UC safer than HB with Midwife? UP?

[NewSolarMomma]

I was wondering if you all thought UC was as safe, or safer than HB with a MW? I was having this conversation on another board, and a bunch of us thought that UC might be safer. Are there any stats?

I started wondering about this because I've seen so many UC mommas say they know as much as the MW, and can do the same stuff. And I thought, YES, this does sound right! I would think you would trust your own instincts more and wouldn't rely on the MW instead.

I also have been meaning to ask about UP, and why you choose it. I had never even heard of it until I came here. I've been reading here for awhile, but I never heard anyone explain this. I am planning a UC for my next baby, and wondered if there was any advantage in UPing too.

Thanks for the education!

[MsBlack]

Originally Posted by NewSolarMomma

I was wondering if you all thought UC was as safe, or safer than HB with a MW? I was having this conversation on another board, and a bunch of us thought that UC might be safer. Are there any stats?

I started wondering about this because I've seen so many UC mommas say they know as much as the MW, and can do the same stuff. And I thought, YES, this does sound right! I would think you would trust your own instincts more and wouldn't rely on the MW instead.

I also have been meaning to ask about UP, and why you choose it. I had never even heard of it until I came here. I've been reading here for awhile, but I never heard anyone explain this. I am planning a UC for my next baby, and wondered if there was any advantage in UPing too.

Thanks for the education!

I doubt you will find any stats that show UC is safer than planned, attended homebirth. There aren't any good studies out there, but I've been watching on the UC boards for quite awhile--here and elsewhere--and I haven't seen it 'safer' on the whole. Speaking as a UC mama, and homebirth mw who supports UC I will say that for the informed, prepared and sensible family, UC is a safe choice...but the variables are so great among families....

I have met some incredibly knowledgeable UC mamas--and I can agree that a few 'know as much as a mw'...in enough ways to matter to that family for a safe birth. But when I hear someone claim they know as much as a mw, well it's possible since not all mws are equally knowledgeable--but unlikely, on the whole. Seems more likely that those moms (who say they know more than a mw) know things in their own way, about their own bodies/babies, than the mws they spoke to. What matters to a UC family is knowing all *they* need to know, for their OWN safety. A mw is going to know a whole lot more than what 1 family needs to know. With study of the literature along with intuitive awareness, a UC mama might well know 'more than a mw' in her own case.

As for being able to do what a mw does--well, this is something I have to doubt. Again, there is a lot of variation among mws and moms, too--so it's possible but it seems highly unlikely--on the whole. Sounds more like words spoken by knowledgeable and confident mamas who just don't know all of what a mw can do (if she's worth her salt), and haven't seen some of the skills in a mw's toolbox. Besides--let's say your baby needs resuscitation: sure, a mama and her partner might be able to do this. However, they are unlikely to want to do it--more likely to want/need someone else to do it because their own feelings (in the face of a baby needing help) could get in the way of timely, calm, appropriate action. Besides, often if baby is in trouble, mama may need extra help too because of the potential for shock to set in due to the emotional crisis of her baby in trouble (even if mama doesn't have any underlying physical issues such as pp hemorrhage, going on).

Anyway--again, I'm a UC mama and supporter of UC. I don't believe 'every family is best served with a mw or doc onhand'--I do believe that UC is the very best, safest choice for some families. Just as I also believe that mw-attended homebirth, or hospital birth, are the best/safest choices for other families. Still--I share these thoughts because I think it's important for UC families to think about.

[kittywitty]

There are no studies. But I will disagree with the premise. I know a lot of UCs that have ended in transfer (including mine) or disaster, and many hbs and hospital births as well. It really depends on the situation. A UC because you are educated about it and choose knowingly what you are going into and have trust from stories I have seen personally tends to turn out "safer" than the UCs where it's a last resort and there are no other options for mother. UC can be the best option for some people, but not for others.

[MeepyCat]

My biggest concern about UC isn't that a mom and her partner would be *unwilling* to handle breathing assistance, but that they might well be unable. Or that an assisting partner might be stuck with a choice between helping a new baby breathe or helping to stop a hemorrhage.

I've heard a lot of moms say that they know as much as the midwife, but I haven't heard any dads (or non-pregnant partners of pregnant women, for that matter) say that. That doesn't mean that those people aren't reasonably well-skilled and informed - I don't know. I do worry that there may be a lot of situations in which *Mom* knows what to do, but can't physically do it, and may or may not be able to give instructions.

