It’s 1970 and the Board of Health has declared war on Nonnatus House and not for the first time.

In 1979 southeast Michigan, the first out of hospital birth center in the state was opened to meet the needs of women seeking an alternative to home or hospital birth. It was called Family Birthing Center (FBC) and was owned by the hospital. 

Located in former residence of the nuns who staffed the hospital in earlier years, the building behind the hospital was connected and provided easy transport to the hospital if necessary. Those who supported women’s reproductive choices worked hard to establish the birth center but many on the medical staff objected to its existence. They believed the FBC and home birth to be unsafe, despite studies supporting the safety of this option.

A small, cluttered room ringed with a Formica writing surface and file cabinets served as an office at the FBC. As a nurse colleague and I sat charting in the office, we swiveled as we heard a harrumph from the doorway.

“You and your patients are the lunatic fringe,” the attending physician declared as he leered down at us.

We learned not to react.  We went back to our work.

Another time, Medical Chief of the Obstetrical/Gynecological department came for a visit.  He plopped down on a chair and spread out, like a bear wanting to look big and scary. I would rather have had the bear. 

“This place reminds me of a person jumping out of a high-rise building. At each floor, she yells to the people inside, ‘So far, so good,’ as she falls toward the cement,” he told us.

For over 20 years they waged war on the FBC, campaigning to close it.

I worked there as a staff nurse. Then, I returned to school to become a midwife, inspired to achieve more power to advocate for women’s choices during pregnancy, labor and birth. It was an honor to do so at the FBC for the first nine years of my midwifery career. Like many midwives, I feel strongly that women should have choice of where to birth: hospital, home, or birth center.

They should also have choice in how they birth: free of unnecessary interventions or an epidural if they choose. Although I don’t believe I would ever choose to have an elective caesarean, without medical indication, I never had to choose so I don’t judge other’s choices. 

Additionally, women should have choice in who attends them in labor: physician or midwife, doula, family and friends. In all choices, women have the right to be informed about their options and accompanying risks and benefits in order to make the best choices for her and her family.

“Sometimes nature must be overruled by science,” says Nurse Crane.  

If you had a previous caesarean section and desired a vaginal birth like Winnie Welch, what would you choose? What would you need to know in order to make an informed choice? Would knowing that the risk of uterine rupture is 1% help? Would a 1-2% risk of dying if a rupture occurred change your mind? Would a 6% risk of the baby dying after a ruptured uterus give you pause? 

Caesarean delivery carries surgical risks and a longer, more painful recovery as well. That’s a lot of numbers and a lot to consider. 

Each woman’s choice is complicated and personal.