world means moving into the next.

Have you seen BJ Miller’s TED talk on hospice care? It sounds counter-intuitive, but the model of care that is slowly taking over end-of-life care has LOTS to teach us about beginning of life care. BJ Miller has a lot of very astute observations borne out of his experience of being on palliative care after losing both legs and an arm and sustaining serious burns in an accident. He has also helped hundreds of people die with dignity and love at the Zen Hospice Project in San Francisco. Here are some ways we could take his thoughts on hospice care and translate them to birth care:

A system designed with diseases in mind and not people

Midsection of male doctor and nurse with fetal heartbeat report

Dr. Miller says that health professionals go into the healthcare field with good intentions but become unwitting agents of a system that doesn’t serve the needs of patients. He says this is because we have a system that is centered around treating diseases and not treating people.

We have this exact problem with birth care in America. Childbirth is seen as a dangerous medical condition that is so fraught with peril that constant vigilance is required to keep both mother and baby alive.

Of course this is the height of hubris.

Evolutionary biology would require that for any species to survive, the process of reproduction must allow both the mother and the offspring to survive without intervention most of the time. Our interventions are there to improve on that and allow more mothers and babies to live who might not live otherwise.

People are afraid of suffering

Folks, I’m going to level with you about something:

You can not get a human being out of your body without some kind of discomfort.

There will be some kind of suffering associated with giving birth- any birth. Cesarean, vaginal, natural, medicated and hell yeah you would be suffering if you were to get something like scopolamine. (You just wouldn’t remember it. It was kind of like the GHB of obstetrics.)

I love how Dr. Miller gets into this concept of suffering. He says that there is suffering we can’t do anything about, that is just a part of life and then there is suffering that can be alleviated.

Suffering we can’t alleviate

Dr. Miller says this is the kind of suffering we need to make space for. It gives us a sense of cosmic proportionality. (Remember, he was a burn victim and triple amputee. He knows about suffering.)


Labor is like this. I’m not going all “curse of Eve” here. Labor pushes your body to the maximum and it is an intense experience. The immediacy you will feel to get this little body out of your body is overwhelming. As I said in my bio, I’m just not one of those birthing goddesses. When I give birth I suffer.

But to me, there is beauty in that suffering.

Even the fear and sadness that accompanied my first son’s birth has beauty. What was most beautiful is how much I did love him. Despite all the depression and anxiety, the moments I bonded with him touched my soul and bound him to me even when he was separated from me. The victory I felt when my second son was born would not have been possible without the hardship of my first son’s birth. The sweetness of my daughter’s birth stands out as one of the most incredible moments of my life. I think I was able to feel that attachment and joy better because I went through each stage of suffering. I felt alive as I was giving life.

A pain free birth shouldn’t be the goal. A birth with dignity and respect, whatever way it happens, should be our goal. As Dr. Miller says, “Necessary suffering creates compassion and unites caregiver and care receiver.”

Suffering we can alleviate

Dr. Miller points out that on the systems side, much suffering is created and invented that serves no purpose.Mid adult pregnant woman with fetal monitoring belts around bell

And this is true of birth care in the US. The vast majority of labor interventions in the United States do not improve the safety of the mother or baby. Some are outright more dangerous than a simple natural labor. Some simply need to be used less frequently and more judiciously. (For a whole run down on all of the unnecessary and overused procedures that are still being commonly used in childbirth in America, see this post complete with scholarly citations embedded.) We need to get rid of the things that cause unnecessary suffering in birth.

Palliative care- living well at every stage

Dr. Miller makes a distinction between palliative and hospice care. The two are often used interchangeably but are different. Hospice care is about end-of-life care. But palliative care is about living well at every stage and eliminating suffering as much as possible.

He gives the example of Frank, a patient with prostate cancer and HIV who went rafting on the Colorado River. Dr. Miller’s response to this was, yeah, it was dangerous. But what an adventure! This man knows that his time on earth is limited and he wants to experience an adventure while he still has the chance. Rafting the Colorado River helped alleviate his suffering and allowed him to live better.

Pregnancy - Pregnant Woman Natural Water Birth

Mind-blowing idea: What if approached birth like palliative care? What if the idea behind birth care was to birth well, no matter what your circumstance?

 Rose petals at the end

Dr. Miller says that at the Zen Hospice Project where he works, they have a ritual they perform for everyone who dies there. When the person dies, the coroner’s office comes to collect the body. The staff at Zen Hospice have arranged that before the body is taken away, loved ones and staff come and sprinkle rose petals over the body and say anything they want to. They might sing songs or read poems before the body is taken away.

Rose petals on the body don’t serve any medical or physical need.

But it’s beautiful. And dignified. It shows honor for what has taken place.

bigstock--137375441What if we treated birth like this, with warmth and joy rather than repugnance and contempt?

Hospitals are anesthetic, not aesthetic

Dr. Miller says that hospitals offer an anesthetic experience, not an aesthetic experience. That numbness takes away the pain and the joy. He very rightly points out that hospitals are for acute trauma and treatable illnesses.

Of course, birth is generally neither of these. This is why moving more births into birthing centers makes sense– and even improving care for home births.

First eliminate unnecessary suffering, then comfort the senses

This is Dr. Miller’s framework for end of life care. And it should guide us for maternity care as well. There is nothing about eliminating unnecessary suffering or providing comfort that inherently makes birth unsafe. Even when cesareans or inductions are medically indicated, the parents and baby can be treated with respect and allowed reasonable comfort measures.  Skin-to-skin contact for breastfeeding initiation after a cesarean can almost always take place.

Truly, we need to lift our sights to well-being as Dr. Miller says. Health care should be about living better. In the context of maternity care, we need to move past the “live baby standard”. We need to start asking if the birth was about the well-being of the mother and baby, not just whether the baby survived. (And that “at least your baby is alive” standard takes on a dark irony when you find out that the State of the Mothers World Report ranks the United States as having the highest rate of first day mortality of any developed nation.)

Dr. Miller says we need to give rise to art in dying. We need to make space for “a crescendo”.

Let’s do that for giving birth too.


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