A Good Birth: Finding the Positive and Profound in Your Childbirth Experience

by Anne Lyerly

Drawing on a landmark study involving more than one hundred pregnant women and mothers, a renowned OB/GYN synthesizes the secrets to a good birth—medically and emotionally. Most doctors are trained to think of a “good” birth only in terms of its medical success. But Dr. Anne Lyerly knows firsthand that there are many other important elements that often get overlooked. Her three-year study of a diverse group of over one hundred expectant moms asked what matters most to women during childbirth. The results, presented to the public for the first time in A Good Birth , show what really matters goes beyond the clinical outcome or even the usual questions of hospital versus birthing center, and reveal universal needs of women, like the importance of feeling connected, safe, and respected. Bringing a new perspective to childbirth, the book’s wisdom is drawn from in-depth interviews with women with a wide variety of backgrounds and experiences, and whose birth stories range from quick and simple to complicated and frightening. Describing what went well, what didn’t, and what they’d do differently next time, these mothers give voice to the complete experience of childbirth, helping both women and their healthcare providers develop strategies to address the emotional needs of the mother, going beyond the standard birth plans and conversations. Transcending the “medical” versus “natural” childbirth debate, A Good Birth paves the entryway to motherhood, turning our attention to the deeper and more important question of what truly makes for the best birth possible.

Genres: Nonfiction, Parenting, Health, Reference, Adult, Medical, Mental Health

288 pages, Hardcover

First published August 1, 2013

About the author

Anne Drapkin Lyerly, MD is the author of A Good Birth: Finding the Positive and Profound in Your Childbirth Experience. She is also an obstetrician, an Associate Professor of Social Medicine and the Associate Director of the Center for Bioethics at The University of North Carolina at Chapel Hill. Widely considered to be an expert in women's health, she lives in Chapel Hill, North Carolina with her husband Kim and their four boys.

Reviews

[Sarah · Rating 4 out of 5]

I found this book personally helpful. Most of the books about birth that have been recommended to me have been very biased against doctors and hospital births. God brought an amazing OBGYN into my life after a loss. Due to some complications with my pregnancy, a hospital birth is the option that my husband and I are most comfortable with.
While I agree, it was obvious that this doctor prefers hospital births, she still explores well what makes a good birth and includes plenty of positive things about home births and birthing centers.
Personally, I found this book to be very encouraging. It affirmed for me that I have chosen the best option for me and have been well set up by my family and my doctor for a good birth.

While perhaps not perfectly balanced, it is still one of the better-balanced books out there.

[Monica Roy · Rating 3 out of 5]

The real message of this book is that birth is subjective: whether or not your birth was good depends on what you value and wanted from the experience. The author tried not to take sides in what she calls the "birth wars," but I felt that she seemed more protective of women who had c-sections or epidurals than those who chose home births. Overall, this book gave me a sense of the things I can control and things I can't as I approach the birth of my first child. That being said, there was no discussion of the labor process itself or what to expect, and this is what I am really looking to understand at this point in my pregnancy.

I agree with the criticism other reviewers offered, that Lyerly had too many audiences in mind for this book. At times, I felt I wasn't getting as much out of the book as I might have I had already given birth to a child and was looking towards subsequent births.

[Aj 4575 · Rating 1 out of 5]

I do not feel that this author was objective. She did not disclose her bias in the book and her own preference for surgical birth. She also did not disclose her own financial benefit as an OB -Gyn and promoting surgical birth. I felt that the information she provided did not include the risks involved with narcotic epidurals and the risks to the mother and baby. She also failed to include the higher incidence of breastfeeding issues, bonding issues and higher post pardom depression with surgical births. This book does a disservice to women looking for evidence based medical information.

[Victoria · Rating 5 out of 5]

This was really good for me to read. It helped me let go of my expectations for a certain kind of birth and helped me understand that a birth experience can be good (or bad) regardless of whether it follows what you planned, and that agency, personal security, connectedness, respect, and knowledge are key elements to a good birth, whether it's a vaginal or C-section, medicated or unmedicated, etc.

[Sharon · Rating 4 out of 5]

I wish I had this book years ago. Pregnancy and birth can be a stressful time when it really doesnt have to be. First time mothers would benefit from this book greatly.