[StrongBeliever]

I think what MsBlack is saying is pretty close to how I feel about it. I don't think UC can be considered a universally safe choice. I do think that a well prepared mother is VERY capable of handling her own birth safely, but I don't agree that ALL mothers are just as capable as a MW when it comes to handling emergency situations. Even the most well prepared, knowledgeable mother could run into something she couldn't handle that a midwife might. Then again, something could come up that the MW or any medical professional couldn't handle.

There are just so many infinite variables that I think make it impossible to access the real safety of any method of birthing, UC or otherwise. While I believe that UC is safe for me, and I support any mother who makes the choice to UC and UP, I'm not really doing it because it tops the list for safety... When you really get down to the nitty gritty, nothing is "safe". I chose UC and UP because it is what resounds with my personal beliefs. One of those beliefs is that pregnancy(and birth) isn't a medical condition, an illness. Therefore, for me, it doesn't need medical support or monitoring. Much like eating and digesting and excreting, all of which our bodies do pretty much on their own in reasonable health, I think our bodies can manage pregnancy and birth. It's part of human physiology. After that it gets into a personal responsibility/personal freedom thing. And from there it gets spiritual.

In a nut shell, I don't think anything is truly safe. This doesn't scare me. I don't feel I need anyone or anything to protect me from the big, bad and scarys. I accept whatever outcome may be the result of the choices I MAKE FOR MYSELF, as they are educated and made with respect to their fit in the rest of my life. I couldn't have the same complacency with the choices others would make for me, as no one else can know what is best for me, a unique individual.

[jeminijad]

I believe it is safe enought to make it a valid choice, but in no way as safe as birth attended by a trained midwife, or even an MD who practices evidence-based medicine.

If mama has an incapacitating problem, all of her knowledge (comparable to a MW or not) will not help. If mama and baby both have problems, Dad (or other partner) is only one person.

And the statement that a women may "know as much" as a qualified birth attendant seems very, very unlikely to me. Book learning alone is no replacement for witnessing many births.

[klemomma]

Many of the responses have quite eloquently addressed the issue of safety, the validity of the choice to UC, etc.

I wanted to addresses this question from a bit of a different angle.

I personally feel that a major issue is not whether or not a woman has a trained attendant, but rather whether or not the focus of identifying issues is centered on the mother.

By this, I mean to say that the most highly skilled attendant cannot feel and understand the mother's body the way she can. If a mother turns her safety primarily over to a caregiver rather than with herself, I believe that her birth is less safe. When caregivers promote this concept, i.e. I will take care of you no matter what just trust me kind of attitude, the birth will be less safe.

Birth is never "safe" per say, but more safe or less safe depending on the circumstances. When the birth is primarily in the mother's hands, and her caregivers observe the mother and follow the mother, I believe that birth is more safe.

A dangerous situation is a mother not trusting her own feelings / body because she believes her caregiver(s) will do things for her or because she feels she isn't allowed to or because she doesn't have the confidence, or whatever, and then expecting the caregiver(s) to identify and handle any and all issues quickly and well.

I guess what I am getting at is that no person, no matter how well trained, will no if something is going wrong in my body as quickly or as well as I can if I am paying attention to my body and letting it guide me. If I am doing this, and my caregivers are observing me and following my lead, and only intervening if something truly warrants intervention, that will be a safer birth.

I believe that for birth to be safe with an attendant, the attendant must be working in cooperation with the mother, not in charge of the mother.

If you have for choices only caregivers who will be in charge and will not work cooperatively, UC may be the safer choice for you. If, however, you have a trained and cooperative caregiver to work with, that may be the safer choice for you.

It isn't a one size fits all kind of answer. It is a case where each individual situation must be evaluated based on the circumstances to determine what is safest at that time for those circumstances.

Good luck with your journey, mama :-)

[Hedgehog Mtn]

I've had 3 hb midwife attended births although some were within only moments of her getting there; 1 unexpected uc and one planned. I'm planning another uc in March.

I would say that to generalize......no, uc is not safer than an attended birth.

