Discussion about UC birth

[pamamidwife]

Perhaps those people who are new to the idea of unattended birth have questions, concerns, responses..perhaps those who are NOT new have some!

I'd like to start a discussion - a sane, rational, dialogue - about birth choices.

I've heard some UC birthers all lumped together as radical extremists that would rather die or have their baby die than go to the hospital. I think this is interesting, because I would venture to say that more UC birthers transport to err on the side of caution than maybe they would had they had an attendant present. Not that transporting is negative - that's not my intention to say, I just wanted to clear up some generalizations and stereotypes about those who choose to birth unattended.

As a midwife, many births I see are "unassisted". My definition of unassisted birth is one that happens under the woman's own power and her direction only. What I see UC birth being is "unattended". So, pardon if I get these crossed sometimes.

Years ago, when I was on the original cbirth email list, I came across a small handful of people (out of thousands) that would rather take fate into their own hands than to go to a hospital. That is their perogative. I do not feel this is selfish, irresponsible or stupid. A parent has the choice to do what they feel is best for their baby. Some parents do not vaccinate and people would call that selfish or irresponsible. Same thing with birthing at home with a midwife. See where I'm going with this?

We all have different belief systems. Just as there are a hundred different philosophies with midwives (and their own biases to go with those), there are different values with birth and parenting.

I feel like there is this idea that somehow saying "trust your body, trust your baby" means don't ever succomb to the medical model. That is certainly not the case with UC families I know. Overall, women know that there is a risk they are taking when they birth - whether it's in the home, hospital or attended. I don't feel like it's something that is done often with lack of foresight or thought. Every family I have ever known or worked with has been clear that when they need help, they will seek help. There is no medal for being the most "pure" birther as far as they are concerned. They love their babies, even the ones that believe that their babies are safer with unattended birth than with a highly interventive birth.

I support UC families. I offer on-call support for them - I always have and I always will. Why? Because they deserve to have options. Because I stand by a woman's right to choose. Because sometimes, mother does know best. I must be clear, though, that when I say "I always have" means that since I've started my own practice. As a student midwife, I was not very supportive of UC. In fact, I thought it was downright threatening and weird. I couldn't imagine. The more births I attended, the more complications I saw and heard because of our "routines" the more I understood. The first UC birth story that I found was so intimate that it bordered on erotic, I understood more.

Let's get it all out in the open. Let's discuss it. Ask questions. I ask that people are conscious of the UA when we go from here and refrain from name calling, generalizations or attacking.

(And this is NOT in the UC forum because frankly, those people have enough BS to deal with based on their choice and they deserve a haven of support)

[alegna]

Great dialog topic. I think unassisted birth is a fabulous option for many women. It does make me sad though when they just choose it out of desperation because there are no midwives available for whatever reason (cost, regulations, geography, legalities, etc)

So far not a UCer, but only because I found a midwife who was!

-Angela

[Kidzaplenty]

I have had eight HBs (1 MW assisted, 4 non-professional attended, 3 UCs~1 for a m/c at 18 wks). My philosophy is that my body was made for giving birth, and I don't need a DR to "assist" me to do it. I would go to a hospital IF I had a reason to think it was necessary, if I felt like something was wrong. I DON'T have a MW in attendance becauce I find the expense undo-able, AND I find a MW unnecessary. In addition, I feel that I can not concentrate on my body while knowing I have on lookers.

By this time, I have BTDT so many times that I could give birth in my sleep. And I do know my body and I know what is normal. So I will know if something is not right. I have also educated myself in a majority of the less common circumstances as well as just about all of the common variations of birth. I have no doubt that I could deal with just about anything that arises.

I guess that is about all. I am interested in what others have to say.

[cottonwood]

I'm waiting for the questions.

[MsElle07]

I think UC is a valid choice for women who want one. I personally need the support of a MW during labor, but I understand some people do better by themselves and like to be alone or with their partner. My DH is not great at the whole birth thing, which I'm sure influences my decision making.