[Bethany · Rating 3 out of 5]

A Certified Nurse Midwife (who works in a hospital) told me to read this about two years ago after I attended a beautiful birth with her. I was the families doula. I adored this midwife and found the entire team I was working with in the hospital to be unbelievably supportive to this woman which did ultimately end in a cesarean. To this day, and I have been a doula for over six years, it was one of the most beautiful births I've attended. So, after reading this book, I feel like I now can pin point why it was it was such a positive experience. I appreciate this book in how it magnifies what perinatal workers need to focus on and it exemplifies the emotions and even trauma surrounding the many different journeys woman go on in pregnancy, labor and birth and the role providers play in that.

Other commentors mentioned how she did not seem to know who she was writing too and I concur. Her audience was too large, and she was trying to please too many different views, making her points mute. I would avoid recommending this to someone who is pregnant. While she made some effort to look at every angle, there is clear bias in her tone and writing. She is clearly an OB and what she sees is funneled to higher risk experiences. It was also very difficult to keep track of who was who in her birth stories because they were broken up throughout the book. It made for difficult reading and a bit of confusion.

I also found it humorous that she continually complained about the "birth wars" yet she herself partook in them in this book. Lets be honest, the majority of birth in America is in hospitals, only about 1% of families decide to have a home birth and only slightly more decide to go to a birth center to try to have an unmedicated birth with less intervention. Something like 75% of women get an epidural and usually love it when they get it. The entirety of this book talks about how its ok to have an epidural. Do we need a book about it? I understand where she is coming from on the shame some feel for getting one but thats why we need to focus on people's journey and not if they get an epidural or not. I just felt her unending lecture on the greatness of epidurals got old. (and I am all for epidurals)

Someone else also commented in the reviews that she seemed to be writing to make herself feel better about having four cesareans. I felt that as well. There was a big theme throughout this book about families feeling good about their cesarean and thats great, but again, audience. Maybe she should write a book focused on those who have had one in the past or who were planning to get one.

Birth is hard. People who want to have an unmedicated birth need some assurance that it is possible along with the realistic view that it is ok if they don't have the birth they envisioned. There was quite a bit of indirect shaming going on in this book towards woman who choose to try eschew an epidural. An example of how this whole book is tit for tat.

She also clearly does not like doulas. She tried to throw in some info on them but also showed she didn't understand them or know what they do. If she did, she would know that doulas help woman with each and every aspect she wrote about in this book. We are literally teaching everything she wrote about in this book and yet, she only mentioned that some people hire doulas to "run interference." News Flash, that is not our focus. The story she told was unfortunate, but a good, experienced doula would not argue with an OB who is trying to save a woman's life. Doulas are, more often then not, the reason women who have difficult births, who go into unexpected or planned cesareans, or need an induction, or get an epidural they weren't planning on, still have a good birth. I find it interesting she didnt mention that. What a failed opportunity.

Overall, this was an informative read and she had some beautiful nuggets of information but not my favorite birth book.

[Elaine Waldron · Rating 4 out of 5]

This book is unique compared to other childbirth preparation books. 'A Good Birth' studies the options available to women as they prepare their childbirth experience. It covers everything from midwives, to water births, to hospital deliveries. This book is for nervous parents that want their childbirth experience to be just what they imagined and if you follow the advice of this book, it will be. WELL DONE, ANNE LYERLY!!

[Elynn · Rating 5 out of 5]

This is a really really important book, and stunningly written. I think it is a littler longer than it needs to be, but that does not impact the importance of this text. Would highly recommend

[Cullen Jennings · Rating 5 out of 5]

I greatly enjoyed this book and appreciated the viewpoint of someone who is both an OB and Simone who has birthed multiple children.
I think society (ie social media) strongly skews the way in what a “good birth” looks like. Many paint it as a “one size fits all” yet that is not the case. What is best for you is not best for me.
As someone who has had a previous c-section, I can see how her writing is more skewed towards shedding positive light in that direction. I don’t necessarily think it’s wrong, more so just sharing that a c-section is nothing to be ashamed of. It definitely is frowned upon and seen as “failure” or not a “good birth”.
I would highly suggest reading this if you are pregnant or thinking of becoming pregnant just to see and experience how no two births are the same nor need to be the same. There is so much to be learned on both sides of the “birth wars” she talks about.

