When I found out I was pregnant, I began reading every book I could find on natural birth. As I explored my options, I decided to look for a midwife instead of planning a hospital delivery. That's when I discovered I live in a maternity care desert. Finding the kind of care I wanted meant driving more than an hour across state lines. I started wondering how much choice pregnant women really have when it comes to their own care. I expected challenges in pregnancy, but I didn’t expect finding a provider to be the first one.
I'd never thought of pregnancy and childbirth as a medical freedom issue. That is, until I spoke to Rep. Kim Holloway.
When I met Holloway, a Kentucky Hazlitt Coalition member from a neighboring county, I realized my situation wasn’t unique. Our conversation quickly revealed a shared experience: living in a small community and realizing how few options there actually are for maternity care.
Holloway told me she had no trouble finding a provider willing to support a vaginal birth after cesarean (VBAC) while living in St. Louis, where she delivered her third and fourth children. After moving back to Kentucky, however, she struggled to find that same support—even after having two successful VBACs. She ultimately gave birth at a hospital in Paducah.
“That experience in the hospital and the way that I was treated was incredibly traumatizing,” Holloway said. “A nurse was so rude to me, it was absolutely terrible. And there was really no recourse for reporting her.”
Her last two children were born at home in Kentucky under the care of a midwife based in Tennessee. Holloway and I agreed that finding a midwife in this part of the state is difficult, even five years after her last child was born. Despite extensive research, I was unable to find a midwife who would drive to my home. My only option was to drive more than an hour into Tennessee to a midwife-run birth center. Even the nearest hospital offering maternity care is about an hour from my home. I didn’t quite realize the scope of the problem until Holloway said it:
“We have a maternity care desert in nearly half of our Kentucky counties because they just don't make money,” she told me.
We have a maternity care desert in nearly half of our Kentucky counties because they just don't make money. - Rep. Kim Holloway
Our conversation quickly moved beyond where women give birth to who gets to make decisions once they're in labor.
“Women are leaving hospitals traumatized by their providers and by the healthcare system,” Holloway said. “That is devastating. It impacts a woman for years, if not the rest of her life, and also impacts the way she interacts with her children and the way they are raised.”
Women are leaving hospitals traumatized by their providers and by the healthcare system. - Rep. Kim Holloway
While I've spent a lot of time researching common medical interventions during pregnancy and childbirth, many women aren't prepared when their doctor recommends one.
“The whole idea is to improve outcomes for mothers and children,” Holloway said. “So few women really know what their rights are. They think they have to be allowed by a physician to do certain things, and that's just not the way it is.”
Listening to Holloway, I realized I'd spent months researching labor positions, birth centers, and prenatal nutrition. I'd devoted far less time to understanding what rights I had as a patient once labor actually began.
Holloway and several other Kentucky legislators are now drafting a Patients' Bill of Rights for pregnancy and childbirth. The proposal would educate women about informed consent and encourage them to understand their options before labor begins.
“Women don't know what their rights are,” Holloway said. “They don't know they can decline things. They don't know they are supposed to have the final say in any intervention that is performed or any medical procedure.”
Women don't know what their rights are. They don't know they can decline things. They don't know they are supposed to have the final say in any intervention that is performed or any medical procedure. - Rep. Kim Holloway
Holloway said she'd like to see the bill of rights posted in every physician’s office, along with the actual data on the risks of every intervention.
“They have a right to know exactly what is about to happen to them before it happens, what the necessity is, what the risks are, and what the real numbers are,” she said.
When I first started looking for a midwife, I thought I was simply trying to avoid a hospital birth. Months later, I realized I was asking a much bigger question: How much say do women really have in their own medical care?
Holloway hopes her proposed Patients' Bill of Rights will encourage more women to ask those questions before they ever step into a delivery room. Whether her proposal becomes law or not, our conversation changed the way I'll walk into mine.
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