However in my situation where 4of my births were VERY quick and we live in a very rural area with the closest midwife at least 45 min away now (and that's if they walk right out the door that second) I believe a planned uc is best for me. I believe planning a uc and being prepared to leave for the hospital at the drop of a hat is the choice that is likely to give us the best result. My husband has studied neonatal resuscitation, assisted with all of my births and is very calm and clear headed under pressure. I believe birth is natural and it is only an emergency that requires medical care and if I require that I will seek it at the nearest hospital.

I was the assistant to my midwife for years and while I might make a different choice if I had every single option available to me I don't. Therefore after much thought I feel it is the safest choice *I* have in my particular situation. I feel planning on having someone else in the position of responsibility who is unlikely to arrive in time puts me in a worse situation. Out of pocket costs for a homebirh would exceed 5000.00 and I don't feel its a good option for my family when we would have to pay it even though they would be unlikely to arrive until the end. I of course would have no issues with the money if it was needed but since our solution fits in so many other aspects I feel the money is better used on our other expenses and is not the best use of the funds.

[MsBlack]

Originally Posted by klemomma

Many of the responses have quite eloquently addressed the issue of safety, the validity of the choice to UC, etc.

I wanted to addresses this question from a bit of a different angle.

I personally feel that a major issue is not whether or not a woman has a trained attendant, but rather whether or not the focus of identifying issues is centered on the mother.

By this, I mean to say that the most highly skilled attendant cannot feel and understand the mother's body the way she can. If a mother turns her safety primarily over to a caregiver rather than with herself, I believe that her birth is less safe. When caregivers promote this concept, i.e. I will take care of you no matter what just trust me kind of attitude, the birth will be less safe.

Birth is never "safe" per say, but more safe or less safe depending on the circumstances. When the birth is primarily in the mother's hands, and her caregivers observe the mother and follow the mother, I believe that birth is more safe.

A dangerous situation is a mother not trusting her own feelings / body because she believes her caregiver(s) will do things for her or because she feels she isn't allowed to or because she doesn't have the confidence, or whatever, and then expecting the caregiver(s) to identify and handle any and all issues quickly and well.

I guess what I am getting at is that no person, no matter how well trained, will no if something is going wrong in my body as quickly or as well as I can if I am paying attention to my body and letting it guide me. If I am doing this, and my caregivers are observing me and following my lead, and only intervening if something truly warrants intervention, that will be a safer birth.

I believe that for birth to be safe with an attendant, the attendant must be working in cooperation with the mother, not in charge of the mother.

If you have for choices only caregivers who will be in charge and will not work cooperatively, UC may be the safer choice for you. If, however, you have a trained and cooperative caregiver to work with, that may be the safer choice for you.

It isn't a one size fits all kind of answer. It is a case where each individual situation must be evaluated based on the circumstances to determine what is safest at that time for those circumstances.

Good luck with your journey, mama :-)

That was awesomely well said, and I agree 100% Thanks for sharing those thoughts!

[NewSolarMomma]

Thanks for the honest answers. I didn't expect there would be any real stats but you can't know unless you ask Nothing in life is safe, this includes labor and birth. I also would not say UC is safe overall, but I don't think anyone chooses it for that reason. I would love to hear the various reasons, it would be interesting for sure!

I agree that the mommas that say they know more might be referring to intuitive knowledge of their bodies, rather than knowledge gained by experience or education. It seems to me that if the birth is "normal", it wouldn't matter who was there, if anyone. But if there are problems, do you feel you would ask for help sooner than a MW that may think she can handle it? (this is assuming you are near a hospital, not hours away which is a different problem). I think I would be more likely to call for help faster, but also may be too quick to call when it's really not needed.

The thing about MWs is that US MWs are not trained the same way or have equal skills. It can be tricky to know exactly what they know, and if you are trusting someone else to make lifesaving decisions for you, it's critical to trust their level of experience. With UC it's your choice, for better or worse.

And, exactly this:
"I do worry that there may be a lot of situations in which *Mom* knows what to do, but can't physically do it, and may or may not be able to give instructions"

Anyone care to comment on UP and why they do it? I'm learning about it and trying to decide if it fits me or not.

THANKS AGAIN

[NewSolarMomma]

Originally Posted by MsBlack

That was awesomely well said, and I agree 100% Thanks for sharing those thoughts!

Couldn't agree more, that was just what I was talking about but she put it SO much clearer!

[Almi]

I figured I'd answer your other question, since the safety question has been thoroughly answered.

