Unassisted childbirth
Encyclopedia
Birth
Birth is the act or process of bearing or bringing forth offspring. The offspring is brought forth from the mother. The time of human birth is defined as the time at which the fetus comes out of the mother's womb into the world...
without the assistance of a medical or professional birth attendant
Birth attendant
A birth attendant, also known as “skilled birth attendant” , is a midwife, physician, obstetrician, nurse, or other health care professional who provides basic and emergency health care services to women and their newborns during pregnancy, childbirth and the postpartum period...
. It is also known as freebirth, DIY (do-it-yourself) birth, unhindered birth, unassisted home birth, and couples birth.
Unassisted childbirth is by definition a planned process, and is thus distinct from unassisted birth due to reasons of emergency, lack of access to a skilled birth attendant, or other. It is also different from homebirth: while most UCs do happen within the home, planned homebirth usually includes the presence of a midwife or other birth attendant.
History
The UC movement grew out of, and is an extension of the natural childbirthNatural childbirth
Natural Childbirth is a philosophy of childbirth that is based on the notion that women who are adequately prepared are innately able to give birth without routine medical interventions. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained...
movement, pioneers of which include Grantly Dick-Read
Grantly Dick-Read
Grantly Dick-Read was a British obstetrician who is regarded by many as the father of natural childbirth movement. He dedicated his life to educating expectant parents about the benefits of giving birth naturally, with as little intervention from obstetricians and health professionals as possible...
, Robert A. Bradley, and Fernand Lamaze
Fernand Lamaze
Fernand Lamaze was a French obstetrician, most famous as the popularizer of psychoprophylaxis, a method of childbirth preparation and pain management that has come to bear his name ....
. Influential proponents of UC include Marilyn A. Moran, Jeannine Parvati Baker
Jeannine Parvati Baker
Jeannine Parvati Baker was a Yogini, midwife, herbalist, published author, and poet. She was also an international activist on the matters of homebirth, unassisted childbirth and newborn rights issues.-Biography:...
, and Laura K. Shanley.
Moran, who wrote several books advocating UC, was motivated primarily by a strong belief that childbirth is a private, deeply sexual experience that should be shared only between intimates. This belief led her in 1972, after nine conventional births, to give birth to her tenth and final child with only her husband in attendance at their home.
Parvati Baker, a yogini
Yogini
Yogini is the complete form source word of the masculine yogi- and neutral/plural "yogin." Far from being merely a gender tag to the all things yogi, "Yogini" represents both a female master practitioner of Yoga, and a formal term of respect for a category of modern female spiritual teachers in...
, writer, poet, herbalist
Herbalist
An herbalist is:#A person whose life is dedicated to the economic or medicinal uses of plants.#One skilled in the harvesting and collection of medicinal plants ....
, and "spiritual midwife", coined the term freebirth to describe UC. Following the birth of her own children, she began to advocate for UC, speaking at conferences, giving interviews in various media, and writing extensively on the subject. Parvati Baker credits Moran for persuading her to practice and promote unassisted childbirth: "I was a young mother when Marilyn Moran wrote to me thirty years ago. Characteristically, she got right to the point. She told me that my work to promote midwifery was missing the boat. She had a better idea. Her letter changed my life. I had my next three babies without the paid paranoid in attendance, and expanded my own book, Prenatal Yoga and Natural Birth, to include these freebirth stories.".
Shanley, a writer, poet, and self-styled birth consultant, is the author of the book Unassisted Childbirth (1993), which helped popularize the practice. Inspired by the writings of Dick-Read, Shanley, who has no formal training in gynecology or obstetrics, gave birth to all five of her own children unassisted and with no prenatal care. Four of them survived; Shanley's fourth child, born four weeks premature in her bathroom, died a few hours later of a heart defect, pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
, and sepsis
Sepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
.
In response to the recent growth in interest over unassisted childbirth, several national medical societies, including the Society of Obstetricians and Gynaecologists of Canada
Society of Obstetricians and Gynaecologists of Canada
The Society of Obstetricians and Gynaecologists of Canada is a national medical society in Canada, representing over 3,000 obstetricians/gynecologists, family physicians, nurses, midwives, and allied health professionals in the field of sexual reproductive health...
, the American College of Obstetricians and Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists is the body responsible for training and examining obstetricians and gynaecologists in New Zealand and Australia...
