Unassisted Childbirth in North America

Home birth with a midwife may not be considered a "fringe" practice for much longer. An old birth option has been getting a lot of media coverage in the past few years and it is now being called a trend, although only a fraction of a percent of women are making this choice. What trend am I refering to? It has been called "free birth", "DIY (do it yourself) birth", "unassisted birth" (or UC), and even "pure birth". In essence, it is the practice of women giving birth in the place of their choice without a professional birth attendant to help them.

I first learned about UC through a midwife friend who chose to have her third and fourth babies alone with only her husband present. Her first two were born at home with midwives, and they went smoothly, but access to midwives was a little more tricky with her last two, so they were born peacefully into their daddy's hands and both mom and her babies recovered well.

Although my introduction to UC was a postive one, I didn't think much more of it for a long while. I was currently trying to become a student midwife adn unattended birth was not forefront on my list of interests. Future exposure included reading stories of the early experiences of selt-taught midwife Ina May Gaskin (author, Spirtual Midwifery), and lots of birth stories online. But my interest in UC did not become prominent until I cam close to having an accidental unassisted home birth with my second child. The midwife made it in time, but it got me thinking about what if's, and who is really needed for births to happen smoothly.

I was not mentally prepared to give birth without a professional who knew what she was doing, so when my second birth started happening really fast, I layed on my side for most of active labor (until the midwife arrived) which resulted in more discomfort than I probably would have had if I had been upright. After my baby was born, and I had more time to think about what happened, I realized I would have been just fine giving birth on my own. Babies who come quickly usually do so because everything is going very well and an emergency is unlikely. Plus, I am the one who is giving birth, not the midwife, so the strength and body knowledge has to come from within me, whether or not a birth attendant is there.

When my second baby was a few months old, I was sent a link to a thesis on unassisted childbirth in North America, written by a college student who had a UC herself. This thesis has been an eye opener for me, and it has been helpful to me, not only as a doula, aspiring midwife, and potentional UCer, but as a woman who has given birth and will give birth again. I recommend that any woman (or man) who has time to read this 360+ page thesis to do so because it would be an empowering experience in itself.

The author explains right off the bat that as she is a proponent of UC the thesis may be considered a biased opinion, but after reading it myself (and not being a proponent of UC, per say) I can say that she did a very good job of writing and collecting interviews to create a well-rounded, unbiased presentation.

The average person who is confronted with the concept of UC will probably have one or more of these thoughts cross their mind:

"That's dangerous!"

"That's selfish!"

"They're brave!"

"I could never do that."

"Why would someone do that?"

To be honest, before I read this thesis I had a few of these thoughts as well. Not to say that I will now plan to give birth to my next baby at home without a midwife, but it has addressed my concerns about the midwife not making it in time, and I certainly feel more comfortable trusting myself, my baby, and my body.

Some of the subjects the author, Rixa Ann Spencer Freeze, addresses include: What makes birth safe? Why do some women choose to give birth unassisted? How has the UC trend changed over time? Why do some women prefer UC over midwife attended home births? What happens if something goes wrong? How women prepare for a UC and manage their pregnancy care, and how maternity careproviders have responded to this trend. Some of the answers (which she has gotten directly from UCers, doctors, and midwive) may surprise you.

For example, it appears that most women who choose to give birth unassisted do so because they feel they have no choice; perhaps there are no midwives in their area, or perhaps the hospitals in their area do not offer the care they want. Some women choose to give birth unassisted after having a bad birth experience with an attendant and feel they could do a better job themselves while others had a previous good birth experience with an attendant and that encouraged them that they could give birth on their own. For the most part though, UCers did not choose this option as original preference, but the more they learned, or experienced birth, the more they came to support UC over other options.

Here is the unassisted birth story of a friend of mine, who gave me permission to share it with you:

"Well it all started when I had no insurance. I had applied for mainecare and was denied but they covered an emergency visit when I was having severe chest pains. At that point I was 21 weeks pregnant. They covered that then a few days later I got a letter stating I no longer had mainecare so we started looking at alternate options. However all the midwives I talked to said they couldn't help me because I was so late in my pregnancy. So we were waiting patiently for our daughter to be born I was thinking about what
everyone used to do in the olden days and came to the conclusion that they had faith in their families or the doctor. So my husband and I started doing research on what we had to do to give birth at home and all the procedures. We got in contact with Maine department of vital statistics and they sent us the paperwork for a live birth. Our daughter was 2 days late when she was finally born. I hadn't been feeling well since 4 am but i just thought i ate something that didnt agree with me since my husband was sick
too. It was 1:30 and i had to use the restroom and I went to wipe myself and she was already crowning. I yelled for my husband and he came running thinking i had fallen because of the tile floor. Before any of this I had decided I was going to give birth standing up. The delivery of our beautiful baby girl was 10
minutes and the placenta took the longest at 50 minutes.We had a beautiful baby girl who weighed 6lbs 5oz and was 20 inches long. I found that standing made me feel empowered and invinsible."

