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attending an unassisted birth

Last post 11-14-2010 11:24 PM by Syracusedoula. 11 replies.
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  • 10-20-2010 5:04 PM

    attending an unassisted birth

    I am a doula and student midwife. A friend of mine is pregnant and has decided to have an unassisted birth and has asked me to be her doula.

    Hmmm.

    Personally, I would not choose an unassisted birth for myself. I value the skills and support of midwives. And aside from the obvious possible emergencies that worry me, I am also concerned that nobody will be monitoring baby during labor, that mother is receiving no prenatal care through pregnancy and that a simple complication that could easily be remedied by a midwife (like a laceration requiring stitches) would mean a trip to the hospital. Also, should a serious complication arise, I would technically be the one with the most knowledge of birth, and in such a case it seem inevitable that the responsibility would fall into my hands. And I am FAR from qualified to hold that responsibility. 

     

    So those are some of my fears around being at the birth. On the other side, however, I have a very deep trust in birth and in the mother-baby to work out complications together. And although I may be the one at the birth with the most birth experience, I am also aware that a laboring woman has access to all the knowledge and wisdom of her foremothers.  I trust and honor a woman's decision to birth at home unassisted. The question for me is 'am I comfortable with being present at an unassisted birth.' I don't know. I do know that, if I attend her birth, I must make my role clear to her and to myself right from the beginning. I am a doula, not a midwife.  She is choosing an unassisted birth, not a birth assisted by a student midwife. But how do I put my student-midwife-self aside to attend to her as a friend? 

     

    Any thoughts/ stories/ advice/ empathy would be greatly appreciated.

     

  • 10-20-2010 6:29 PM In reply to

    Re: attending an unassisted birth

    Have you asked your friend why she wants you there?  Is this her first baby? Does she want you there because you have enough experience and knowledge of birth in her eyes to spot a variation of normal or a complication should it arise?  Have they themselves learned to take fetal heart tones so that they can check on the baby's well-being themselves?  And what about afterward?  Do they have the skills to help a baby who may not be in good shape after the birth?  And what about mama?  These are all the things they should have in place in calse they need to pull them out of their back pockets to use in case of a problem.  You need to also assess for yourself that if a complication should arise, what are the legal ramifications for you.  I'm in no way trying to be the voice of doom and gloom, but you are correct in looking at it from all angles.  Tough decision.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 10-20-2010 10:00 PM In reply to

    Re: attending an unassisted birth

    Good questions. This is mama's second baby. She had midwives for her first birth and had a traumatic experience with them which is part of the reason she is makeing the decision to have no midwives present at this birth. 

    When she went into labor at midnight with her first baby she could tell that she was going to have a fast labor. She called her midwife (who lived 20 minutes from her house) and told her that her baby was coming really fast and requested that she come IMMEDIATELY. The midwife spoke to her in a way that my friend described as condescending and told her to take a walk and time her contractions and call her in an hour. My friend then told her that she could not walk, that it is urgent and she is on the edge of losing it. The midwife said sternly, "Take a walk and call me in an hour!" and hung up the phone. My friend's husband was not there. She labored alone. Her midwife didn't even call her to check in. My friend's labor progressed so quickly after her midwife hung up that she couldn't even call her back. Her midwife casually walked in the door almost 2 hours later after not having even called to check on her.  My friend's baby was crowning when her midwife walked in.  Second push, baby was all the way out!

    This birth experience confirmed for my friend that she is capable of birthing her baby all by herself.  But, personally, I long for her to have the experience of being fully supported and empowered by a sensitive and loving midwife. 

    They have no experience listening to fetal heart tones. They would probably be open to learning.

    As far as having the skills to help a baby who is slow to start... I don't believe so. I think that they are planning on relying on intuition. 

     

  • 10-21-2010 12:02 AM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: attending an unassisted birth

    mandalamama,

    I would ask all the same questions as Susan did; but for me, it would not be a tough decision at all.  If I were in your shoes, I would go. 

    A friend, wants you, at her birth. You want your friend to be supported and empowered. 

    Cover all the expectations with mama and papa. 

    Give her love and support.

