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Monday, 28 November 2011 04:27

Unassisted Birth Explained and Why I Chose It

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What is unassisted birth?
Unassisted Childbirth (abbreviated UC and also known as freebirth) refers to purposefully giving birth without the presence of a doctor or midwife.
Some women prefer to birth completely alone.  Many share the experience with their husbands, children, friends or extended family.   Some women choose not to have a professional birth attendant, but still hire a birth doula for non-medical support.
My first son’s unassisted birth was in 2003; it was solo (though not planned that way,) with only my cats as witnesses.  I’ve since birthed two more sons, one in 2005 and the other, 2008 in the presence of only my husband.  The births of my children have had a profound effect on my life, my confidence and my vision for women everywhere.  After the birth of my third son, I continued studying childbirth and became a birth doula (certified through Childbirth International.) I’m expecting my fourth child in June, 2012 and hope to have another unassisted waterbirth.
Isn’t UC irresponsible?  Choosing unassisted birth means taking full responsibility.  It means learning information about childbirth and newborns that most women defer to their birth attendant.  It requires a woman to tune in to her body and her pregnancy in ways many women don’t consider.
Choosing unassisted birth also means going against the mainstream and facing questions and judgment from others. Contrary to what some critics seem to believe, having an unassisted birth isn’t a status symbol.  Most people will not think it’s cool; people are more likely to react with negativity or discomfort and it can be a very lonely path when family and friends are unsupportive or even downright mean.  Women who choose unassisted birth don’t take the decision lightly.  We know that birth does not come with any guarantees.  We know that, not only are we solely responsible for our children’s births, but that we will be held to an impossible double-standard.  If our births end beautifully, public opinion will credit ‘dumb luck’ yet blame will surely fall on us if we face complications that injure our children.
Isn’t UC dangerous?
Birth has risks.  Many complications of pregnancy and childbirth can be avoided with good health, nutrition and hygiene and many complications present before birth allow time for transfer to a hospital during labor. Women who choose unassisted birth learn warning signs to look for and create plans for hospital transfer in the event of a true medical emergency.  However, if a serious complication arises that requires immediate medical attention, the likelihood of injury or death is greater without a skilled professional (and applicable medical technology) available.  
Women who choose unassisted birth feel it is a safe option because we believe that interference in the birthing process creates complications. Essentially, we are trading less likelihood of getting help in the event of a (rare) severe life threatening complication for less likelihood of complication occurring. Statistics of unattended births show that they are not as safe as births attended by trained professionals, but these statistics include unplanned unassisted births and births attended by illegal midwives.  There are no accurate statistics on the safety of planned unassisted births.  It would be very difficult to gather information for scientific calculation as much of the philosophy of UC revolves around removing assessments and quantification, instead focusing on being in the moment. Those who choose UC for our families feel that decisions about how and where to birth are very personal.  We balance the benefits and risks individually for each pregnancy.  While we do familiarize ourselves with scientific studies and the likelihood of certain complications, our personal calculations of risk are often intuitive in nature tailored to our bodies (who we have taken great care to learn about and understand over our years living in them) beyond statistical probability.  We also consider risks that may not be life and death, but can have far-reaching consequences on the entire family.  These things may include the effects of unnecessary interventions, birth trauma, bonding and post partum depression.
Religious or spiritual beliefs often play a role in the decision to UC, whether directly indirectly. Though I wouldn’t say that my decision was a religious one by any means, my spiritual beliefs are part of the foundation of my values which include the beliefs that I’ve been entrusted to care for my children and that I should not pass the responsibility on to anyone else (much less someone I hardly know) before the need for assistance is clear. I believe we take part in choosing the life we are born into and that it is my duty to preserve the physical and spiritual integrity of my newborns by offering them as gentle and loving an entrance to the world as I can.  I feel that a naturally occurring complication is preferable to an iatrogenic one even if the outcome is as devastating because I believe in a power (nature, infinite intelligence, god...) that is bigger than me; I think a tragedy born out of man’s desire to control that power is a greater tragedy.
Isn’t UC Selfish?  