Most women who give birth unassisted are willing (and do) seek help when they need it, but they have had to take greater responsibility for whatever the outcome. It is in large part due to that responsibility that UCers say that option is not good for everyone, as some women do not feel comfortable taking that responsibility into their own hands.

Fear of death is probably the greatest concern parents and careproviders have about UC. The fact is that moms and babies die in the hospital, and moms and babie die at home. Yet if a careprovider is involved, the family can mentally pass off the responsibility onto the careprovider to ease their pain. If they choose to go it alone, they have only themselves to turn to, even if a death was unavoidable. Some say this is the best way to judge whether or not a woman is a good candidate for UC. Although deaths are very rare, would a woman feel good giving birth unassisted even her baby died (eg. deformity of the baby, cord accident, or other scenario that might have resulted in death even within the hospital)? If death is something a woman can process on her own and consider as a phase of life, perhaps UC is a good option for her. If she doesn't think she could handle it, than a home birth with a midwife or a hospital birth are probably her best options.

Now that I have looked at the worst case scenario, I'll look at the benefits of giving birth unassisted. I'll start with the story of one woman who was interviewd for the thesis. She decided to give birth at home unassisted and everything went very well. But after her baby was born she realized her placenta and cord were not in very good shape. She got a second opinion and learned that having a UC probably saved her baby's life: if anything had been done to manipulate her labor (eg. induction with Pitocin, breaking her water) the baby could have easily suffocated and died very quickly.

There are many benefits to leaving a mother's body to do it's own thing undisturbed, and having a UC is the easiest way to garauntee an undisturbed birth. Some home birth midwives practice "hands-off", meaning they do little more than observe for signs of trouble and offer emotional support as needed. While many women are happy with that, others say midwives offer a "hospital at home" service and they want no intervention at all.

Unassisted birth can make women feel more at peace, more in control, able to "let go", healthier because of less stress; and can result in a happier baby because the mothers do what their bodies are leading them to do under their own authority. And of course, responding to labor in a way that supports the process (eg. being active in labor) makes it easier on both mom and baby.

As for prenatal care, some UCers see their careprovider and then "accidentally" give birth unassisted, some only have a prenatal near the end to confirm position of the baby, some do their own prenatal care, and others are lucky enough to find a care provider who supports their decision to UC and offers prenatal, birth, and postpartum care as the parents feel the need. The choice of what kind of prenatal care women want often depends on whether they want to share their pregnancy with others as it is a social and celebratory time of life. Most UCers understand how their lifestyle affects the baby and focus on exercise, rest, and diet to help prevent complications. When they do their own prenatal care, or have none at all, they have what is called, an "unassisted pregnancy", or UP.

Here are a few books available on UP and UC:

1. Unassisted Childbirth by Laura Kaplan Shanley
2. Prenatal Yoga and Natural Childbirth, Conscious Conception, and Hygieia: A Woman's Herbal by Jeannine Parvati Baker
3. Pleasurable Husband Wife Childbirth The Real Consumation by Marilyn A. Moran

Here are some YouTube videos of unassisted births, or discussion of them (viewer discretion advised), many more can be found on YouTube:

1. Clio
2. Maelle
3. Logan
4. Laura Shanley interview

And here are a few websites about UC:

1. www.unassistedhomebirth.com
2. www.unassistedchildbirth.com
3. www.orgasmicbirth.com
4. www.birthkeeper.com

In a time when home birth midwives are working very hard to get recognition for their work, to get state licensure, and to ensure women's right to safe and empowering home birth, it is interesting that unassisted birth now makes its appearance into the media. While many careproviders support women's right to choose their place and manner of birth, their is a battle arising over who should have the right to decide these things.

The AMA and ACOG issued a resolution last year stating that they would support any legislation against home birth. This is dangerous ground they are treading on and is completely unconstitutional. It is a slippery slope to controlling birth when they have no right to do so, and many will fight against it. Some fear that women giving birth unassisted will fuel the fire against home birth in general, whereas others feel that getting UC in the media will encourage more women that it is okay to trust their bodies and make their own choice.