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.
As soon as I found out I was pregnant I knew I wanted a home birth this round, I was done with the hospitals and things they try to force upon you. I was determined to make it to at least term to make this possible. At 29 weeks I went on bed rest and stayed there till 36 weeks. Contractions happened all the time and we had one scare where I went to the hospital. Everything checked out though and I got to continue on with my pregnancy!
37 weeks came and went and I had made it the longest I had ever been pregnant. I was shocked and excited I had made it that far. The days went on, contractions were happening just nothing that stuck or got me super excited.
The day finally came where I started having stronger more consistent contractions that I had to stop everything and focus through. I called my midwives she checked me and I was shocked to hear I was only 2 cm dilated and 90% effaced. This is nothing like my other pregnancies where I was at least 4cm by this point. I sent them home frustrated and took a sleeping pill, in hopes to get some sleep.
When I woke up the next morning I was having contractions still but nothing timetable, so we decided to make a trip to Costco. While pushing my 80lb cart around the store I had a few contractions where I had to stop and sway my hips and moan; haha got a few good looks for that. But by the time we got home they were pretty consistent again, about 11:30. I timed them for an hour and called my midwife. She came and checked me again and to my frustration and shock I was had gone back down to 1cm and 80% effaced. She got to my house at about 2:30. She left at 3 and I was very frustrated with my body, I didn't know what it was doing. I had my husband take the kids and leave so I could relax and try to stop the contractions if they weren't doing anything. At about 4 I got in the tub thinking it would help slow them down and it only made things that much stronger. I got out at about 4:20 and by 4:25 I had had 4 really strong contractions. I called my husband at 4:30 and told him to drop the kids off and get his butt home. Called my midwife back and she turned around and came back. I started filling up my pool because I just wanted water and relief. I got in the pool and immediately felt I needed to push, but was hesitant because I was just 1cm 2 hours ago. I was scared and didn't trust my body I had no idea what it was doing. I had another urge to push put my hand down and felt his head, he was crowning. I yelled to my husband who was filling pots of water, he ran in jumped in the tub, just in time to help deliver. His head and body flopped out with one push and his bags of water broke right when his head came out. He had the cord around his neck, but it slipped off super easy. He started breathing right away, and cried for about 30 seconds before he calmed down and just looked up at me with those perfect blue eyes.
It was perfect!!! My midwife walked in about 2 min after the birth. I couldn't have asked for a better experience. I held him, and nursed him right away, something that I didn't get to do with my other kids. It was amazing. I didn't even tear. He is 8lbs even 21 inches long.
Unassisted Childbirth (UC) refers to giving birth without the assistance of a trained birth professional, but most women who choose UC will tell you that they did have support and assistance in many forms throughout pregnancy and birth.
The first relationship to consider, if you have one, is your spouse or partner. One of the most common questions I hear from women who desire an unassisted birth is, “How do I convince my husband?” Just like any other situation where conflict or disagreement occurs, making decisions about your baby’s birth will require productive communication. As unfair as it might seem, you’ll probably have to really take the lead in discussing things. You may need to dig deep to find out what is really behind your partners apprehension. Often, spouses who have only seen modern, industrialized childbirth (even worse, fictional depictions of birth on TV) will feel fearful and concerned that they will be expected to deliver the baby or fill the role of “doctor.” Sharing birth stories or videos of undisturbed births or mothers catching their own babies might help him/her see another way that birth can occur and facilitate further discussion.
Sometimes, a spouse is completely against unassisted birth (or even midwife assisted homebirth) and cannot be convinced otherwise. In this situation, many women decide to compromise by hiring a midwife or delivering at a birth center. Others find their only alternative (or the only one their spouse will accept) is birthing in the hospital. As the woman carrying the baby, the decision is ultimately yours. You may find you have to choose between an ultimatum (which may involve birthing without your spouse’s support, or even without his/her presence) and a compromise.
My body, My birth? Or Our baby, Our birth? Ideally, we’d all have secure, healthy partnerships before having babies and this wouldn’t even be a question. In reality, many pregnancies occur before relationships have matured fully; your partnership might need work, or be stressed for a variety of reasons; and either or both partners might be seriously lacking in effective communication skills needed to work through conflict.
With my first son’s birth, I took the ‘My body, My birth’ approach. Though I never technically set an ultimatum because my boyfriend claimed he agreed with my decision, I knew he was unreliable and I don’t think I would have compromised my birthplan for him. I ended up giving birth alone. He only remained in my and my son’s life for a few more months. Given the circumstances, even though I didn’t fully understand them at the time, I made the right decision. I’ll be forever grateful that my son and I had an amazing birth experience, just the two of us.