[ElphaReads · Rating 4 out of 5]

I got a lot from this book when it comes to emphasizing the various aspects that are valued to ensure a positive birth experience. I liked that Lyerly is sure to highlight that different people can have different definitions for broad themes, like agency, comfort, control, etc, and that it is important to figure out what is right for you when it comes to your childbirth experience. While she is an OB I thought that she did a good job of being fair and balanced when it came to other perspectives and paths within the childbirth game (and while some on both 'sides' think that it's skewed, I wonder if the very idea of saying that the other side could be valid for others is insulting and 'biased' in their eyes no matter what). Overall, I really enjoyed this book and may have to get my own copy to have when it's closer to go time.

[Grace Wursthorn · Rating 3 out of 5]

This book was good—albeit a little wordy for a nonfiction book. Overall, it was good for getting lots of opinions on women + their expectations in birth, but this is definitely not a medical resource. There were plenty of ignored statistics and medical facts. However, presenting medical facts and statistics wasn’t her intended purpose—but I think it would have significantly strengthened the writing and research of this book if she had made the decision to bring in medical evidence to her stories and thoughts.

[Adina Hilton · Rating 3 out of 5]

Interesting to read as I was expecting, and wondering what kind of birth I would experience. I feel like a re-read now might help me get more out of this, now that I've actually gone through the chaos of birth. I honestly don't know exactly who this book is for--because you can't really know what your labor and delivery experience will be like ahead of time. And then afterwards, I think you need to process what ended up happening in your own way.

If you're curious how women feel about their labor and delivery experiences, it's a good read.

[Aleka · Rating 4 out of 5]

Read this ages ago as a professor of mine was involved in the study behind it and loved it at the time – re-read after we got through the anatomy scan with our daughter and it still holds up. Sometimes a little uneven (weirdly anti-doula - maybe a product of the time/some bad experiences?) but the major takeaways - that what makes a good birth is more about respect / autonomy vs specific interventions - are valuable. (Also, I just love reading birth stories!)

[Jasmyn · Rating 2 out of 5]

Okay...not life changing. It felt like the author (an OB with 4 cesareans) was just trying to find meaning and positivity in her own birth experiences. Lots of stories of "failed" birth plans, etc. Like, see, I'm not the only one! I just thought this could have been such a great book, but it was way too negative and seemed like the authors way of working through her own angst over childbirth...

[Bronwyn · Rating 5 out of 5]

Finally! A truly intelligent look at birth written by a doctor that weaves in evidence-based facts with philosophy. A holistic look at birth that’s grounded but still acknowledges the deeply personal. Expecting moms must read; probably just as important as a birth class to prepare yourself for the big day, as much as any person can.

[Rebekah · Rating 3 out of 5]

There are some amazing points made in this books as a midwife reviews her birth and the births of other women and combines this to describe what a good birth should include. I felt like allot of this book though was from a medical providers point of view and the author was constantly defending Drs instead of informing patients.

[Claire Woodward · Rating 5 out of 5]

This book was very healing for me as I prepared for the birth of my second child after having an emergency (and life-saving) c-section with my first. Hearing stories from other women about what makes a good birth empowered me to make more confident decisions about what I want from this next birth experience.

[Avocados · Rating 5 out of 5]

As I prepare for the birth of my first, I found this book to be very helpful. Much more in touch with the modern experience of medical and birth options than other more "holistic" books I've read. Gave me reassurance that no matter how birth happens it can still be good. Highly recommend.

[Kate · Rating 5 out of 5]

This is on my top 5 list of books to recommend to expecting parents! The author totally breaks down the crap surrounding the "birth wars" and helped me to think about the real ways that can make a birth "good." It kind of got me more excited to do this thing!

[Zoe · Rating 3 out of 5]

I found some of this immensely helpful and some too flowery. I had hoped the qualitative interview element to the book would be more comprehensive.

[Julie · Rating 4 out of 5]

Dr. Lyerly, a mother of 4 and an OB with 20 years experience interviewed more than 100 women with varying birth experiences, as well as midwives. She drew themes from the interviews to try to explain what makes for a good birth. This isn't a rote formula, but instead she notes certain aspects that helped women classify their birth as good.

She tries to be impartial and see the good in different birthing options, from hospital epidurals to home births.