[stayathomecristi]

Originally Posted by alegna

Great dialog topic. I think unassisted birth is a fabulous option for many women. It does make me sad though when they just choose it out of desperation because there are no midwives available for whatever reason (cost, regulations, geography, legalities, etc)

So far not a UCer, but only because I found a midwife who was!

-Angela

Still not sure which way my birth is going to go, but I CAN say that initially I felt forced into a UC because my options here were so limited and I was a bit resentful about it. (FINE! I'll just do it myself---grrr.) Once I became educated about the whole thing, I realized that not only was this the "only" option, it was the best option for me. I recognized that I could trust my body and know that I can do this.

That being said, some things have come together for me and I *may* have a midwife now (if dh lets her in the door--but that's another story for another day ). Having a midwife present is my preference (based on my previous history), but I know that I can do it myself if necessary AND I have chosen someone who is very hands-off so I know that I can still have my birth "unassisted" as Pam mentioned.

I think that each mama should decide for herself what is best for her and her baby. It's awesome that so many trust birth and strive to have the intimacy of a UC. My experience with UCers is also that they will not UC "at any cost". The majority recognize that things can happen and they are prepared to transfer or do whatever is necessary at the time should something unusual arise. Most are very educated about birth (and what constitutes an emergency) and see UC as a way to keep control over their births in their own hands--fully accepting whatever consequences (good or bad) that may have. There is something very empowering about that!

Pam--thanks for bringing this topic up. I hope that someone will take you up on your offer to ask questions and really get a dialogue going about this.

[Mama Poot]

UC is definitely something I am thinking about. I think that I am totally capable of handling that situation on my own. Henri's birth was for lack of a better word, easy. The only "snags" we encountered were a stubborn lip of cervix and my blood pressure plummeted to something like 60/30 ( and that was my own fault for not taking enough fluids in the days before the birth and during the labor ) While it was wonderful having my midwife there to help, and she gave me an incredible sense of empowerment and really had faith in me, I just know I could have done it on my own. I don't remember this completely, but DH says that when Henri was born I immediately reached down and picked him up and tried to put him to my breast. This surprised everyone The cord wasn't quite long enough and my MW wanted to rub him a little bit to make sure he was OK, but he said it was like a reflex. I just reached down and delivered my baby. Help is great if you want it or need it, but womens bodies are made to have babies without intervention from anyone.

[sapphire_chan]

I really like the distinction between "unassisted" and "unattended".

ETA: This is actually the appropriate forum for this discussion/debate (um, as soon as people with concerns and questions show up)

[mama in the forest]

I'm waiting for the questions.

Me too.....

Something you said papamidwife was interesting.....that one of the UC stories you had read bordered on erotic.....this was very true for me. My births have all been this way and I believe they could not have been as beautifull, private, sensual, intimate, & erotic had I had an attendant present. There was no attendant present during the conception......there can be no attendant at birth.

[MamaTaraX]

Dang, I'm having an Electonic AlmostFree week at my house and have used up my time for this mornign so I'll have to subscribe and come back to this! (though I'm with the other two who want to know where the questions are )

Namaste, Tara

[Emilie]

I have a question! What happens if something goes wrong? How much can we do instinctually? How much reading do you have to do?

Is it scary? It sounds really nice to me and I would be interested in it if I had more children.

[cottonwood]

Originally Posted by mama in the forest

they could not have been as beautifull, private, sensual, intimate, & erotic had I had an attendant present.