I’ve since married a man who is a true partner to me (he also adopted my oldest son.) Convincing him to have our second baby unassisted was easy because, from the beginning he knew the story of my first birth and that I’d want to birth any future children the same way. If we had a disagreement about the birth of our child today, I would absolutely compromise – unless I was convinced that our baby would be put in real danger – with the best interest of our entire family unit at heart.
In many ways, setting an ultimatum says a lot about where your relationship is and can even set the tone for where it’s heading. If you are new parents, this might also be your first big parenting decision together. Emotions (and hormones) are often running high. Communicate your needs, fears and desires carefully. Stretch the conversation out over months if you have to; and be prepared with lots of information to answer your partner’s questions and concerns.
Besides your partner, there may be the question of who else will be invited to share the birth experience. Possibilities may include: older children, extended family members, a friend or a doula. Young children should be provided with their own support person, who can tend to their needs and give one on one attention while you labor. Anyone else present should be fully respectful of your decision to birth unassisted. If they are fearful, unsupportive, or if there is any tension or power struggle between you (as is often the case with family members) keep the negative energy out of your birthspace and don’t invite them!
If you hire a doula, it is important to understand her role as a non-medical support person. She is not there ‘just incase’ something goes wrong. Think of it this way, she isn’t there to play the role of the hands off midwife you couldn’t find (or afford.) She’s there to fill the role of the supportive friend/sister/mother you always wanted.
You will also want to identify your prenatal support system. Will you have prenatal care provided by a doctor or midwife? Will you seek the services of a Chiropractor, Acupuncturist, or other alternative health care provider during the pregnancy? Do you have friends or networks in the community where you will be able to openly discuss your plans to birth unassisted? Where will you seek education about childbirth? Who will you turn to if you have questions? You may find that the internet is an amazing source for information and support from like-minded individuals, but if you run into serious challenges having a support system of people you can talk to face to face is ideal.
You may also find it helpful to identify your extended support system – people and resources that help you maintain a healthy pregnancy – for instance, your baby sitter, yoga class or an organic farm share.
Last but not least, you’ll want to establish a ‘safe zone’ by identifying who needs to be kept out of the loop. If you’re concerned aunt is likely to harass you throughout your entire pregnancy, it may be best to keep the birthplans from her. If your mother in law threatens to call an ambulance, she should not be notified when you go into labor. Friends who feel the need to tell you every birth emergency story they hear in an attempt to change your mind about UC might need to be told, “If we are going to continue our friendship through my pregnancy, this topic is going to have to be off limits from now on.”
Choosing unassisted birth is an ongoing process that is only finalized when the birth has reached its completion. Until then, there is always an option to seek help or transfer to a hospital for assistance. When planning an unassisted birth, it is important to understand the natural physiological process of birth, variations and complications that may occur, how those variations or complications might be remedied at home, and which require immediate medical attention. Seek this information from as many sources as possible. You will find information presented in a variety of ways, especially when it refers to ‘safety’ or ‘risk.’ Relying too heavily on one source, you may find yourself following someone else’s dogma rather than your own truth. Be extremely wary of any source that implies that there is a ‘right’ way to birth or that you can guarantee a good outcome if you follow a certain method.
Make the commitment to research, pay attention and take responsibility. You will need to know more about birth complications than the average mama, even though you’ll most likely never use that knowledge. You’ll also need to be more in touch with your body – a skill you will find valuable for maintaining health and wellness throughout your life. If you have health issues that put you at higher risk of complication, you will need to carefully factor those into your decision.
Check your ego. Birthing unassisted will provide you with a greater level of autonomy – not to be confused with control. You will be able to prepare the atmosphere – set the stage – and you deserve credit for that preparation. Pat yourself on the back for all the research, meditation, prayer and love that you’ve poured into your birth plans. Congratulate yourself for being an expert in your own body; but don’t fool yourself into thinking there is never a place for birth professionals or medical intervention. Understand that when labor is in full swing you will be at the mercy of nature.
Know what’s at stake. If you’ve never lost a child, you can only begin to imagine what it might be like, but it’s important to explore your values and spiritual or religious views about death as you prepare to take responsibility for your baby’s safe arrival. You must face the reality that preventable deaths happen during unassisted births and there is a possibility (however small) that it could happen to you. A birth injury or death during an unassisted birth could have additional consequences such as blame from family or friends or even investigation by government agencies seeking fault.
