In this article, I seek to understand how the COVID-19 pandemic has impacted childbirth in Puerto Rico, an island that was already in recovery following the occurrence of two devastating hurricanes in the fall of 2017 and a major earthquake in the winter of 2020. Thus, I argue that it is important to discuss not only how individual disasters impact birth, but also how their compounding effects do so. In order to address these research questions, I conducted remote interviews with Puerto Rican birth workers and researchers. During times of crisis, this pandemic included, home and midwife-attended births have become increasingly more popular. However, Puerto Rican midwives and doulas currently have less institutional support than ever. In a time of quarantine when home births are rising, we need to consider whether society is designed to facilitate these models of care. In Puerto Rico, pre-pandemic, there was a less than 1% home birth rate and there still is a lack of legal recognition and protections for homebirth midwives. As this article demonstrates, an acknowledgment of the near-invisible labors of these birth workers is needed, in addition to supplies, support, and protections for them—and not just in times of “crisis.”

ObjectivesThe World Health Organization recommends a target cesarean section rate of 10‐15%. In recent years, the US has had a nation‐wide rate of 30.3% and some developed countries are even higher. Many factors account for this high rate, but our hypothesis is that women who elect cesarean section do so at least in part because of unallayed fear.MethodsOur sample was comprised of American women of childbearing age who have not given birth but may in the near future. We received 368 online survey responses with a 92% completion rate. Responses were categorical and hypotheses tested with non‐parametric statistics.ResultsThose who reported a preference for cesarean section were significantly more likely to be extremely fearful of birth (43.9%) than those who reported a preference for vaginal delivery (20.6%). 73.2% of the cesarean section group state that fear is what influenced their birth preference, 9.8% said their fear had no influence, while in the vaginal birth group 18.9% said fear influenced their birth preference and 53.7% said it did not.ConclusionsIn our sample, women likely to elect cesarean sections are motivated at least in part by fear. They report both more extreme levels of fear than the group anticipating non‐surgical delivery and they more often say that this fear influences their birth decision. This study offers productive, non‐interventional, and inexpensive ways to address women's fears in the hope of reducing unnecessary cesarean sections.

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