My take on it: While I hated the very first thing written in her introduction -- a cheesy quote about mothers and humanity -- I LOVED what she promised. She told a personal story about worrying if her birth was enough, and the search for a good birth.

She tries to bridge the gap between those who argue for a "traditional western birth" using doctors and epidurals, and "natural birth" using as little intervention as possible. She instead focuses on helping pregnant women decide what is best for them and their specific situations.

In one interesting set of stories, she compared 2 women who both wanted to feel connected to their babies in birth. Lyerly explained that connection is very important to so many of the mothers she interviewed. The first woman had an epidural and, afteward, was very upset. She hadn't really felt her baby being born, and for her, hadn't felt connected to the birth. Conversely was the story of Natalie. Natalie had 2 children, the first without painkillers. She was proud of her birth, but for her next child she chose to have an epidural. She said that her second birth was so much better because she felt connect with her child. See, while laboring the first time without drugs was so painful, she felt like she couldn't concentrate on the birth. Her second birth, with an epidural, she felt like since she was not in lots of pain, she could focus on the baby coming out and she had the mental energy to really appreciate it.

I loved that Lyerly put these 2 examples side by side -- one mother who felt like she shouldn't have had the epidural and the other who felt like it was a really good thing for her because their situations were different and how they wanted to feel connected to the baby was different. A main idea of the book is that every birth is different and so there is no one-size-fits-all, and that education and choice are important.

I will note that as much as the author tries to be unbiased, there is definitely a leaning towards interventions. I did not mind it, but it is worth noting. For instance, Natalie who loved her epidural on her second birth, was brought up at least 3 times in the 250 page book. The woman who hated her epidural was brought up once (which is why I can't remember her name).

I also really appreciated gaining even just a little more knowledge about some of the medical possibilities that go on with birth. This being written by an OB was very beneficial to me. The fact that she is a mom of 4 and talks a lot about the sacredness that is both is also very beautiful to me as well.

I would say the last reason I liked this book is that I have done a lot of study about what I believe will help me have the best birth experience -- after a lot of thought, reading, and talking to moms, I decided that finding a provider I trusted was extremely important. Lyerly definitely voiced my own feelings about this in one of her chapters. She doesn't suggest blind trust -- in fact she gave a personal example of a time when she chose a different course of action than suggested by her doctor and why. But she says having a supportive doctor who you really trust is so much better than trying to figure it all out on your own. It can make a huge difference in your birth experience.

This is different from so much of what you read online, and it was refreshing to see the fleshed out chapter.

Update: Now that I have read 10 books on pregnancy, childbirth, and early motherhood, I just want to note that this book has had a lasting impact on me. It wasn't quite everything I wanted, but I really appreciated this book.

[Krista · Rating 4 out of 5]

Quite a valuable book! I had a primary c/s for breech, and then a VBAC. Struggling to process both of them, I've found a lot of good advice in it, both for planning (for those who are), and for hindsight. I wish I would've had her perspective & summarized criteria a few years back! Lyerly has really done her research about what helps make a birth feel successful, "good", or whatever other non-traumatic-to-the-mommy vibe, without judging any particular option, although she doesn't seem very excited about doulas, and she minces no words about calling out providers and propaganda in the "birth wars".

Honestly, about halfway through the book, the tone changes a bit (or maybe I was just getting tired?); it becomes a little more critical of natural birth advocacy and a little less empathetic toward those who choose birth locations outside a hospital. BUT... considering Lyerly was a medical birth attendant, it's understandable. She really tries, though, and on a lot of levels, she really does "get it," and without criticizing, even if others' choices would not be hers.

Her charge to remember the humanity in birth is simply awesome. These are real people - women, babies, and families - and the bookend of life at which they find themselves means a stray remark or thoughtless administration of a procedure can have lifelong consequences. Her Epilogue, directed toward providers, really bears reading by anyone who has more than a passing, directly personal, interest in "birthy" topics. She talks earlier in the book about the downsides of "family-friendly" hospital policies, as well: sometimes, individuals being so individual, after all, new parents can use the space. Flexibility and accurate assessment of an individual's needs and wishes are much more helpful than policy!

And BLESS HER for finally sharing a couple instances in which natural (drug-free) births were less than a great rush for the women enduring them! Those stories need to be heard, too, to avoid making women feel like failures for experiencing pain or not having a rush of blissful baby-connectedness afterward. It's just a shame that I have had to go to private conversations or stereotype-busting, help-processing-your-birth literature to find them.