Critics say that women choose UC because they are focused on their own experience above the well-being of their babies.  I can speak for myself and many of the UC parents I’ve communicated with over the years when I say this is completely untrue.  First, a woman’s experience is important and her wellbeing (emotional and physical) during pregnancy and childbirth directly affects her baby. The two cannot be separated and pitted against one another.  We know that stress has negative effects on labor and can even cause it to stop completely so a mother feeling safe and comfortable is important to the wellbeing of her baby.  A woman’s experience during labor does matter (after all, one could argue that if the mother’s feelings are unimportant we should abolish the use of epidurals and other forms of pain relief since they are solely about her experience,) and feeling broken, abused and powerless is no way to begin motherhood – sadly many women leave the hospital feeling this way (sometimes directly leading them to chose to birth future babies unassisted).  Secondly, the call to birth unassisted is also about protecting our children.  Any birth professional brings with them another set of interests – their own.  However wonderful and caring a midwife or doctor is, they must answer to licensing protocols, insurance companies, supervising physicians, hospital policies, boards of directors, or lawyers, none of whom know my family or my individual experience – none of whom trust my judgment or intuition as a mother.  These entities see our families – our babies – as statistics and in some cases, liabilities.  We feel strongly that our babies’ safety and best interests are best served by those that love them most: mom and dad.  
At one point during my first pregnancy, lonely and fed up with being unsupported and misunderstood in my decision to UC, I thought “F- it. I’ll just go to the hospital and be a good little patient so I don’t have to feel like such an outcast!” and it was at that moment that I realized if I went to the hospital and played ‘the good patient’ and something happened to me or my son as a result of my failure to do what I felt was best for us… I could never forgive myself.  I’ve heard a lot of women over the years say “I could never UC, because if something happened to my baby, I’d never forgive myself.” But that sentiment goes both ways. UC is not for everyone – it’s not for most people.  But when you feel the calling to birth unassisted it’s every bit as profound and every bit as valid as feeling the need to seek support or technology your child’s birth.
Why not at least hire a hands-off midwife?
The simplest answer is that it’s rarely an easy task to find a midwife who attend a homebirth and just sit in the corner and knit (and to those who will, if you’re reading this, God bless you!)  
In some states, practicing midwifery in a homebirth is illegal making it difficult or impossible to find a professional willing to attend a homebirth.  In other states, midwifery is regulated making it difficult or impossible to find a midwife who will agree to remain hands-off (she may, for instance, be required to perform vaginal exams at certain intervals).  Regulations also may prevent a midwife from attending a VBAC (vaginal birth after Cesarean), a woman over 35, a pregnancy that has progressed past 42 weeks or other situations that are considered to be a higher risk for complications.  Mothers who find themselves classified as high risk, might feel that their risk is not increased enough to warrant medical necessity.  Some might simply be victims of rigid rules restricting homebirth though their relative risk is actually quite low.  For instance, a woman who’s had one Cesarean followed by 2 vaginal births has a ‘proven’ uterus and is not unreasonable to expect a third successful VBAC, but there may not be an exception for her when the rules say a midwife cannot attend VBACs at home.  Or, a woman whose 35th birthday passes in her last month of pregnancy might be in excellent health, but nonetheless past the age restrictions for a homebirth.
 Where there is not a shortage of homebirth midwives, or issues with regulations, often cost is an issue.  Many insurance companies do not cover homebirth midwives as they would a hospital birth and many families can’t fit thousands of dollars into an already tight budget. If this is your deciding factor, though I encourage you to at least talk to midwives in your area as many of them will try to accommodate clients with limited funds available.  Some may have difficulty finding a trusted midwife, or a negative past experience (for instance a midwife who claimed to be hands-off but ended up interfering significantly). Often, families choose not to hire a midwife because they feel that even her presence disrupts the natural flow of the birthing process, and undermines the mother’s innate knowledge and authority over her body and her baby.   This was certainly the case for me as I felt I needed to have a great level of trust for someone entering my birthing space.  Feeling watched, or judged, I feared would impair my process.  I had concerns that a midwife’s fears would intrude on my confidence, or that her confidence would supersede in the event I felt I needed to transfer to a hospital. I didn’t want anyone else’s voice, opinions or self-interests overriding my instincts as a mother.  The political climate around midwifery is harsh and unjust and I don’t think it’s fair to ask a midwife to martyr herself by accepting clinical/legal responsibility for something over which I’m not willing to give her authority.  
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