Unassisted Childbirth: Self Empowering or Irresponsibly risky?

Video

I have seen the same fear mongering argument waged by OB docs against the dangers of using home-birth midwives, but this instance lacks any basis. A midwife who is trained and experienced can recognize the signs of a normal birth gone wrong way before it becomes a dangerous liability. She also comes with emergency tools and is usually close to an emergency room or can have an ambulance on standby just in case.

However, unassisted childbirths no matter how informed, prepared and empowered parents may be, may be sending the wrong message to people. This is a very interesting summit but I think that parents should have all the information to make informed decision about how they give births. I don’t think its responsible to only give one message that you can do it at home easily. They say on their website that they have been considered “heros to thousands of followers”, for defying the medical system. Don’t drink the kool-aid bay area, I know its hard to resist. I would suggest always having somebody there with medical training on standby. In the words of comedian Chris rock, “you can steer your car with your feet but it doesn’t make it a good [expletive] idea!” I think this holds true here. Lots of women have given birth alone, but 5% of all births have complications, and many women before surgical procedures died of complications of labor. I would hate for a solo birthing trend to develop and see the maternal and infant mortality increase, it is already too high in the U.S. with all that we spend on technology and health care. So don’t play Russian roulette with statistics that are in your favor unless you have a failproof plan B.

Always evaluate the risks using game theory, or common sense, by weighing the progressive, idealistic birth against a lifetime of regret if death ensues. I think about this every time I want to jaywalk or pass a car or speed pass the red light… is what I gain, a few seconds really worth the worst case scenario. If you look at things from a broader perspective its easy to see that its really quite foolish. If you have risk seeking behavior and frequently employ moral hazard perhaps you derive a certain utility from living on the edge. At the end of the day its all about what you stand to gain versus the everything you have to lose.

I am reading the baby catcher and I will write a synopsis on it, but she says there is a midwife adage about birth unpredictability: “the first time is hard, the second time easy, the third unpredictable.” She was surprised with her own birthing outcomes. She said there was no rhyme or reason to it, no universal thing to count on to get her through each one. The pain and the natural birth methodology she tried to apply to all of them, she learned that each pregnancy is different and each coping mechanism is unique. Standardizing labor techniques, such as the proper application of the different breathing patterns for each stage, etc. was a fool’s errand.

However, since this is bay area buzz right now in the birthing community, I would be remiss to share it. So below is a link to the online summit and embedded is a link to their video showing their inspiration for going unassisted.

http://consciousparentingsummit.com/cps/
http://consciousparentingsummit.com/category/videos/

Vodpod videos no longer available.

14 responses »

  1. Pingback: Where there are no midwives… there are unassisted Births « Natural Birth Guru

  2. “So don’t play Russian roulette with statistics that are in your favor unless you have a failproof plan B.” It is very rare to find a UC family who does not have a plan B. Unassisted Birth is not something you go into thinking “I will UC no matter what”. It’s a careful planning process, caring for yourself, and re-evaluated plans if something comes up. I think it’s unfair to assume that most UC parents are just afraid to ever seek out medical attention. In most cases, it’s part of plan B or even C. Yes, it’s unfortunate when someone ignores the warning signs and does not seek medical care. It is also unfortunate when homebirth midwives, hospital midwives, and doctors do the same. It’s also unfortunate when midwives and doctors overcompensate during a normal birth out of fear. I’m just saying, please be careful how you portray unassisted childbirth.

    During my first UC (2 years ago), We had two backup plans during birth. One included calling EMTs, just blocks away from our house, and either being evaluated and staying home, or taking a ride to the hospital. Our other plan involved our car, a full tank of gas, a car seat ready, and a ride to the hospital, our quickest exit in the event of an emergency. Homebirth, even with a midwife, doesn’t get safer than that. If you believe it does, then you would be in disagreement with large population of home birth midwives.

    • Good for you, like I said, unassisted births are only an issue that 5% of births that can go wrong. Things can go wrong fairly quickly and to be able to diagnose whether its a compressed cord, or if there is an anterior lip that is causing the baby not to come out. etc, requires some type of medical training. Even as a doula, and midwifery student myself, I wouldn’t want to be liable for the small chance that something might go wrong. I wish you all the best in your births, but understand that births are unpredictable, and I am criticizing the message that is being sent that just everybody can just have an unassisted birth is just the wrong message, everybody is different, and everybody reacts to labor differently. There is no way to go into a birth knowing beforehand how you will react in an emergency. People often freeze or to panic to the point inaction during an emergency. So even with the best intentions, and a fail proof plan, will you be in the right state of mind to execute it.