Check in with yourself. Choosing unassisted birth is a journey. Ask yourself tough questions. Know your heart. Know your fears. Know your motives. Know your alternatives. If you aren’t facing difficult emotions, or learning important truths about yourself, dig deeper.
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.
Ensure that baby is breathing (it might be a good idea to use APGAR scoring, it is up to you) and mother isn't losing too much blood.
After giving birth, you may find that you have torn. Take appropriate measures to resolve any problems properly, even if it means a trip to the hospital. Also keep in mind that every mother is different. One woman can lose a lot of blood and be fine, and another may lose less but need help. (Generally, if you have lost more than 2 cups of blood, this is cause for concern.) This is why it is important to take good care of yourself during pregnancy. Hemorrhage is definitely a concern for those women that are anemic (have low iron levels). It might be a good idea to get your hemoglobin checked during pregnancy. Normal range is 11-14. Tears can be glued together with liquid bandage or super glue, or you can choose to do nothing and hold your legs together in bed after the birth. It depends on the woman, and the tear.
Also, it is not necessary to wash the vernix off of the baby. Vernix is beneficial. It protects the skin and will soak in within a few hours after birth.
Birth kit supplies may be purchased from a variety of sites (some may be cheaper on certain sites than they are on others, and supplies vary, so look around), but a popular site to purchase from is this one: http://inhishands.com/shop/Birth-Supplies.
I personally recommend doing a search for a particular item you want one at a time, unless you plan to order many different things. (A lot of things can be found at a local department store or laying around your house.) You may also decide that you want monitoring (the baby's heart rate, your blood pressure, cervical checks, etc.), in which case you can use supplies that you have used for your UP (or purchase them via the www.unhinderedliving.com, or wherever you feel comfortable getting them from).
You might even decide that a birth kit is unnecessary. Alternatively, it might be a good idea to pack a hospital bag, in the unlikely event you need to transfer.
Visualize your birth and decide what you need. If you think you might run into (or fear) a certain complication, you may want to especially prepare for that one, even just for peace of mind. Most women find that they don't need hardly anything that they put in their birth kit but it is better to be prepared than need it and not have it on hand.
This is important as it documents what your wishes are, ensures your birthing attendess know what you want and is important in the event you need to transfer to the hospital.
In your birthing/back up plan:
It is helpful to have your birthing plan and medical documents all together prior to giving birth.
Include any prenatal care documentation
Outline your birthing desires so all people involved in your birth have a reference.
Determine ahead of time what warrants a trip to the hospital, and make sure your birth attendant(s) know what to look for. For instance, if you are turning white and passing out, you could be losing a lot of blood (internally or externally) and need immediate medical attention.
Also, it is a good idea to include all of your medical information with your birth plan should you need to be transfered to the hospital as this expodites the process.
It is a good idea to read about and learn how to handle complications (variations of normal) at home and possibly print out the "variations of normal" sheets (from the Unhindered Living website or from wherever you chose) to have with you when you are in labor and giving birth. Hope for the best and plan for the worst.
Be ready for any possibilities, so that you don't find yourself panicking when your baby begins to emerge in a breech position or his shoulders get stuck, or if the cord is wrapped around the neck (which is common). Most "complications" do not require medical assistance, especially for the possibility that you might feel you need to transfer to the hospital.
This will help you to tolerate your labor better, and you won't have to try and think of what feels good or helps you cope when you are in a lot of pain. You will already know a lot of positions to try, and you will soon figure out which ones feel best to you. Here are few suggestions of positions.
What helps you relax? Massage, music, deep breathing? You may find that labor is suddenly very intense and that you need to relax to relieve pain or use breathing techniques. It helps to know what best relaxes you. And remember that pain in labor is your body signaling you to do something: move, eat, change positions, rid yourself of fear or emotional upset, relax, etc. It can also signal that something is wrong.
The more you believe you will have a good birth experience, the better chance you have of it coming true, because not only will you then not fear birth, but you will have a positive mindset about it and welcome it. This allows the process to happen more quickly and easily, and the baby is then more likely to be born without any complications.
It is also important to check in with your baby, because, remember, they are part of the birth process too. It might be a good idea, for instance, to "explain" to your baby (I use mental pictures) the best and safest way for him or her to be born, and to tell them that you are there with them and will birth them peacefully. Above all, trust birth, trust your baby, and believe in yourself. One of the most important parts of your prenatal care besides diet will be mentally preparing yourself (and your baby) for labor and birth.