True for me also. That's not alone a reason (for me anyway) to choose UC, but it was one of the profound differences for me between my births at which there were midwives and others were present and my birth at which only my husband was present. The assumption sometimes is that this happens when the mother is ashamed or uncomfortable with her sexuality. To the contrary, I consider myself a very sexual person. The problem is rather that I am very easily distracted and extremely sensitive to the presence of others. I can be typing along here on the computer deep in a thought, in that creative bubble, and a friend could walk in the room and it vanishes completely and my attention is on them, and I can't draw it back away and get back to where I was. I can't find it at all until they go away again. I have a lot of trouble staying in altered states of consciousness, even under the influence of drugs. (My neocortex apparently has great power over my primal brain.) I can do it with someone else present, though, if that someone else is in it with me.

That for me is a primary reason I have chosen UC. I recognize that optimal birth (that is, birth as efficiently, easily, and safely as the body is capable of) is dependant on the mother being in an altered state of consciousness in which the hormones that regulate the process can be produced and released in perfect choreography with the body and baby's actions, and that for me that altered state of consciousness is hugely disturbed when I feel observed or distracted or emotionally stressed. Given that I was in an optimal physical and mental situation for giving birth (in other words, unlikely to experience natural complications), I felt that the risks of disturbing the hormonal process were far greater to me and the baby than the risks of not having someone immediately available to help in the event of an emergency.

Some people believe that the risks for them of not having a medical attendant nearby always outweigh the risks of disturbing the hormonal process. Those people are of course best suited to having a medical attendant present. What galls me is when they assert that this is true for everyone. Those who are most adamantly opposed to UC often complain that UCers believe that their way is the only right way. Not only is it not true, but it's ironic, given that they themselves believe that their way is the only right way.

Anyway, so I had my UCs, and the hormonal process was not disturbed, and I gave birth physiologically optimally as far as my body's ability to do so. For the hormonal process to not be disturbed meant that my second stage was quick and normal, my third stage was problem-free, my baby's emergence was gentle and peaceful, bonding was intact, and I had no postpartum depression affecting my ability to care for my baby and the relationships with my children and husband. Allowing the safe emergence of the baby to be possible was paramount, but these other things were important too. As was the fact that the birth was satisfying to me spiritually and as a sexual being.

[...] respecting the woman as an important and valuable human being and making certain that the woman's experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strong. Marsden Wagner, MD

[2+twins]

For the record, I'm a supporter of UA birth, have had an unintentional UA birth, and I'd consider my last 2 births unassisted, although there were mw's present (very hands off & under my direction, as pamamidwife said). That being said, I have one looming concern, so perhaps this is sort of a question for those of you dying to answer some! Here's the deal. Despite how prepared you are (book knowledge, experience attending births yourself, prior birth experiences, etc.) for an emergency situation (and I'm thinking primarily of baby being born with immediate medical needs of some sort) how can you be sure that under the circumstances of it being YOUR birth and YOUR baby that you (and/or your partner, if present) will be of the mind to hold it together enough to deal with whatever it is that needs to be dealt with? Granted, for my UA birth I didn't count on it happening that way, but my baby was born knocked out (or something - I really can't say). I didn't expect that and while I (thankfully) felt calm and sure that everything was going to be okay, dh didn't handle things so gracefully. And he's a person with emergency medical training (paramedic). I know and he knows that on the job, he'd have known just what to do and would have been calm about it. But when it was HIS child, he quite simply panicked. She was fine and in retrospect we probably didn't need to do anything to encourage her to "wake up". But in the moment, this is what it was like. So I've often thought about that in terms of UA birth. Just how exactly do you know that you can hold it together in the unlikely event of a true emergency? And please don't pick apart my example - I know I wasn't prepared in the same way that a planned UA person/couple would be. But my question is still the same. How do you know?

[Kidzaplenty]

How do you know how you are going to react?

For me, I base it on what I have experienced in my life already. How I handle situations. How I handle pressure. How I labor.

When I am in labor, I am usually talking and in control until right at transition.

I have had two daughters nearly drowned and had to deal with CPR until paramedics arrived (10 years apart). I have had to deal with many childhood injuries and illnesses, in other emergency situations. These tell me how I will react in a crisis.