      • Firstly, midwifery should never be about medical training. I understand that we probably differ on that viewpoint fundamentally. But I just urge you, before you complete your education, you may want to think deeply about what position you are taking on the foundation of what midwifery is, and what it’s not.

        Secondly, Nobody is saying that unassisted is for every women, or even that every woman should try to have an unassisted birth. Again, you are portraying UC advocates with a straw man argument. All we are saying, is the UC is a perfectly valid choice for any woman who feels it is best for her. It is not yours nor my position to tell a woman that she is not “cut out” or low-risk enough for a UC. Sure, could advise against it, just as a doctor can advise against a vaginal birth, but you cannot make the decision for her. And you are just a bigot if you go around basically calling these woman stupid and ignorant for choosing UC, just because you are a student midwife.

        Thirdly, you say “There is no way to go into a birth knowing beforehand how you will react in an emergency.” There is also no way to go into birth knowing beforehand how your doctor or midwife will act in an emergency. That’s exactly why women need to be the driving force and power in their own birth, not the midwife. If a midwife (or doctor) is present, they should be the advisory committee, not the sole decision makers. That’s how women, babies, and entire families fall into a position of being helpless and abused in their own birth scenario. And yes, MANY midwives are those abusers. They abuse their power and knowledge, and use it to make decisions FOR families instead of with them. The use it to stick their hands in women to “diagnose” instead of listening to women first and then asking if they would like a second opinion. They use it to lord over women who choose UC and tell them that their choice is “dangerous” and “irresponsible” (like you are in this post.)

        Many women would rather go unassisted than have a midwife like that.

  3. I get notice from google each time something concerning unassisted birth appears. I must say I was naive in thinking I’d never come across something like this as my intent was to get notice of more of the beautiful UC births videos I’ve seen.

    It seems to me that you are perpetuating the very fear mongering you accuse OB’s of spreading concerning homebirth. You also note that a “trained and experienced midwife can recognize the signs of a normal birth gone wrong way before it becomes a dangerous liability.” I find this to be a rather prideful and pretentious statement. It denotes that the pregnant woman is a complete moron who doesn’t know her body or baby well enough to know when something is wrong. As a doula, midwifery student, and mother, I am *the first* to know when something is awry with my body or baby as *I* have lived with both my body and baby then entire time. Of course there are many who are *not* in touch with their bodies and babies. There are many who prefer to give all responsibility for their bodies and babies over to Ob’s and midwives but there are those of us who, for many reasons, wouldn’t dream of handing over our bodies, births and babies to anyone else just because they are “trained and experienced”. Their “training and experience” does not make them an “expert” with regards to *my* experience.

    Another point I take issue with is the pseudo “informed decision” adage that’s commonly touted. It seems that one is only informed if they come to the same conclusions as you do which is that UC is irresponsible.

    Because I don’t see birth as a medical event, I don’t see the need to have anyone with “medical training on standby”. It is a normal physiological process. One either believes it is, or it isn’t.

    • I am not fear mongering. I am simply stating facts. It seems like when people are passionate about natural birth, and want to live in the extremes, they want to ignore reality. The truth is that while birth is a normal process, and isn’t a medical event, it has the potential at any moment to become one. whether you do it is at home or in a hospital. The difference is the proximity to the operating room. I just read the baby catcher and the one birth that had her close her practice, was the one, in which the ambulance wasn’t cooperative, because the baby had cord issues, and even with her there arm in the vagina protecting the cord, the ambulance there, her husband there, the baby came out with brain damage. The mother didn’t recognize the signs fast enough, and oxygen deprivation and fetal distress, can only take a minute. Peggy, the midwife who wrote that book, had moms during the emergency transfers begging her to perform the c-section desperately right there at their home.So, no, not everybody can go unassisted. There are a laundry list of complications that are foreseeable, that exclude a woman from even being able to have a baby with a midwife. So no, to put out a one size fits all message to natural birth moms is in fact irresponsible. I am not risk seeking, that isn’t my nature, even with my knowledge of natural birth, and birthing techniques and my medical knowledge, I won’t risk it. Why? Because pregnant woman (I have been with over 350), they are not in the best position to make decisions during labor. I questioned my research study’s consent process, as we approached women upon admission to ask if they would like to participate, many in transition, were just complacent. Then afterwards, they would be like who are you, and why are you taking cord blood, and swabbing my baby? Yes, they can feel their bodies, and can intuit if something is going wrong, but in the heat of the moment can you switch out of a primal mode interior focus, to make cerebral decisions and act on it? I am all for women empowerment, but I truly don’t believe a woman should be alone to labor by herself, nor should her partner have the onus to make life or death decisions for her, in the event of an emergency. Yes, the rare, RARE, emergency. 100% safe would be in a birthing center… and the risks only increases from there. I do not endorse birthing centers, or midwives, or doulas, although I think they are amazing, and I think home births are amazing too even more so, under the right circumstances