In summary, and speaking from experience, I believe her findings and counsel would be really helpful for planning and making sure you have a workable mindset and the right providers in place, so that you're prepared to truly appreciate and celebrate the arrival of your little one.

[Pamela D · Rating 3 out of 5]

I received this book as part of a GoodReads First Reads giveaway.

This book came at the right time in my life. My husband and I are planning on having children in the next year or so, and I am in the early stages of doing some research about what I am in for. Two of my friends had babies last year, and I spent a large amount of time with them. Although both had healthy babies, their pregnancies were both rough, so I have been wanting to do research on what a more typical pregnancy and birth is like.

This book was really refreshing, because it focuses solely on the birthing process. I feel like most books focus on (1) getting pregnant, (2) the pregnancy, or (3) what happens after you take the baby home. I rolled my eyes when one of my pregnant friends described her elaborate birth plan, after reading this book, I have a better appreciation for why she created a birth plan. I liked the interviews that were sprinkled throughout the book. I felt like I got a good idea of what childbirth was like for these women.

Also, I really liked that when the author referred to research studies, she has the references in the back of the book. I hate reading books that refer to research, but there is no further information.

There were two things that I did not like about this book. First, I wish that the book had been more grounded in sociological research. I feel that there must be research on the childbirth process or similar women-only events, and I think this research would have strengthened the book. Second, I feel like the book's audience kept changing. I am not sure who is supposed to read this book: soon-to-be mothers, new mothers, mothers, medical care professionals, the author (I feel like the book was a bit cathartic for her) or someone else entirely. The book needs just a bit more tightening before it is perfect.

[Erin · Rating 5 out of 5]

I'm clearly biased by where I'm sitting right now: three pregnancies completely behind me and the fourth one with delivery imminent, I connected completely with this book. While the author also had biases of her own, I can appreciate her attempt to overcome them (she wasn't always successful), but I am fully supportive of her intention to initiate a discussion about the choices that women make and the way we assess outcomes of birth.

No, she doesn't discuss risks of procedures, and this is absolutely not a manual for the nitty gritty details of pregnancy or birth. If you're a first-time mom I would recommend looking elsewhere for statistics and medical information. What I got from this was a discussion of how we make choices in childbirth, and how we can make better choices as women, as patients, as mothers, and as caregivers.

Would recommend for people who like the gray space, who don't think that birth (or anything really) should be distilled to two competing and mutually exclusive options. Others who may be interested: moms who have been through disappointing births, caregivers looking to support a pregnant woman, or anyone who finds the way people make choices to be an interesting topic.

May be anger-inducing for those who think cesareans and those who perform them are the embodiment of evil. May cause eye-rolling in those who think home births are for dirty hippies. For me, I reveled in the reassurance that I can control many aspects of a childbirth, but not all, and that's okay. And regardless of how it all goes down, I can look back on it and have the power to say it was a good birth.

[Amber · Rating 4 out of 5]

So yes, the book could have been more succinct (and thus shorter) and yes, there is a bit of a bias towards western medicine and doctors (some owned, some not and the latter is obviously more irritating) BUT Lyerly really did an amazing job distilling the critical components of birth and began to shift the conversation from being about our list of dos/don'ts on or birth plan and decisions we can't control (including knowing how we will react to pain and how severe the pain will be based on a number of factors) to being about critical components of a good birth in terms of how a woman is treated and feels in the process of growing and birthing a tiny human.

Truly her work and synthesis are really important and while sometimes I wished she could have tightened the prose up a lot--her work is actually pretty groundbreaking and to have started the conversation is enough. My kudos to her and her team for this important work which has implications of helping women get to know themselves and their needs in relation to these components rather than entering the birthing room only with that list of do/don'ts. The interior work and self-questioning is far more important in terms of understanding that a birth that went exactly according to plan can be truly "traumatic" and one that goes haywire can still be "good." The deeper work of knowing is critical and no one talks about it. A birthing class that helps women and their partners make decisions this way will be far more useful than most currently are.

[Erin · Rating 2 out of 5]

I found this read like an academic essay based on non-conclusive qualitative research.

