One major factor affecting your freedoms if your family is growing is the state law regulating birth options. If the hospital makes you more concerned than other options, are you allowed to pursue a home birth or use a birthing center? What sort of professionals are allowed to work with you if you seek an option other than hospital delivery?

It is a strange time we live in when pro-choice means that a woman can unilaterally terminate a pregnancy at her option without recrimination, but if she decides she’s having the baby then her choices are suddenly and sometimes drastically reduced.


Let’s say you picked Alabama as the state for your retreat, but don’t want a birth in a hospital for good reasons. Under 2016 law in that state, your choices other than hospital delivery would be:

  • Unattended home birth
  • Attended home birth with a professional willing to violate law and risk prosecution
  • Drive to a neighboring state for the birth

If manner of birth is important for your family, suddenly that retreat location is a lot less appealing.


Why wouldn’t someone want a hospital birth?

C-sections carry a benefit of saving lives in dire circumstances, but can be tempting when not medically necessary because it puts people in control of an unpredictable natural process and drastically shortens what could be a very long process. But major abdominal surgery is not a risk free procedure, thus unnecessary surgery is unnecessary risk, sometimes with permanent life-altering implications. In 2015, the World Health Organization renewed its stance that national C-section rates up to 10% show benefit of reduced mortality, but above that there is no evidence of further benefit. As of JAN2017, the last data from the CDC showed a 32.2% C-Section rate for the USA for 2014.

A good tool to analyze the local risk can be found here, created by a healthcare facilitation company. Their data near the end of 2015 found US C-section average at that time at 37.1%. They also provide a map of how various states compare to the national average. Read the rest of their article for further risk analysis, generously illustrated with simple charts and graphs.

For a quick look at the states including the American Redoubt, here’s the state-by-state comparison to national average:

image from Amino article

So Montana is not bad at average, and Idaho and Wyoming are good with a below average score.

But if you’re planning a Survival Relocation, you probably already disagree with the common sentiment that:

“What’s selected is average.

What’s average is normal.

What’s normal is good.”

Average isn’t necessarily good in the above image. So you may want to look at local the local risks with the previously linked interactive tool.

Local data tells a different story. Image captured from Amino interactive map.


Overall, what’s the solution?

Well, how does the target state treat midwives? All states allow Certified Nurse Midwives, who are nurses with a specialty in midwifery. But what about direct entry midwives who do not pursue the nursing training? For that, you should take a look at maps of midwife licensing, like this one:

CPM map by Push For Midwives.

However, state licensing is a two-edged sword. On the good side, midwives can practice without fear of prosecution. On the bad side, the state now dictates what a licensed practitioner may and may not do.

For example, Idaho never lacked a robust midwifery presence. But adoption of CPM licensing in 2010 gave a benefit of freedom to practice as well as the downside of dictating to the midwives which cases they could or could not take (Idaho code Title 54 Chapter 55 Section e). Suddenly, common birth cases like breech or multiples are no longer allowed to be deliberately attended outside a hospital. How did the human race across the globe survive these things before the advent of modern hospitals, even in the first half of the 20th century?

Spelling out a standard of care or best practices can be a good thing. But a legally binding one-size-fits-all regulation means the choice sometimes no longer is between you and your health care provider, lest they risk losing the right to practice.


You can also find an excellent resource for midwife organazitions and regulations listed state-by-state at Midwives Alliance of North America (MANA).