      • I understand that you may be afraid of it and indeed many, many women are as well and would never choose to give birth in this manner. My issue is that when someone who has a wonderful experience without a midwife, it’s touted as something akin to an occult where “kool aid” is involved. I don’t understand why people who wouldn’t make this choice seem to want to decide for all that it is irresponsible and risky.

        I believe that there is a place for hospitals with regards to emergencies during the birthing process. I personally think birth is far safer outside the hospital than within it’s walls but I don’t tell people that their choice to give birth in the hospital is irresponsible or risky although one could very well present a good case for that argument. I believe people should be able to make decisions that are best for them and because a “family birth” -which is a far better name for unassisted birth -isn’t for everyone, this is precisely why there will always be a need for good midwives. In this way, nobody loses their right to decide.

  4. Well thank you for your spirited replies. It is always a pleasure to be able to talk to natural birth proponents about what we are so passionate about. I write for writing’s sake, but it is great when I hear a new perspective on these ideas. I am writing often with the bay area mothers in mind, who have quite the tendency to jumping on every new granola trend. a lot of cults had their start in the bay area, very progressive people, but often don’t question what direction the progress is heading. I like to take a step back and re-examine trends I see developing, and as objectively as an unabashedly biased pro natural birth person can, start to question some of these practices. I would just like to make sure we are all think critically, about them before we start jumping on the bandwagon, with the skepticism of a scientist. Even practices like placenta encapsulation, cranial-sacral therapy, perineal massage, what do we actually know about them before we just do it? Even if they are organic and seemingly innocuous. I question even more critically, standard protocol in the hospitals, because patient care isn’t one sized fit all. That is the real message I want to put in my post. I would love to follow your blog as well.

    • It seems that you assume that because there is a growing population of families in and out of the bay area who are choosing to give birth in this way, they are simply “following the crowd” without thought or research. I don’t think that’s a fair assessment because it would be impossible to know, and further, it’s truly not *for* anyone to know or decide for them. It’s an individual choice.

      I’d be and am more apt to assume that, in light of birth in America and all the successful fear mongering, a family choosing UC has most definitely put some thought and time into such a decision. It’s not easy to go against the grain, especially with people all around you telling you you’re crazy, irresponsible, selfish or just plain stupid. It can’t be assumed that because someone chooses this valid option, they’ve not critically thought it through. I feel it’s even more hurtful coming from midwifery students and seasoned midwives who normally send the message (whether they believe it or not) that birth is normal, natural and then turn around and say except it’s dangerous and risky when I’m not involved.

      As a placenta encapsulation specialist I can say that I *have* looked into it and did plenty of research before “jumping into it”. Again, it seems that because these aren’t decisions you agree with or would make, they are invalid, dangerous and irresponsible. That’s not a fair assessment to make of an entire group of people you don’t know or understand. You may not agree in the end, but listening to a few of us may shed some light on *why* we make such decisions.

      • I am speaking from my experience living in the bay area for 10 years, and being in the birth community for 7. I am a midwifery student and I have had only natural birth clients, and despite all the will power in the world and pulling out all the stops, they still end up under the knife. I have learned that we have become so focused on the process that we forget what is MOST important is the outcome. Yes, I understand that the midwife has her ass to cover, and so does the docs, but they don’t have the same motivations. Midwives aren’t money motivated, nor time motivated, that is part of the profession and we accept that. Midwives don’t want to lose their right to practice because a mother is too stubborn to make the call to go to the hospital because she wants that perfect home water birth. That is precisely why I feel that births should be assisted, they can be hands off, but to have somebody there, like a lifeguard at a pool. They don’t manage your swimming, its just when you don’t come up for air they intervene.
        The midwife is present at birth to facilitate its normal course, not to change it, speed it up, or utilize forms of intervention (unless absolutely necessary.) Midwives also believe in giving the mother and her partner the freedom to make their own decisions about the birth. If the woman wants to sit, stand, eat, drink, or have her other children present at the birth, she can. I love how empowered people feel, but its really like saying that i’m a good driver, so I choose not to wear a seat-belt, totally ignoring that accidents will happen regardless, despite your best driving techniques. Its not worth it to me, and it isn’t worth the worst case scenario, and that is what I’m trying to impress upon you. I think that you have a myoscopic picture of the that is very idealized about birth and I admire that but I feel that it is a bit niaive.