Specifically regarding HB, I have dealth with the cord around the babies neck in all seven of my living children, some were wrapped twice around and one had it three times wrapped around.

One baby did not breathe for 8 minutes (we have it on video) and we had to perform CPR for her until she took a breath.

I have had a dry birth, where the baby was born with litterally NO fluid (it must have leaked out prior to labor).

I have had two posterior baby labors, one fully posterior baby birth.

I have delivered on baby at 36 wks, and one at 42 wks (all the others were in between).

I have had REALLY fast labors (1 hour 15 minutes is my best time).

I have delieverd babies from 7lbs2oz to 9lbs8oz.

I have had a second-third degree tear that healed naturally on it's own.

I have had one baby that the belly button never stopped dripping blood (had to be carterized).

I have had one baby with an embilical hernia due to embilical cord that did not heal properly, that healed up naturally after we took action.

I have had one PROM (my 36 wk baby).

I have had a partial retained placenta (we allowed nature to take its course, and it finally delivered by it self).

I can't really think of anything else at this time, but I am sure there is more if I really look.

I read a lot, I studied a lot over the years, but mostly, I just let nature takes it course and trusted my body. When I had my first baby, I did not know ANYTHING about birth. I was totally clueless, but other than some retained irritation at my "non-MW attendants" for the way I allowed them to run my birth, but my baby and I were both fine. After that birth, I decided that I really needed to know what was going on in my own body, so I began to study. (Up to then I was a newly married, full-time student, full-time supervisor that just happened to get pregnant, I did not have time to worry about my body changes or what to expect.) I study a little more with each consecutive birth. As it is now, I have as much knowledge as most any OB on natural births and their variations.

Plus, like I aways say, if something does not feel right, I can always call 911. And the hospital is only minutes away.

[MsElle07]

Here is a question: Is UC a good choice for a mother who does not educate herself regarding pregnancy/birth? If a mom does not wish to read or learn from others, would it be better for her birth to be attended?

[Kidzaplenty]

From my experience, yes. That is exactly how I was with my first, and although it was not perfect, it litterally changed my entire life and out look on birth.

[pageta]

I think we all have varying degrees of experience with birth...and I'm talking about mothers as well as providers. No two births are alike, and even if a midwife has attended 2000 births, she still hasn't "seen it all" IMO.

I think the fear of providers regarding people who choose to UC and all the things that can go wrong is very similar to the fear of parents when their teenager gets behind the wheel of a car. The teenager does not have the experience of the parents who have been driving for many years, but that does not mean that the teenager, once s/he understands the basics, cannot take a car out alone.

Along the same lines, I grew up in Florida so even though I may have seventeen years of driving experience under my belt, I consider myself a teenager when it comes to experience with driving on ice. I've had a friend take me out to an empty icy parking lot and practice losing control of my vehicle and getting control back, which was very helpful. I understand the physics of losing control of a car on ice. But I still avoid driving on ice as much as possible and approach it with fear and trepidation when I do have to drive on it.

As far as UCing is concerned, for myself, I can see how attendants could be helpful and I can also see how they could hinder the situation. I've chosen my attendants carefully, but I still would confess that I am just as fearful of an attended birth as I am of a UA birth. So I approach both with the best of intentions and look for the positive. UCers have the concern of "what if something goes wrong - how soon would I be able to get help?" and those with attended births have the concern of "what if something goes wrong and those around me just make it worse by intervening and thus causing more problems when the situation would have resolved itself?" To me, those fears are equal. Even though I have educated myself as much as possible and I have spent lots of time choosing my attendants and discussing my concerns with them, I don't see myself being any more relaxed alone than I do having attendants or vice versa.

So I think of UC as an equal option next to attended birth in those terms.

[cottonwood]

Originally Posted by Emilie

What happens if something goes wrong? How much can we do instinctually?

