This is a question I see raised often and a passionate (even heated) debate usually follows. Unassisted childbirth (UC) or freebirth refers to intentionally birthing without professional assistance, so there is question as to whether a family who has hired a professional doula can claim to have an unassisted birth. The idea behind freebirthing is one of personal responsibility and freedom from medical management, so the real question is whether everyone involved understands this. The terminology is unimportant if the doula and the family are on the same page.
The family must understand that a doula’s role is to help provide information and support during pregnancy and birth. She is not trained to make clinical assessments or give medical advice – even if she is knowledgeable in these things they are outside her scope of practice.
When choosing a doula, you should make sure she understands and respects your reasons for choosing freebirth. Even a very experienced doula may never have come in contact with a UC family and her understanding of unassisted birth, and your expectations, may be limited.
Some families find themselves choosing unassisted birth when they cannot afford to pay out of pocket for a midwife. These families must be even more careful to remember: A doula is not someone you hire to be there “Just in case” a complication arises. She’ll make a great replacement for the supportive and knowledgeable mother, aunt or sister you never had, but she is not a cheap alternative to the midwife you couldn’t afford.
If you are a doula who has been asked to attend an unassisted birth, you must make sure the family understands and respects your scope of practice. If you have trouble communicating with them, if you feel they are keeping something from you, or if you are just not 100% comfortable with unassisted birth – if you have any doubts – do not take them as clients. The arrangement requires mutual respect and openness beyond what one normally has with clients.
Remember that the mother will be calling the shots all the way. She is not without a caregiver, she is her own caregiver. Do you feel comfortable with her in this role? How will you feel if a complication arises and she doesn’t feel she needs to transfer to a hospital; but you disagree? These things should be discussed in detail when deciding whether doula and family are a good match. Doulas usually have a contract that outlines their scope of practice. Some who attend freebirths may choose to create more detailed contracts.
Certified birth doulas should find out if their organization has a policy against attending UCs. Those with clinical experience or studying to become a nurse, midwife or other medical professional, attending a freebirth may run additional risks such as losing license or certification.
Another important point for doulas to consider is the legal or emotional ramifications of an unassisted birth gone bad. Even having a crystal clear understanding with a family and a well written contract may not protect you in a worst case scenario. If public officials are called in to investigate a birth injury or the death of a baby, especially if you are in an area that is particularly hostile to homebirth, you could find yourself in the middle of a witch hunt stamped with the label “illegal midwife.” The implications are serious enough to warrant careful consideration even though the likelihood of facing this scenario is unlikely.
I am a mother who has given birth to 3 children unassisted, and one self-directed in a hospital. I am also a certified birth doula. I chose to certify through Childbirth International specifically because they do not have a policy against doulas attending unassisted births. I believe every woman deserves whatever kind of support or privacy makes her feel safest during childbirth. I believe it is part of my calling in life to help preserve these rights. My personal convictions outweigh any personal risk in attending an unassisted birth as a doula.
Do I think other doulas should attend unassisted births? I think each doula should take the time to consider if it is something she’s comfortable with. Just as every woman who freebirths has to feel it’s right for her and right for each individual pregnancy, a doula must decide if attending UC’s is right for her, and if it feels right with each individual client.