  5. As a family only birther I must say this does not hold water. Women have been UCing for thousands of years. If it were not safe we would not be here! Mothers who chose this are of the vaer, very informed kind and know this is the best choice for them and baby. Stay out of our birthing choices—you reveal your ignorance when you “fear monger”. We are not afraid, you keep your midwife and anything elses you want. Freebirthing is OUR choice.

    • Do what you want, but for sure I don’t want to have a client who would take such risks, because they would be risking my career and well being. I don’t pretend to paternalize people and what they do with their bodies. However, Its not just the woman’s life who is at risk, it is the safety of the unborn, who also has rights to reasonable safety. Even Christian Scientists have had the law put pressure on them on this point. If you don’t like what I say, and prefer to troll my blog with non sequiturs, because my viewpoints, that has the support of WHO, and are evidenced based. Then that’s fine, just do it on somebody else’s blog.

  6. “Because pregnant woman (I have been with over 350), they are not in the best position to make decisions during labor.”

    ….. They are the ONLY ones that should be making decisions during labour, and we should trust them to do so.

    “The midwife is present at birth to facilitate its normal course, not to change it, speed it up, or utilize forms of intervention (unless absolutely necessary.) ”

    …. Actually, the body does the facilitating, not the midwife. Of the 350 births you’ve attended, how many times did the midwife (or Dr….) refrain from intervening in any way? Or would you deem them all “medically necessary”?

    Sadly, your post & comments have managed to give all power to the attendants of a birth rather than the birthing woman and family.

    • I disagree. Although the woman makes her birth desires known in her birth “preferences” it is not the woman rather than the BABY who makes the decisions, I think that it is the birth process itself that dictates the need for interventions. All interventions I have seen has been in response to the baby not tolerating the birth, and have seen those babies come out with nuchal cords X2 over their necks and other circumstances. I haven’t seen a third of the births most medical professionals have seen, but I know enough to know how unpredictable it can be, even with the best intentions and best birth plans. I just read yesterday how a strict birth plan increases the risk of ceseareans, this is what I usually advocate for women. I think that birth preferences rather are the women’s directive, and it speaks for her. The hospitals that I go to follow them pretty well, even if it means reading a couple of pages. My last c-section, we tried everything we could to get that baby to turn, even a failed internal rotation of the baby which my natural birth client decided 2 hours of stalling the decision to get the epidural to do. It is not an easy decision but women will cede to reason, given the options. With homebirths you take away the options. Midwives I know don’t carry pain meds, effectively not giving the woman a choice even if she decides later that she needs them, and to hell with their plans of natural birth. Having studied economics I hate information assymetry, the biggest market failure. However economics assumes a rational consumer to be able to make good decisions as well. So I will stop here at trying to rationalize the irrational. Women with the best intentions CANNOT make decisions that MAY endanger her child for the vain pursuit of a perfect “dream” birth, not without legal consequences. I had wiki’ed UC the other day and found that in 2009 one of the most vociferous leaders in the UC movement lost her child during birth in a ‘cardiac event’ which is being investigated by the police. I can’t help but wonder if that child would still be here today if somebody was there to intervene in the critical seconds of life or death.. or perhaps the outcome would be the same in the hospital. We will never know, but I would much rather know that even if the child died they had somebody their immediately with the aptitude to do something to prevent it.
      I would like to say that we will have to agree to disagree, and I will no longer entertain as they said on wiki this “danger courting”. “it is a sign of a learned mind to be able to entertain an idea without accepting it”- Aristotle. Thank you for sharing your perspectives though, however radical they may be, it makes us examine how messed up our medical system is to drive women to such extremes for the sake of a safer birth.
      ~Shanti

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