A student midwife contacted me recently asking for more information about unattended birth and midwifery. Specifically, she had questions about how a midwife would protect herself legally when working with a family that desired an unattended birth.
Care providers are always at risk for legal action. No matter how many informed choice documents your clients sign, no matter how defensively you chart. With that preface, here’s what I would offer someone interested in midwifery and unattended birth:
First, I suggest that midwives be exposed to as many unattended birth resources as possible. I learned a great deal from my formal school education and apprenticeship but my most valuable insights into birth came from families who have had unattended births. I cannot tell you the resistance and eventual sighs of relief that came over me when presented with information, beliefs and physiological evidence that proved contrary to what I had originally been taught or believed. I am grateful for the women who patiently (and sometimes, not so kindly) gave me an education that was priceless.
My dear friend Linda offered the most gentle persuasion and discussion on the topic of normal, physiological, unhindered birth. Her stance was not always about unattended, but it was clear to me that many of the minute hormonal balances during labor and birth were best served in an environment that was free from observation and judgment. She was the first person to use the phrase “autonomous birth” on a regular basis (though Laura Shanley used it in her book, see below) - and these two words perfectly describe the type of birth that I feel is the safest and most normal. Linda had a great blog (aptly titled “Autonomous Birth”) but has taken it down. She’s working on a book (aren’t we all?) and I eagerly look forward to her wise words and thoughts in one collection.
Rixa is an amazing writer who happened to recently obtain her doctorate (yay Rixa!), with her dissertation on unattended birth. Her blog is thought-provoking, well-written and extremely informative.
Laura Shanley is, quite possibly, the mother of the unattended birth movement. With her book, Unassisted Childbirth, the term to describe the DIY birth was born. When Laura wrote the book back in 1994 there were people having unattended births but certainly there was no open, public discussion about it (remember, the internet was still a wee baby at that point, many of us not having access to it the way we do now - and certainly there were few online resources for this type of dialogue). Her website is full of information, stories, and amazing photographs of women. All midwives should read these stories and learn why women choose this option of birthing.
Mothering.com has a great discussion forum - informative and comprehensive (if not, at times, overwhelming in content), including a great section specifically for unattended birth.
Doing a search for “unassisted birth“, “unattended birth“, “freebirth“, “autonomous birth” turns up some great reads, both supportive and critical.
(Certainly, as midwives, we will see some erroneous information on the internet pertaining to advice, medical tests, procedures or the physiology of birth - the point isn’t necessarily that these women should know everything a midwife knows. The point is that these women are truly assuming full responsibility for the outcome of their pregnancies and births.)
Books that have greatly influenced my views on unhindered, normal birth include:
Any book by Michel Odent.
I remember in midwifery school one article by Odent really got me and my fellow student’s blood boiling. What is interesting is at the time I was appalled that he could suggest a man (husband/partner) at birth might be obstructive or not helpful. This was contrary to the types of homebirths that midwives were involved in - of course the father wanted to be there, of course the mother wanted him there. Now, I view his writing on the subject in a much more realistic sense (the way it was intended) and know that he isn’t saying that men shouldn’t be at birth - he’s merely pointing out that the general mindset of most men and how they approach problems in life are often at odds with normal labor needs and processes.
All of his books are necessary and important for student midwives and midwives to read. He does have a tendency to have repetitive information in each of his books, but how could you not when there is so much that aligns various birth issues? The Scientification of Love is one of my favorites.
Sarah Buckley’s Gentle Birth, Gentle Mothering. Finally available through Amazon.com, Sarah explores the delicate balance of hormones necessary for a smooth, safe birth. I cannot say enough good things about this book. While some people may not “get” the information on lotus birth and elimination communication, what she has to say about pregnancy, labor and birth is vital to our survival as conscious, aware beings.
The Power of Pleasurable Childbirth by Laurie Morgan. Laurie Morgan was really my first not-so-gentle kick in the butt towards understanding and listening to unattended birth families.