, have issued strongly worded public statements warning against the practice. Professional midwives' associations, including the Royal College of Midwives
Royal College of Midwives
The Royal College of Midwives is a British midwives organisation which has existed under its present name since 1947.-History:The Matrons' Aid Society, renamed the Midwives' Institute in 1881, was founded by Louisa Hubbard and Zepharina Veitch to raise the training and status of midwives...
and the American College of Nurse-Midwives also caution against UC.
Common reasons and motivations
Reasons and motivations for choosing to give birth unassisted range greatly from mother to mother; those most frequently cited in unassisted childbirth literature and advocacy sites include the belief that birth is a normal function of the female body and therefore not a medical emergency. Other beliefs are that most interventions commonly used by the medical profession during birth cause more harm than good in a normal birth, that the mother will be more apt to follow the natural flow of her individual birth in an undisturbed birth setting, thus enabling her to find the optimum positions or techniques to birth her child safely and the view that birth is an intimate, sexual, and potentially orgasmic experience, and the belief that privacy is essential for enabling this erotic dimension.Advocates believe that unassisted birth gives rise to a significant increase in maternal feelings and the mother's ability to bond
Maternal bond
The maternal bond is typically the relationship between a mother and her child.While it typically occurs due to pregnancy and childbirth, it may also occur between a woman and an unrelated child, such as in adoption...
with and take responsibility for the welfare of her child. Some followers are unable to find a birth practitioner willing to attend their desired home birth. In many areas of the United States, there are no midwives or physicians available to assist at home births. Likewise, the woman may find her specific case presents difficulty in finding a willing practitioner, as is usually the case with a vaginal birth after caesarean
Vaginal birth after caesarean
Vaginal birth after caesarean refers to the practice of delivering a baby vaginally after a previous baby has been delivered through caesarean section . According to the American Pregnancy Association, 90% of women who have undergone cesarean deliveries are candidates for VBAC...
section.
Types
Unassisted with friends and/or family:While unassisted childbirth does not include the use of medical personnel or birth attendants in a professional capacity, the birthing woman may still wish to have other people present at her birth. This might include her partner, close friends of the mother, the grandparents-to-be, or other family members. These people may take on various roles such as minding the other children in the family, preparing food, making sure the mother remains undisturbed by phone calls, etc.
Couple's Birth:
A woman giving birth and her partner may wish to be alone together for the birth of their child. Some couples who choose unassisted childbirth consider the birth to be a consummation or extension of their married life. In terms of wanting to have an ecstatic or orgasmic birth, a high degree of privacy is desired. Others may simply consider birth to be an intimate bonding time between the spouses and their newborn child.
Solo Birth:
Some women choose to give birth completely alone. They may retreat to a room alone at the time of the birth and then bring their partner in afterward; or they may remain entirely alone in their home or another location. Women who choose a solo unassisted birth may see birthing as an intensely private process, or may feel they have all the resources they need through their intuition.
Birth preparation and prenatal care
With respect to medical prenatal care, two broad categories are recognized by unassisted childbirth proponents:Assisted: Many women who are planning an unassisted birth choose to have professional prenatal care as part of their birth preparation. This may include regular prenatal visits with a doctor or monitoring by a midwife. Seeking the assistance of a doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
or midwife may allow for discovering risk factors that might make an unassisted birth inadvisable, such as placenta praevia
Placenta praevia
Placenta praevia is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of antepartum haemorrhage...
. Professional prenatal care may also help identify risk factors that could be managed so that the unassisted birth can continue as planned. Rather than keep to a traditional prenatal care schedule, some women may also selectively choose prenatal care.
Unassisted: Some women who choose UC also choose to have a medically unassisted pregnancy; i.e. they do not visit a doctor or other birth professional for prenatal care. There are potentially life-threatening consequences of having no medical follow-up in case there are complications.
Prevalence
United States:The National Center for Health Statistics
National Center for Health Statistics
National Center for Health Statistics is a division of the United States federal agency the Centers for Disease Control and Prevention . As such, NCHS is under the United States Department of Health and Human Services...
reports that of the 4.1 million babies born in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
in 2004, more than 7,000 were born at home without a midwife or physician attending. It is unknown what portion of these births, roughly equivalent to a sixth of 1% of the nation's annual total, occurred by choice.
Australia:
It is not currently known how many women in Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
give birth at home by choice without medical assistance. Home births in Australia represent just 0.25 percent of all births, with the majority of these done with the assistance of a midwife.
Risks
Unassisted childbirth has been linked to substantially elevated rates of both maternal and neonatal mortality. One of the few, and perhaps the only, formal investigation of the mortality rates associated with the practice was conducted by the IndianaIndiana
Indiana is a US state, admitted to the United States as the 19th on December 11, 1816. It is located in the Midwestern United States and Great Lakes Region. With 6,483,802 residents, the state is ranked 15th in population and 16th in population density. Indiana is ranked 38th in land area and is...
