The overarching theme of The Birth House is women’s struggle for independence and to be seen and respected, and the challenges inherent in that struggle. The story is set after the turn of the 20th century and coincides with the suffragette movement in the United States, which Dora witnesses while in Boston. However, there is also a timelessness to this theme, as women have faced these same challenges throughout history and still face many of them today in fighting for equal rights.

Throughout the book, Dora struggles against various masculine powers that seek to control her. First, her father: He may wish to protect her, but he views Dora as separate from and inferior to her brothers, especially after she reaches sexual maturity. Seeing she has matured, Dora notices, “he acted as if it made him sick just to look at me. He shook me so hard he put his fears right into my body” (44). He also makes Dora burn her books after reading a supposed scientific journal that asserted “overthinking and novel-reading causes, at the very least, fretting, nightmares and a bad complexion,” and at worst, “impure and sensual” thoughts and actions (39).