Well, first, all complications are not going to be something that all people need to worry about. For instance, risk of prolapsed cord was irrelevant in my situation because the baby's head was engaged and the hearttones sounded great (I listened with a fetoscope) and movement was normal. So clearly no cord compression was already going on, and with the head engaged it wasn't going to happen. If my waters had released with a big splash and kept flowing and the baby was still high up, I would consider that a concerning situation and probably would have sought out some more intensive monitoring until the baby was engaged. In that situation, to me the risks of natural complication would outweigh the risks of disturbing the process.

Second, what do we consider a complication? For instance, I don't consider a cervical lip a complication that needs to be put right by someone sticking her hand up the mother's vagina. Or a slow-coming placenta. There are a whole slew of circumstances that might be considered a complication in a medical setting, that UCers regard as simply normal variation.

And others that might be caused by a medical setting. Sometimes the body is able to take care of what might become dangerous if the birth process were disturbed. An example is when my third labor was oddly long and slow and mellow. I was not alarmed -- my intuition was clear on this, very strong, that everything was fine. But I thought it strange that my second attended birth should be relatively quick (13 hours) and my first UC would be so much slower. Aren't undisturbed births supposed to be quicker? Afterwards, in describing the cord to a midwife friend, she said it sounded like it had a velamentous insertion, a touchy situation, potentially dangerous. "Good thing there was no one fooling around with your labor," she said, "trying to speed it up." Some might scoff, but I believe my body knew that my baby needed a slow and gentle labor and an extremely fast second stage, and it was capable of providing that, both naturally and because it wasn't interfered with.

And others that might be dealt with instinctively. A mother who thinks she needs to be in a particular birthing position and is waiting for the midwife to tell her what to do, is in a very different situation instinctively speaking than a mother who is moving only as her body compels her to. With my first attended birth, I was expected to stay in one position to give birth (reclining so the midwife could do perineal massage, urgh) and to focus all my strength and energy in bearing down. With my second, I still thought there was a proper birthing position, although at least I'd been enlightened that vertical is better than horizontal. Finally with my third I threw birthing convention out the window and change position multiple times within a contraction in the ten minutes or so leading up to the baby's emergence. I'd previously been fairly still during contractions, changing position once in a while. My body was impelling me to move, and I believe that was for a reason, and that reason was that the movement was helping to get my baby into an ideal position for a fast emergence. Now, say my baby had had quarterback shoulders. What would these different approaches have meant to my ability to birth him, and my need for assistance?

Another example from my personal experience: after my attended births, I was divorced from the rest of the process to a certain extent partly because I was tired, and if I didn't have to do any more, why bother?, and partly because the conversation, instruction, observation, etc., took me out of that altered state of consciousness where intuition and instinct reside. The midwife pushed down on my uterus. "This," she said, "is to make sure it isn't boggy." (To her credit, she didn't maul me.) She showed me how to check it myself. She worried about the placenta taking so long. I was glad to let her worry, after all that's what I hired her for, right? So that I wouldn't have to worry myself. In contrast, with my UC births, I never checked out and so never felt the need to have someone take care of it for me. I was inside of it fully as long as my body needed me to be. I knew when the placenta detached -- I didn't feel it, but my consciousness shifted (the hormones were doing different things now.) I knew, without thinking, to get into a squat and put slight traction on the cord to create sensation and stimulate me to bear down. I didn't think to myself, oh great, now I have to push out the placenta, hm, and what would be the best way to do that. I never thought once about it, I just did it. Every move was spontaneous, instinctive.

Perhaps most interesting was what I did after the placenta was out -- I sat back and stroked my belly. Sometime after I read that there is a controversy within midwifery over how best to manage third stage, and that some midwives feel that uterine massage is unnecessary as a preventative measure, and that light stroking of the mother's stomach is enough stimulation to encourage the uterus to contract. The difference was that it was more sure to have an effect, because my body was calling for it to be done right then -- it was an instinctive response to an instinctive need, rather than a perfunctory action based on a guess of what my body might need. I hope that distinction is clear. The other difference was that there wasn't something to create the feeling of being observed and distraction, which sometimes, either alone or in conjunction with any one of a number of weakening variables, create issues with bleeding. I hadn't bled before, even under unideal circumstances, but I didn't want to take the chance of creating a situation that wouldn't have been there naturally.