State Board of Health in 1984, among members of a religious community in Indiana. The investigation found a perinatal mortality rate 2.7 times higher, and a maternal mortality rate 97 times higher than the state average. In this community, pregnant women receive no prenatal medical care and deliver at home without medical assistance. This community avoids not only prenatal medical care but all medical care.
According to the president of the American College of Obstetricians and Gynecologists, Dr. Thomas Purdon, twenty percent of all previously normal pregnancies turn into complications and high-risk situations during the course of labor that could result in serious adverse outcome to mother and baby, including death.
Controversy
Controversy over the practice of UC has largely centered over whether it is, as claimed by proponents, a safe method of childbirth. Critics of UC, such as the Society of Obstetricians and Gynaecologists of CanadaSociety of Obstetricians and Gynaecologists of Canada
The Society of Obstetricians and Gynaecologists of Canada is a national medical society in Canada, representing over 3,000 obstetricians/gynecologists, family physicians, nurses, midwives, and allied health professionals in the field of sexual reproductive health...
(SOGC), claim that unassisted childbirth is quite unsafe, and that those who engage in it are "courting danger". A spokesperson for the American College of Obstetricians and Gynecologists issued a one-word assessment of freebirth: "dangerous". The SOGC notes that more than 500,000 women worldwide die annually from complications during childbirth, and that even in developed countries, in which expectant mothers generally receive complete prenatal care, as many as 15% of all births involve potentially fatal complications. In poor countries in which there are conditions of malnutrition and taboos surrounding childbirth or there is a lack of qualified birth attendants, rates of maternal and infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
and complications such as fistula
Fistula
In medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...
are much higher, with disparities in death rates from childbirth between developed and developing countries approaching two orders of magnitude. Critics also point out the high rates of complication and death arising from childbirth that existed before the development of modern medicine: between 1,000 and 1,500 deaths per 100,000 births.
UC proponents have responded to these criticisms by emphasizing that childbirth is not a disease, but rather a natural, physiological process requiring proper nutrition, hygiene, prenatal self-care, and psychological preparation. They claim that both throughout history and in the impoverished regions of today's world it has not been the lack of medical assistance, but rather conditions of poverty and nutritional ignorance which cause maternal mortality to be a major health issue. Rickets
Rickets
Rickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium , phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries...
, for example, is prevalent in daughters of malnourished women, resulting in deformation of the pelvis
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
and an increased chance of hemorrhage in scenarios of anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
. Proponents assert that the women who plan unassisted childbirth today (many of whom are giving birth to their second or third child, with a 'proven' pelvis), do so with a wealth of information and self-care, and are better prepared than most women who depend on care providers to deliver their child.
Proponents also claim that modern maternal mortality rates in American hospitals are often obscured by being statistically tracked under 'anesthesiology'. However, evidence suggests that if this is in fact the case, the practice is unlikely to account for more than a small fraction of maternal deaths: one study of maternal mortality records lists the 'total' share of maternal mortality deaths recorded as stemming from anesthesia-related complications as just 5.2%.
Other aspects of this response have also been called into question by scientific research. First, an analysis of historical data from Europe and the United States concluded that in developed countries, the main determinant of maternal mortality before 1937, and its decline since the 1930s, was not levels of poverty and associated malnutrition, but rather the overall standard of maternal care provided by birth attendants.
Second, with respect to UC proponents' claim that unassisted childbirth is a natural process, researchers in the field of paleoanthropology have asserted that assisted childbirth is, in fact, a central evolutionary aspect of humanity, and may date back as far as five million years to when humanity's ancestors first began walking upright.
On 27 March, 2009, Janet Fraser, a leading advocate of UC and national convener of the highly popular Joyous Birth website, lost her child during a birth assisted only by her partner and a female friend. In an interview five days earlier with The Sunday Age
The Age
The Age is a daily broadsheet newspaper, which has been published in Melbourne, Australia since 1854. Owned and published by Fairfax Media, The Age primarily serves Victoria, but is also available for purchase in Tasmania, the Australian Capital Territory and border regions of South Australia and...
, Fraser, in the early stages of labor at the time, stated that she had at no point during her pregnancy consulted with a health professional, and that she intended to deliver the baby at her home without an attending midwife. The cause of death was reported to be cardiac arrest. A police investigation was underway as of 6 April 2009.