Beyoncé’s Instagram announcement that she is pregnant with twins broke the internet in February and was the post-election boost we all needed. As we await the newest additions to the Carter-Knowles family, gossip mags are abuzz with speculation about the celebrity’s childbearing plans.
This weekend, the Daily Mail wrote that the family is planning a home delivery, equipping their Hollywood mansion with a state-of-the-art neonatal suite. This conflicts with earlier reports that the family was moving closer to Los Angeles’ Cedars-Sinai Medical Center for a planned cesarean. Either way, two things are certain: Beyoncé is likely to attract criticism from all sides, and giving birth under scrutiny and judgment is familiar to Black women across socioeconomic strata.
Whatever her decisions, reasons, or outcomes, this highly-awaited delivery provides the opportunity for a conversation about how best to support people in birth.
If she does give birth at home, Beyoncé will join a very small segment of U.S. women. Nationally, fewer than 1 percent of births take place at home each year.
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As a Black woman, Queen Bey would be among even more rarified company: Black women’s rate of home deliveries is less than one quarter of white women’s. This is no accident, but a product of an oppressive history: As the emerging medical profession entered the business of delivering babies in the early 1900s, it worked to muscle out Black midwives (also known as granny midwives) who had been caring for both Black and white women using skills passed down from their enslaved foremothers. In the South particularly, this meant passing laws to criminalize midwifery, forcing women toward hospital-based care. While the laws are finally and slowly changing in states such as Alabama, rates of home births remain lowest in the South.
A million-dollar home maternity ward is out of reach for most pregnant people, but the Carter-Knowles’ choice lends some insight into families’ decision-making around birth. In the Daily Mail, one of Beyoncé’s neighbors reported, “It is all about privacy and safety. It’s not usual for someone expecting twins to have them at home, but Beyoncé has discussed it with her doctors.” Setting aside the question of why a neighbor has any business making a public statement about anyone’s birth plans, a desire for privacy and safety underlies many families’ decision to deliver at home.
One criticism Beyoncé can expect is concern-trolling about safety: The safety of home birth has been the subject of considerable and heated debate. But even with a plethora of studies on home birth outcomes—all drawing different conclusions based on what is counted and who is counting—safety cannot be measured in absolute terms. As with many other intractable debates in reproductive health care, health statistics have failed to provide satisfactory answers to questions that are actually about people’s values and personal desires. Beyond the risks and benefits of any type of care, individuals also think about nonclinical factors. They mull whether they will have access to a health-care provider they know and trust, or whether they will be subjected to racist stereotypes and microaggressions at a vulnerable time.
The fact that maternity care is less safe for Black women further complicates the notion of some standard idea of safety. This country is experiencing a maternal health crisis: With the maternal mortality and rates of severe complications rising domestically as they fall internationally, our nation lags behind other wealthy nations.
This crisis is not experienced equally across races, leaving Black women three to four times more likely to die because of pregnancy than white women. This disparity, which affects rich and poor alike, has been aptly described by birth justice activist and Mills College professor Julia Chinyere Oparah as “obstetrical apartheid”; the difference is so stark that in many places it is almost as though Black women are giving birth in an entirely different country from white women. Costly medical interventions have thus far failed to alleviate the fact that, as writer and doula Miriam Zoila Pérez described in a 2016 TED Talk, racism makes Black women and babies sick. Pérez pointed to The JJ Way, a holistic approach developed by Florida midwife Jennie Joseph, as one proven solution. That is, for some, the safer care might be a “low-tech, high-touch” approach, even if it means being further away from incubators or surgical suites.
The calculus of safety may also include weighing the possibility of threats from the state or health-care institutions themselves. This is a serious consideration for Black women, who are more likely to face reports to child protective authorities by hospital personnel, sometimes for their birth-related choices. Even for affluent Black women paying for VIP care in upscale hospitals, birthing while Black can mean being treated with disrespect or given subpar care.
Celebrities are not immune: Mariah Carey was investigated by child protective authorities after a hospital social worker reported her for supposedly nursing her newborn twins while drinking alcohol (never mind that leading experts say there is little danger from “reasonable” consumption while breastfeeding and new mothers are commonly told that beer promotes lactation).
There are likely to be some home birth advocates who scoff at the idea of a high-tech home delivery with incubators, ambulances on standby, and a “team of medical staff.” After all, the point of delivering at home is to avoid unnecessary medical interventions fostered by technological monitoring and other trappings of a hospital delivery.
But Beyoncé’s apparent desire to bring the hospital home illuminates the need for a range of options for birth. Many people want the homelike environment, but also want access to rapid intervention in case of an emergency.
Unfortunately, labor wards are disappearing in swaths of the country, and with them the ability to choose a home birth knowing that help is at hand. Birthing centers, which provide a “home birth away from home” middle-ground option, are rare (344 in the entire country), and sometimes face onerous regulation—like admitting privileges requirements—pulled straight from the anti-abortion playbook.
Like many other people who choose a home birth after having given birth in a hospital, Beyoncé’s past experience with a hospital birth seems to have played a role in her current decision. While the family’s public statement described the birth of their first daughter as “extremely peaceful,” Beyoncé and Jay Z attracted negative publicity when families of fellow Lenox Hill Hospital patients alleged that the singer’s security detail prevented them from visiting loved ones (the complaints were later dismissed by the New York State Health Department). This time around, the family’s earlier-reported attempts to negotiate security and shield themselves from paparazzi at Cedars-Sinai have been called “impossible” and portrayed by tabloids as “diva demands,” likely contributing to the decision to avoid the hospital.
Beyoncé has a luxury so many birthing people of color don’t possess: the wherewithal to buy her way out of a system that won’t meet her needs. The lengths she’s going to for the birth she wants call attention to a need for a range of options for birth, and highlight that people’s past health-care experiences affect their future willingness to engage with medical institutions.
In the end, no matter what the fans and the armchair quarterbacks think, it will be up to Beyoncé to decide what feels like the safest, best fit for her and her babies: She’s a grown woman. She can do whatever she wants.