Why am I choosing to birth unassisted?

Like others, I don't believe that pregnancy and birth are medical conditions, and when you have healthy mothers/babies and no complications, UC can easily be accomplished.

But one big thing for me is privacy. When I am in pain or discomfort of any kind, I need to be in my own little world to deal with it. As a child, whenever I got hurt, I would yell at my mother (who would run over and try to comfort me), "Don't touch me, don't touch me!" I do not deal well with pain (not saying labor/birth is always painful no matter what, but you know what I mean when I say pain) when there are others there trying to touch me, or even talk to me. Being around people (even family members) when I am in discomfort just stresses me out and annoys me.

I also believe that a lot of interventions they do in hospitals are completely unnecessary, and are usually for the convenience of the doctor, not the benefit of the mother and baby.

One more thing, I just think the hospital setting is so...UGH. It's so impersonal and ugly and gross. I just do not think of it as a good place to give birth.


All of this being said, I do still think of the safety of UC. Because I don't believe I will find a midwife that will assist me with the birth of my twins, or one that will be covered by Medicaid, or one that will be hands-off, I have not searched for a midwife.

I did, however, go to the hospital and was assigned a random OB (I'm not really picky, and he's not a jerk or anything, just pretty straightforward) to do my prenatal care. I have been thankful for this care, because if I hadn't gotten it, I may not know I was carrying twins, and I'd worry about my health and the health and presentation of the baby (in this case, babies). So getting prenatal care has been good for my peace of mind, and it has been a deciding factor on whether or not I would definitely birth unassisted or not.

So far:

- I am completely healthy and have no complications. I will be going on leave in less than two weeks (I will be 32 weeks then) to avoid complications...I'm measuring full term and have 7 pounds of baby in me already.

- Both twins are healthy and so far have no complications. No TTTS, one isn't growing at the expense of the other, and both are head down and have been since before I was 24 weeks.

These are two huge deciding factors for me. Another is the fact that I can get to the hospital in five minutes, no exaggeration. If I lived farther from a hospital, I'd at least want to give birth closer to a hospital. If I just lived too far away, I'd probably have a hospital birth.

So for ME, so far so good. But UC isn't for everyone.

[klemomma]

As far as UP goes, I haven't done it myself, but I have really wanted to. The only reason I didn't was basically to cover myself so that I wouldn't get the "no prenatal care" card thrown at me in an emergency.

I have, however, basically made up my own appointment schedule and gone in much less frequency that what they recommend.

In a normal pregnancy, I can easily do all the things the OB does for myself. I know the baby's heart is beating, because I can feel the baby moving. I can take my own blood pressure and weight. If I felt so compelled, I could easily buy urine dipsticks online and test my own urine.

I pay very close attention to my nutrition (which, IMO goes much farther to a healthy pregnancy than standard prenatal care), and I pay very close attention to my body. I know what is normal to me.

If I noticed any deviation from normal at all, I would seek out medical assistance / advice. If I had a "non-standard" pregnancy, such as multiples or some other "complication", I would also probably seek out assistance, simply for peace of mind.

It is frankly a waste of my time and money to drive to the OBs office, sit and wait, and have to take time off of work, for him to spend three minutes with me evaluating the things I mentioned above and tell me I'm healthy, which I already knew. Now, if prenatal care for healthy mothers involved a less strenuous schedule of visits and was affordable, I'd feel less grumpy about just going along with the standard , but that is my personal feelings.

HTH, OP.

[rajahkat]

I'd like to say for the record that I don't choose UC because I see it as a bragging point, as somehow superior to an attended birth, or because a gratifying birth experience is more important to me than the health of my babies. I see this said by those who criticize the choice to UC and it annoys me greatly.

All mothers want what is best for their babies, we just have different viewpoints as to what that may be.

I originally chose to UC because I didn't like the choice of midwives in my area. I had 3 babies there. After I moved to Oregon where there is a greater selection of midwives with varying philosophies, one that I met with actually encouraged me to UC my 4th baby, rather than hire her.