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 10-21-2010 3:24 AM In reply to

    Re: attending an unassisted birth

    Here's the sticky wicket for me in situations like this and I've been in situations like this although I am not a student midwife--being asked to attend an unassisted birth.  Should a complication like too much bleeding or a limp baby arise, do you have enough skill to be able to reverse the situation?  If you do not, what's the game plan? How receptive are the EMTs and the hospital should a transport need to happen?  One of the midwives in my area, whom I love and admire, calls this "making the Oh SH*T List".  Complications are rare but they happen.  If you are there, what are the implications for the parents? for you? I don't know if it's not a tough decision for April because of her experience, her reputation and the are she lives in.  In my neck of the woods, it would be a huge problem with arrests and social services being called into the situation if there was not a legal midwife on the scene and even then it could get quite sticky. If I decided to go, I'd go under the conditions that mama and papa learn how to take FHTs, know how to prevent and stop a hemorrhage should that happen, have herbs and non-western meds on hand for these kinds of things, know how to revive a baby or an adult ... those kinds of things.

    Are there no other midwives in the area who could just be on standby if not simply be in the home or area during the labor?  For ex., on one of the unassisted births that I know of, the couple paid for a midwife to be on call for them and when the labor happened, they called her and she just sat in an all night coffee shop enjoying catching up on her reading, email, etc. and was in the area if they needed her.

    I'm not debating free birth vs assisted birth.  I'm simply looking at it from all the angles that you are, too. And yes, it's a tough decision.  With no prenatal care, should something happen--unlikely, but things happen--they could get into big trouble should a hospital be needed for them.

     

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 10-21-2010 11:09 AM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: attending an unassisted birth

    I meant that if I were the op with her 'to date' experiences, learning and desires, I would still go. 

    Who are we, if not women fully supporting other women's choices?  A friend has asked her to attend her birth.  This is birthing as we know it.  Yes, all the possible complications and scenarios and preparations should be addressed but in the end this rises above legalities, IMO.

    Let's play the what if game;

    What if her friend has an amazing birth and mandalamama is there to serve her and her choices and it shapes the way she empathizes and practices in the future with other mamas?

    What if birthing mama is moved by her friends loving support in spite of hesitations and she then moves through her life with confidence and she supports other women and their choices, passing this on to her children and they to theirs, etc.etc.

    What if at the most intimate of moments this friend needs mandalamama with her loving support and she is not there for her because she is afraid of the ramifications?

     

    Women serving other women is a most holy act.

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 10-21-2010 8:40 PM In reply to

    Re: attending an unassisted birth

    I totally agree with you, April. These are definitely in the scenarios to be included in the decision making. I would want to be clear on what was wanted of me and I--me--would want to be peaceful with holding that space without worry and that I could do that and be that person for them.  When I am faced with these choices, I usually find that getting quiet with myself and just letting things be for a while is helpful and then the answer becomes clear.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 10-22-2010 1:38 PM In reply to

    Re: attending an unassisted birth

    Thank you both for your replies. You each represent a different voice within me.  I will get quiet and sit with it for a while and see what comes. I think that a conversation with my friend will help a lot. 

  • 10-24-2010 3:02 PM In reply to

    Re: attending an unassisted birth

    My intitial knee jerk response is:

    It ain't an unassited birth if she asked you to be in attendance. PERIOD! You are the assist in her mind wether she articulates it or not. Otherwise can't she just go it alone and have you come by after to celebrate, love on her and tuck her in...

    My compassionate thought is:

    Make the "oh :-( list"

    Check the laws in your state and PRAY

    Don't make a decision, either way, that you can't live with! BE AUTHENTIC LIVE YOUR TRUTH...

    I've always told my children to obey the laws of the land and that if in fact they encountered a situation where they "needed" to be above the law then be above it enough, big girl panties and all, to accept the lands consequences. Everything legal isn't just and I so appreciate those who came before me that through advocacy, protest, action and/or legislation made things change. But there are laws for a reason and you have your birth communities reputation at stake if things are less than optimal (however "they" define that).

    Alternatively since you are  a doula and aspiring midwife can't you just find a skilled and knowledgeable preceptor to attend with you for mom/baby safety and a teachable experience? Additionally, planned homebirths usually come with planned prenatal care... has your friend accessed care and eliminate all risk that would otherwise deem her ineligible for homebirth?

    I admire women intuned enough to birth on their own, had an uncaught precip myself 16 years ago but I wouldn't deliberately go it alone unless I had to.