It succeeded in showing that almost any kind of birth c-section, home-birth, with or without pain medication could be deemed a good birth. It mostly came down to relationships with health-care providers and labour support. And also a lot, I think, depended on the women's perspective.

It was reassuring for anyone who may feel guilty about having c-section births, or for people who want to go natural and end up with epidural. In fact it showed many examples of births that did not go at all as planned, and yet still the mothers were satisfied. That, I think, was the most positive part of the book.

The book was organized around very loose and overlapping themes, e.g. respect, support, connection, which made it tiresome to read. I also felt that even though the author was not anti home birth there were many more examples of hospital births than home births in the book. Looking at the demographics of participants as listed in the appendix, it seems it was heavily skewed towards women that had graduate degrees. I can't help but wonder if the results would have been different if she had interviewed a broader spectrum of the population.

I'm giving it 2 stars. It's not worthy of reading cover to cover and it offers very little practical information for mothers-to-be.

[Errica · Rating 4 out of 5]

I really loved the information I got out of this book. I'm pregnant with my first and it really helps to mentally prepare myself to enjoy my birth experience no matter what happens. One thing I didn't like is that the author says birth is something you can't be prepared for and until you experience it you just can't know what's it's like. While I agree, I also feel like she contradicts herself with that statement. She has all these opinions about cesarians being just as special and equal to natural births, and how cesarians shouldn't be looked at as a lesser birth, but she herself has not experienced a vaginal birth. As she says, no amount of research can give you the knowledge of experience... I can appreciate women who have had cesarians, but I think she puts way too much emphasis on the fact that having surgery is still considered 'giving birth'. It seemed to me like most of this book was written to equate cesarians to vaginal births. I can't say one is better than the other, or that one is easier, but they are definitely two completely different experiences, and if someone who hasn't given birth can't possible imagine what it's like, then someone who hasn't given birth vaginally couldn't possibly imagine what that's like either. Great book, but I would probably only recommend it to women who have had a cesarian.

[Kirsten · Rating 3 out of 5]

This interesting book attempts to take a closer look at what makes a "good birth," beyond the two extremes of "completely natural and intervention free" on one hand, and "any birth that results in a healthy baby is a good birth" on the other. For women who felt their birth had been a good, non-traumatic experience, what made it that way? What can make birth into a frightening or unhappy experience?

While this book has some value for women who are trying to sort out their feelings about birth, I really feel it has the most value for practitioners. So many of the things that contribute to making a birth "good" -- respect, communication, security, connectedness -- are by and large outside of the control of the patient. It left me, as an expectant parent, mostly with a feeling of, "Well, I hope I can get some of this from my provider." I do like, however, that the book makes it clear that even an emergency caesarian can be a good and gentle experience, with some work from the providers and the patient together.

[Amber · Rating 1 out of 5]

While I appreciate the themes that she writes about on what makes a birth good, I did not appreciate her clear bias. In the back there is a chart that says that about 30-35% of the birth stories were caesarean, but you wouldn't know that by reading the book. She writes mostly about c-section books positively, and the only home birth or drug free births are spoken about briefly, called "fetishized" and spoken about with condescension. Except the ones where an emergency happened an they transferred to a hospital. She makes a point to point those out. There is quite a bit of fear mongering in this book.
I would recommend this book to someone who has had a caesarean and has shame or guilt surrounding that. You DID give birth, and it WAS good. However, for anyone else I would recommend to read it with a grain of salt and do not believe all of the "evidence" she puts forth. For that, do your own research. She is a surgeon that prefers to give and receive c-sections over any other kind of birth.

[Chloe · Rating 3 out of 5]

I liked this book and chose to read it because of I'm working with some pregnant teenage girls right now, and thought it might provoke an interesting discussion. I don't know if it's really done that, but I enjoyed Anne Drapkin Lyerly's analysis of birth experiences. She talks about the central themes necessary for a "good birth" that she and her team found by conducting qualitative interviews with hundreds of mamas. Those themes are control, agency, personal security, connectedness, respect and knowledge. Lyerly is an obstetrician, but you hear a lot from midwives and women who chose a wide variety of birth settings. Essentially, Lyerly says that every woman is going to need something different for her birth, and demonizing C-sections or birth pools doesn't help anyone. "In the bickering that is the birth wars, women lose," she says.