And again, with my 5th baby, I entertained hiring a midwife to have an extra set of hands, and someone to check in with during the pregnancy. Probably not super practical considering my history of really quick births. It's unlikely a midwife would make it before the baby was born. Neither of the midwives I liked were lic. in my state so they can't legally carry pitocin. Only one of them has any experience at all with breech births or twins, and she's only attended one. No shoulder dystocia experience, no resuscitations. Their knowledge in those areas is pretty much equal to mine ~ theoretical and acquired from midwifery workshops. So of course, it makes me question what good they are going to be to me at all.

Is UC my ideal? Not really. But I think we rarely find ourselves in our ideal situation, there is always some give and take. And I've always been a lot more comfortable with the compromises I make on the UC end then I would be with the ones I would be making in the hospital or with any of the attendants that are available to me.

Kat

[MittensKittens]

I don't think it is possible to say that any UC is safer than any midwife-attended homebirth, or vice versa. It depends on so many factors –*mom's health, the knowledge of the birthing mother, the qualities and personality of a midwife, and mom's feelings of safety, to name a few. I think UC can be the safest choice for one mom, and a midwife-attended birth the safest choice for another mom in the same physical condition. Birthing with a midwife could cause complications all by itself if the mother does not feel comfortable with her - fear is extremely powerful. The same goes for UC as well.

Comparing my two births, the UC was more normal, peaceful and healthy than the one where I had a midwife. I didn't mind her as a person, but she got very overbearing during pushing, yelling at me that the baby needed out NOW! and that I was putting her life in danger by not pushing. That's a cultural thing where we are - babies need to be out in three pushes, or they die of lack of oxygen, apparently . She then applied fundal pressure to "push" my daughter out, because I didn't live up to her expectations. Compared to that, my UC was safer. I pushed with the urge, in the position I felt I needed to be in.

[amberskyfire]

I totally agree with klemomma and MissesKittens. UC isn't safer than MW assisted birth, but MW assisted birth also isn't safer than UC. It depends on the woman, the midwife and the situation.

Also, there are different reasons why women UC and it can definitely affect outcome. If a woman isn't educated about it and is doing it because she can't afford medical care or for whatever reason, then problems may be more likely. Most women who UC know what they are doing, but you can't speak for everyone, just like you can't say that all midwives are good at what they do or that all midwives are safe. There are bad midwives just like there are bad doctors and uneducated moms.

For example, I am a UCer. I had a UC with my first and I am planning another home birth. My next birth will, if all goes well, be a UC, but the situation has changed. I now have a little one. This means that if I need a transfer, my husband won't be able to take care of both of us at the same time. He can't very well help me to the hospital and also help get my daughter ready to go as well. He can't be there emotionally for both of us.

It is for this reason that I have decided to get a MW for my next birth, but she won't be in the birthing room. I know it sounds silly, but I just feel better knowing that I have a backup person to help me if I need help so that my husband can help my daughter. We don't have any family that can be there with us when the time comes.

It's like it's part of my nesting instinct or something. There are all of the what-ifs. I'm not scared that anything will happen, but I feel safer when all of the bases are covered, you know? It's like learning CPR. I don't expect that I will ever need to use it, but I sure as heck feel better about knowing it and that lets me completely let go of those "what if" thoughts, push them aside, and get on with my life, or in this case, my birth.

So what I think it really comes down to isn't whether UC is safer than MW assisted birth, but what is best/safest for each particular woman in her particular situation. Sometimes UC is absolutely the safest option. Sometimes home birth with a midwife is absolutely the safest option. Sometimes hospital birth or cesarean are absolutely the safest option. You have to determine which is safest in each particular situation. UC across the board isn't safest and neither is home birth.

[dayiscoming2006]

I wouldn't say one or the other is safer. I personally don't feel safe at a hospital because of all the interventions. My last two births were somewhat traumatic. The second one being the worst. Both were in the hospital. One in the US and the other in Romania. Romania is just horrible - I was shocked. It's a really long story but I believe that the doctor caused me to hemmorage (spelling?) and she gave me a really painful d & c because of the way she forced me to birth the placenta immediately. I would have felt safer without her.
The first I just feel bad about how the whole thing turned out with getting an episiotomy that I didn't want or need and having to push on my back and being treated like an idiot. Just hated that. The dilation checks with both labors and pregnancies were terribly uncomfortable/painful.

I really hope to UC this time because I feel safer that way. I don't feel safe around doctors that are all about the interventions. I'd be OK with a hands off homebirth midwife but I don't know if the only one available here is really hands off and I can't really afford her.