How Can We Bring Trust Back to Childbirth? You could argue that women have never been able to easily access the "birthing experience" they desired. The old days of childbirth, fraught with risk to mother and baby, were followed by a variety of innovations, some more welcome than others. In her story on Ina May Gaskin and the home birth movement, "Mommy Wars: The Prequel," in this coming weekend's New York Times Magazine, Samantha M. Shapiro writes that women once fought to move birth "out of the domain of midwives and the home and into the hospital:" In 1915, a group of suffragists, professionals and housewives formed the National Twilight Sleep Association to lobby for access to scopolamine, an amnesiac that when paired with morphine allowed women to go into labor and forget the experience afterward. In retrospect, twilight sleep looks barbaric; women on the drugs thrashed violently and were often hooded or placed in cage-beds while they labored. But many women demanded it, staging meetings where they testified about the benefits of twilight-sleep birth: shorter, less painful labors, better breast feeding, fewer forceps deliveries and an easier recovery. Now, of course, some women find themselves fighting for the right to a midwife-assisted home birth. They want more of a say in whether to attempt to deliver vaginally post-Caesarean section, or when a baby is breech: practices that many hospitals, fearful of complications and lawsuits, shun. The goal is what Ms. Gaskin calls the freedom not just to decide whether or not to have a baby, but how to have it. But as many women, including myself, have found, there comes a point in some births when a mother, no matter how empowered or determined, no longer has much choice in the matter. In an ideal situation, that's where the health care provider takes over, be she midwife, obstetrician or nurse-practitioner, to help make informed decisions based on the kind of information and experience that few birthing women have. If you trust your provider (a clinical, but hopefully all-encompassing word), then you can know that an emergency really is an emergency, that a treatment is the best, or at least one of the best, options, and that a given course of action was chosen with your needs in mind and not based on a fear of lawsuits, a lack of training or some other incentive. That, I'd argue, is a kind of care that's hard to find. When, in talking about her article, I suggested to Ms. Shapiro that more trust between women and providers would mean less of a debate over where and how women gave birth, she pointed out that other factors - like malpractice insurance requirements, the lack of training in procedures like vaginal breech birth that are now considered too dangerous to attempt, and the various risk management protocols imposed in hospitals on doctors and midwives alike, mean that other incentives will always play into most births. For a woman whose hope is to have as little intervention as possible, it's hard to trust someone who has already taken a number of options off the table. For that woman - essentially the opposite of the women demanding their "twilight sleep," Ina May Gaskin offers something that a hospital cannot, and it isn't just vaginal birth after a Caesarean. It's a shared commitment - a belief that the risks of too much intervention outweigh those of too little, and a willingness to jointly accept those different risks. For someone like me, who was so committed to pain relief that I was once tricked by a midwife into a natural childbirth, it's been possible to find care I trust within the existing system. I believe now, and believed at the time, that my hospital and its providers made the choices I would have made, given the same information they had - up to and including both the withholding of the much-desired narcotics during one birth, and the sudden emergency Caesarean section at the end of another. The result is that the ideological battle that rages here largely escapes me, but what I can see clearly is that by offering such intimate care, Ms. Gaskin is able to win a deep level of trust from her clients. Ironically, it's that level of trust that has also enabled her to (so far) avoid the malpractice insurance and torts system that has helped to erode the relationship between some patients and more traditional providers. I'm not planning on birthing any more babies, and my interest in my own birth stories has waned in the six years since the last one. The real question, it seems to me, isn't about how any one individual woman gives birth - home, hospital, or back-seat-of-a-cab, sitcom-style - but about how more women, at every income level, could feel about their various health care providers the way Ms. Gaskin's patients feel about her.