Unassisted Homebirth: An Act of Love by Lynn Griesemer. This is a great book that focuses on why some families choose to forgo a midwife or attendant for their births.
(I feel that no look at unhindered birth is complete without examining our common practices as midwives and evaluating current evidence and research. Things like checking for a nuchal cord, suctioning babies, putting hats on babies immediately, doing vaginal exams, performing urine dips at every prenatal visit are all challenged by various research and physiological evidence.)
It is my belief that there should be a safe, intermediate option for families choosing an unattended birth and my skills and resources as a midwife could provide that. It saddens me to hear of families transporting to the hospital for something that is minor and likely could have been helped with a call or visit from a willing midwife (meconium in the fluid, the feelings that transition brings, bleeding after birth). Once in the hospital, a woman without any prenatal care that was laboring at home without an attendant or - heaven forbid! - birthed at home alone will not be treated well. This belief system brings me to support - in theory and practice - families who desire an unattended birth.
I have a specific contract with those families that lays out my fees (per visit, prenatal or postpartum), being on-call for questions/support for the duration of the pregnancy and postpartum and additional fees for coming to the birth. I was careful in creating this contract not to encourage those looking for a low-cost birth option towards an unattended birth but to provide a service for families to ensure that they have options locally. I also include in my contract that I, as a midwife, have the right to suggest transport via phone and refuse to come should I deem the situation too risky for my attendance or needing more urgent medical attention.
A midwife cannot just create such a contract and have that be her source of support for unattended birth families. The midwife really needs to believe that unattended birth is a valid and necessary choice for some women. She has to be able to feel comfortable sitting in another room while a woman is birthing her baby in privacy. She has to be able to honor a woman’s desire for no fetal heart tone monitoring during labor. It takes a process and journey to get to this point (and I’m willing to admit I am still on this journey, but I do feel fine attending women how they desire). If a midwife is not completely comfortable with the idea of unattended birth, she should be willing to admit what her limitations are and not overestimate her comfort level. To do so will mislead the parents and likely cause conflict should certain situations arise.
These births are not my births. I definitely have certain choices, plans and options I would want if I was birthing a baby. My clients are not asking for what I would want for my baby. This is their baby. This is their birth. They have the right to ask for the care that they feel is necessary and no more. They are in charge of the process and decision making. I am in charge of my own boundaries as a professional. Honesty is key in all instances not only from the midwife but also from the birthing family - this creates an atmosphere of trust and respect, important for normal birth.
Given full information and options, I trust that parents have a stronger desire for a safe outcome of this process than I do. They love their baby and want their baby. It is rare and unusual the mother that claims the experience of birth is more important than the outcome and health of them or their baby.
I make myself available because I believe in CHOICE. I am firmly pro-choice in reproductive health, including childbirth. I do not think that my role at a birth always makes the birth safer - and recognize that my attendance at some labors/births could actually impede the normal process.
I’d love to hear from students or practicing midwives about how they view unattended birth and the role of the community midwife in response to the growing trend of this practice. I also would love to discuss how the internet has made unattended birth more public, and if certain situations, internet communities or beliefs create competitiveness within this population that may not be safe.
(Please note: I use the term “unattended birth” to describe a birth without any care provider in attendance. I have been to “unassisted births” in which the mother gives birth on her own, in her own way, without any help from me or my assistant. I see both of these terms as separate from each other, even though the most accepted term for an unattended birth is unassisted.)
Has anyone read 
I’ve written on umbilical cord issues before, but it’s nice to have more information on this topic for parents and providers. I hear stories all the time of babies that were “strangled” by their umbilical cords and by deaths that were attributed only to nuchal cords (cords around the neck).
rolapse (when the cord slips in front of, or alongside, the baby’s head before birth)
Things have been a bit crazy over the past couple weeks, had two more births to first-time moms, one cesarean after five hours of pushing, one baby born at home into her father’s hands.