    But I really admire those who share their feelings, voice their concerns and act as their sisters keeper when she is wrong. Did she tell the midwife of her disappointment/ disatisfaction?  Imagine a profession where we are objectively critiqued given the opportunity to right wrongs and grow and improve.How cool would that be?!?!

     

     

     

     

     

     





  • 10-25-2010 2:49 PM In reply to

    Re: attending an unassisted birth

    I'm not a MW or a doula (though i have been an assistant at a birth).

    I would need to talk at length with the parents to make a decision.

    For ME unassisted is unassisted.  Me.  Me alone.  I could not ask another to join me in that without it being a clearly defined relationship (i.e. if DH was to be there we would have had to decide together it was what we jointly wanted, covered what we would do in emergent situations, learned together what might happen and accepted in our hearts both best and worst case scenarios as possibilities we were ready to bear).  To be honest that is how i view my births anyway - my midwife is a very skilled partner in my care, not the sole guardian of it.

    I think if the mama was clear on what she wanted/needed it would help.  Why choose you?  If it is because of your experience with birth i would be careful - does she truly want an unassisted birth, or does she want the reassurance, real or imagined, of having someone else who knows a bunch there?  If it is because you are her very close female friend, the woman upon whom she can lean when she reaches into her deepest depths for the strength to bear fruit, that is a completely different thing - afterall, she cannot help if the person who she feels that about is a doula or a software analyst, and it's largely unimportant which they are if it is the person themself that mama needs and not any skills they may potentially have.

    It's a tough request to handle.  Do you feel you are being asked to take responsibility where the parents are not, or only to share an experience?  I actually think the two are inseparable - if something terrible happens anyone with any ideas on how to help would hopefully do so.  I know i performed first aid on a stranger in the street long after the qualification i had had lapsed - no-one else was reacting and the person NEEDED help.  In that moment it crossed my mind that if i did wrong i might harm the person and be punished for doing so, but i found my hands were already doing the needful even as the thought surfaced.  I agree with PP's - what is Right is not always what is Legal.  What is Necessary is not always what is Permitted.  It is ok for one to accept the risks of doing the illegal and non-permitted, IF one is sure one wants to and accepts what might happen if one is seen to be doing so.

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 10-27-2010 9:07 AM In reply to

    Re: attending an unassisted birth

     Well, as others have said, unassisted is unassisted, if someone is there to help it is not unassisted. As a doula, you might be held responsible for any complications, if the powers that be have their panties in a bundle about homebirth & midwives.

    But, a friend, who just happens to be a doula, I think, it would be a lovely opportunity for you.

    Be very sure, it is clear in their minds, that you are there as a friend, with no other expectations of getting them out of a jam if complications do happen. Not that you can't help, just that they don't expect you to have all the skills necessary to be able to solve any problems.  And *do not take "compensation of any kind" for your part in the birth, no matter what happens! If you recieve any kind of compensation, you could be deemed to be acting "professionally" which in this case would be practicing medicine (or midwifery) w/o a license!

    From the other point of view - I had some uc births, and some w fellow midwives. But, I acted as my own midwife, doing most of my own prenatal care, conferring w a collegue only when I had a question I couldn't figure out on my own. I did not "hire" anyone to attend my births, but did invite my friends to my births. Friends w varying degrees of homebirth experience, from none at all, to nurses, & doctors who happened to be my friends! I guess we just didn't worry about liability so much back then.  I just thought seeing a totaly natural homebirth might be a good experience for them, but I was in no way holding them responsible for my care or anything that happened at my births.  On the other hand, a few yrs ago I as invited to a birth of a friend, I expected to just come as a friend, so I was surprised how much they seemed to be relying on my "midwifery expertise"! I would have been glad to be her probono midwife, if she had asked ahead of time, so it just threw me off guard, because my own attitude in labor had been so different. I was glad to help a friend.

     

  • 11-14-2010 11:24 PM In reply to

    Re: attending an unassisted birth

     Doula/aspiring midwife here.

    I would most likely be comfortable attending the birth in the sort of situation that you're describing. When you read books like Spiritual Midwifery and Ina May's Guide to Childbirth, it was women supporting other women through birth. It wasn't a medical experience. Since she has had an unsatisfactory experience with a midwife who didn't trust the mother's intuition, I would definitely understand where she's coming from. I would also strongly encourage her to express to that miwife how she felt about what happened.

    Apprentice Midwife.
    Homeschooling mom of four with another on the way.
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