A growing number of women are choosing to give birth without the assistance of doctors or midwives, provoked by dissatisfaction with modern obstetric care, fear of unnecessary medical intervention and a desire to reclaim birth as a private, natural act.
It’s a choice the professionals say is fraught with peril. They fear the fledgling “freebirth” movement may undo gains in mother-infant mortality. The women, however, believe unassisted childbirth is emotionally and physically the safest option for themselves and their babies.
Some 33%, or 8708 out of 26 667 homebirths in the United States in 2007 were not attended by a physician or midwife, up from 30% in 2005 and 31% in 2006, according to the US Centers for Disease Control and Prevention (www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_24.pdf). Two-thirds of those deliveries attended by someone other than a physician or midwife in 2006 were reported as “planned” (www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_11.pdf).
Canada lacks similar statistics, but a cursory search online turns up a surfeit of websites, forums, chat groups, guides and home videos dedicated to freebirth. Popular parenting website Mothering.com, for example, currently hosts more than 15 000 active discussions on unassisted childbirth, or what members call “UC” (www.mothering.com/community).
It’s a difficult trend to track with any certainty, not least because advocates of unassisted childbirth aim to avoid interaction with the medical system wherever possible.
While some women forgo prenatal care entirely, others orchestrate a “planned oops” or “accidental” unassisted birth to avoid confrontation with health care providers and the law.
Many are already mothers, wary after a bad experience with a doctor or midwife.
“My first son’s hospital birth left something to be desired. We were both fine, but the doctor I had was terrible. When I became pregnant a second time, I sought out a midwife and while one of the women in the practice was great, the other really talked down to my husband and I, almost like we were children,” explains Andrea Salcedo, a Calgary, Alberta-based mother who has since delivered two children unattended. “I was probably seven months pregnant when I decided I didn’t want [that midwife] at my birth. I didn’t want it to be a guessing game.”
Others fear being coerced into medical procedures they’re not comfortable with.
“There are some people who can go into the birthing room and put their foot down, but I know when I go into a doctor’s office for an appointment, I get overwhelmed, let alone in a case where they’re saying your baby might die,” says Lia Joy Rundle, a Mazomanie, Wisconsin-based mother who delivered all three of her boys unattended. “I think it’s easier to trust yourself if there’s not another voice there. Having that other set of interests involved makes me uncomfortable.”
Doctors and midwives bring their own timelines and expectations about how a delivery should proceed, and will err on the side of intervening in birth to protect themselves against litigation, says Laura Shanley, the Boulder, Colorado-based author of the book, Unassisted Childbirth, who has delivered five babies by herself. “I can see the position they’re in, because if you don’t deliver a perfect baby there’s a chance you’ll get sued, and there’s this idea that if you’ve transferred someone to the hospital or done a c-section then you’ve done everything you could.”
Births by cesarean section accounted for more than 25% of all hospital deliveries in 2004–2005, as compared with less than 18% a decade earlier, according to the Public Health Agency of Canada (www.phac-aspc.gc.ca/publicat/2008/cphr-rspc/factsheet-fiche-eng.php). Significant variations in surgical rates among Canadian jurisdictions suggest some of these procedures “may not be appropriate or necessary,” by recent Canadian Institute for Health Research estimates (www.cihi.ca/cihi-ext-portal/internet/en/document/health+system+performance/indicators/performance/release_16dec10). In 2008–2009, primary c-section rates ranged from a high of 23% of deliveries in Newfoundland and Labrador to a low of 14% in Manitoba.
With up to 15% of all births involving potentially fatal complications, however, “the evidence is overwhelmingly in favour of giving birth with a skilled attendant present,” said Dr. Donald Davis, past president of the Society of Obstetricians and Gynaecologists of Canada, in a statement on freebirth (www.sogc.org/media/pdf/advisories/Release_freebirth_final_e.pdf).
Proponents of unassisted childbirth say it’s all a matter of perspective. They prefer to view birth as a “spiritual, sexual experience, not an inherently dangerous medical event,” says Shanley. “I trust the same intelligence that knows how to grow the baby from an egg and a sperm into a human being also knows how to complete the process.”
Unnecessary intervention in birth is more often the cause of complications than a remedy, she adds. “People counting, measuring and managing birth into this controlled, manipulated act, it’s no wonder women’s bodies shutdown — the way anybody’s would if someone kept interrupting them while they were trying to have sex, go to the bathroom or go to sleep.”
Intervention should be the last resort, not a given, says Salcedo. “When I went to have my son’s birth registered, one of the nurses asked why we didn’t go to the hospital and my husband looked her in the eye and said: ‘Because it wasn’t an emergency’.”
The couple prepared for complications by reading books for first responders on how to deliver babies in emergency situations.
Others look for such information online.
“I had to assess what my personal risks were,” says Rundle. “I’m a healthy young woman, so when people say that 15% of the time there’s a complication, are they talking about women who have different medical histories than I have?”
Some women, like Shanley, prefer to put complete faith in their bodies and refer to complications as “variations of normal.”
“There are going to be babies who die during an unassisted birth who may not have if there had been intervention, but there are also going to be babies who die because of interventions,” she explains. “There’s no way to ensure a successful birth every time. Sometimes a baby dies and that’s just the way it is.”
It’s not a stance Shanley takes lightly, having lost a child to a congenital heart defect following an unassisted delivery, and been told by a coroner that the baby would have died even if she had gone to the hospital.
It’s a difficult stance to counter, says Canadian Association of Midwives President Anne Wilson. “You can’t say to a mum that 60% of all unassisted births result in complications where the baby dies because that kind of statistic doesn’t exist. A lot of complications in childbirth are predictable and occur over time, but a few happen without warning, such as severe hemorrhage. And if a woman doesn’t have prenatal care, doesn’t report the birth to the hospital, there’s no way to know.”
Globally, over 500 000 women die each year from complications during childbirth, according to the Society of Obstetricians and Gynaecologists of Canada.
“Unassisted childbirth is unsafe — period,” said past vice president Dr. Vyta Senikas in the statement on free-birth. “The people advocating this as a mainstream option for women are tragically uninformed.”
Midwives, however, are more “fuzzy” on the issue, says Wilson. The association has yet to take an official stance for fear of alienating women wary of intervention. “If someone came to us who was considering an unassisted birth we would want to keep that person engaged, build a relationship of trust and if they ended up going ahead with it, at least you’re someone they can call if they get half way through a delivery and change their mind.”
Failing that, “some prenatal care is better than none,” she adds.
The debate raises ethical questions of “autonomy versus beneficence” for midwives, Wilson says. “By the nature of what we do, we tend to look after people who don’t want interventions. It would come down to individual choice in terms of how comfortable you are as a practitioner taking that person into your care.”
For Shanley, however, unassisted childbirth is more a question of reproductive rights. “It’s your body, your birth and your baby, so you should have the right to give birth however you want.”