A complication that most people are most fearful of, they also tend to feel "just happens" -- the baby doesn't breathe. But is that true? Does it "just happen", for no reason at all? Does it have nothing to do with the mother's hormonal process? Is it really logical that it would be the natural result of a normal labor? Seemingly freak events do occur. We can plan to allow the body to function as normally as possible, and still something unexpected may occur. That's why infant CPR, normal breathing patterns for a newborn and length of time to switch-over to lung use, the meaning of color, and of course self-knowledge of whether I'd care to have to deal with this myself are all important things (for me) to know. And then, that risk has to be assessed against the possibility or probability of a medical attendant's presence or actions causing the problem.

[cottonwood]

How much reading do you have to do?

You don't have to do any reading to birth instinctively, of course. For myself, the reading I felt was valuable to me included (just off the top of my head):

Prenatal Yoga & Natural Birth, Jeannine Parvati Baker
The Complete Book of Pregnancy & Childbirth, Sheila Kitzinger
Spiritual Midwifery, Ina May Gaskin
Special Delivery, Rahima Baldwin
Heart & Hands, Elizabeth Davis
Birthing From Within, Pam England
The Thinking Woman's Guide to a Better Birth, Henci Goer
Birth as an American Rite of Passage, Robbie Davis-Floyd
Childbirth Without Violence, Frederick Leboyer
A Good Birth, A Safe Birth, Korte and Scaer
The Scientification of Love, Michel Odent
Gentle Birth, Gentle Mothering, Sarah Buckley
Unassisted Childbirth, Laura Shanley
Conscious Conception, Jeannine Parvati Baker
Emergency Childbirth, Gregory White
Pleasurable Husband/Wife Childbirth, Marilyn Moran
The Childbirth Manual, Sandra Roberge
Wise Woman Herbal for the Childbearing Year, Susun Weed

Various articles by many of the above authors, as well as by Marsden Wagner, Gloria Lemay, and Gail Hart, many issues of Midwifery Today, the Midwife Archives run by Ronnie Falcao, the Association for Pre- and Perinatal Psychology and Health, and the Birthlove.com website.

In addition I read much on online forums such as here and CBirth, and learned much from my fellow mothers.

Is it scary?

It wasn't to me, at all, when I was actually inside of it. I am still amazed at the power of intuition, which for someone who is not intuitive at all when not pregnant, is like having a magic power. It's to me one of the most beautiful, profound things about giving birth alone, that alone I was able to access that. And my intuition told me, every step of the way, that everything was fine and as it should be.

With my last UC, I went through a period about three or four weeks before the birth where irrational fear took hold, and I felt like I had lost my ability to hear my intuition. Somehow, amazingly, that was remedied by a visit from a dear friend whose positive energy and love pulled me out of it, and I am grateful to this day. I didn't need her to direct my labor or catch my baby, but in a very real sense she was a midwife for me -- in other words, "with woman" -- helping me through an important transitional time. To me, that's what midwifery is, or should be, about. It's not about there being a relatively few experts out there that everyone else needs to be led by. It's about sisterhood, where we help hold each other up when we stumble or come across difficulty that is too much to face alone.

[sapphire_chan]

Originally Posted by Emilie

It sounds really nice to me and I would be interested in it if I had more children.

I believe you're saying this to mean "at my next birth", but this can also be read as "if I had enough experience with labor to be confident"

Can the UC mamas address the question of a first birth? Some of the commentary is about how you know how you react and respond in labor--not exactly something a first time mama knows.