Midwifery Today Community

 Lovely Ladies, I recently had a birth that has brought up many questions for me.  I wrote about it on my blog and would love some feedback;

http://midwifeyearone.blogspot.com

In short, it was normal primip birth that involved a shoulder dystocia, a baby resuscitation, a partial cord evulsion and a PPH!  All were handled well and quickly, so the outcome was a gorgeous healthy baby boy and proud new Mom and Dad.  One of the things it really made me think about is unassisted birth and the creation of birth trauma.....

As one who has had one unplanned unassisted birth (midwife didn't make it) and 3 planned unassisted births, I'm curious about how this birth made you "think about" unassisted birth.

I would guess that if an OB read your blog, she would be saying that it makes her "think about midwife attended birth", no?

There is a tendency for everyone to assume that if the ultimate outcome is good, it is because they were there, and that if they hadn't been there, the outcome would have been bad. But we really have no way of knowing the outcome in a circumstance that never happened. We can only speculate, and our speculation assumes that things would have progressed and occurred in the exact same way in our absence, which is really something of which we can't be sure.

Something that I think is difficult for anyone to believe who hasn't either been there or been informed of such things, is that a birthing woman is quite capable of sensing when something is not quite right and of changing positions on her own. A mother can, literally, do manuvers for shoulder dystocia on her own baby. A mother can dose herself with herbs or medications and most unassisted birthers have a husband or other person to transport them if necessary. A woman who is attended by a professional tends to slip into a state of near helplessness, as she is depending upon others to tell her whether things are normal or not. She is not calling upon her own knowledge or awareness because she doesn't have to. I know that for me, my level of awareness was so completely different in my attended births versus my unattended ones. The midwives who attended me would certainly have been skeptical of my ability to birth without them, because they had only seen me do it WITH them. I would have been skeptical myself!

A woman who is attended by a professional tends to slip into a state of near helplessness, as she is depending upon others to tell her whether things are normal or not.

Do you really believe that all women "slip into a state of near helplessness"?  Isn't that blanket statement just as false and demeaning as someone saying that those who choose unassisted birth are reckless and negligent?

No, I do not believe that "all women" behave in any one manner. Nor did I say such. I said there is a tendency. I apologize if what I said was construed as a "blanket statement", as it was not intended as such.

Whether or not it is true that women laboring and birthing attended are more likely to seek situational awareness from their attendants is not really something that can be proven like some scientific fact. What I said was based upon my own observations and upon the testimony of women who have done it both ways. Every one of the women with whom I've spoken about unassisted birth told me that they were less aware of their own bodies, their stage of labor, their ability to make decisions,  even whether or not they had permission to change positions, when a midwife was attending than when they birthed unassisted. However, it is obvious that I have not discussed this issue with every woman who has ever given birth.

My comments relate directly to the sentiment expressed by the OP, that what occurred during this birth that she is describing made her think about women giving birth unassisted. Since she is opening the topic for discussion, I would just like to find out what her concerns are. Why did this birth make her "think" this way? I could be completely misconstruing her meaning, which appears from what little she said to mean that she is fearful for women who choose to birth unattended who might have these complications and be harmed or killed by their lack of a midwife. If that is NOT what she meant, I hope she will clarify.

I believe that women, on the whole, are completely equipped to birth. In no way would I attempt to demean women who birth in any  way they choose, with any attendants they choose, in any environment they choose. Making an observation about how women think and act in labor is not demeaning to women. I think few would disagree that a woman birthing in a hospital being attended by an OB is under different mental pressures, and that her behavior might easily be affected, by that enviroment.  There is something about having an "expert" in the room giving suggestions (or orders) that causes a person to assume a more passive or even submissive role. I'm not placing a value judgment on it, I'm just saying that it does happen.

No doubt, many midwives can testify of mothers they've attended that were highly intuitive and so tuned-in to their bodies that the mothers tell the midwvives that something is amiss. But in spite of that, there is really no way to know if they are having the same level of awareness or are drawing as deeply from their own buried strength as they would if they believed there was no one to help but themselves. It is something about which midwives ought to be aware and hopefully they will be nuturing that ability that perhaps the mothers don't even know they have.

It is easy for midwives to comment about things they have seen tens or hundreds or thousands of times, which is, women giving birth while the midwives watch.  But they are somewhat less qualified to comment on what happens when they aren't there, or the exact ways in which a woman thinks and behaves differently when the midwives aren't there. Unless, of course, the women tell the midwives. My opinion is that it is doubtful that a woman who gave birth unatteded, whether planned or unplanned, would say, "Oh, I didn't feel any differently about it than when I birthed with the midwives."  More likely is that you hear comments like, "I really had to depend on myself," or "I just KNEW I needed to be kneeling," or "I just knew I needed to push, even though no one told me." They say things about their inner knowledge and awareness that they normally don't say. Whereas a woman having her first home birth, or having a VBAC tends to talk about what she DID, not what she KNEW.

Midwives should take care not to get on the defensive if someone suggests that their presence at a birth changes something in the woman. Of course it changes something. I wouldn't attempt to repeat everything ever said by Dr. Michel Odent, but we've probably all heard that the number one need of a laboring woman is privacy. Anything that stimulates the neocortex, including speaking, can cause her to make adrenelin, interfering with oxytocin. There are plenty of birth videos on youtube where the midwives can't seem to stop talking. They are influencing the woman, whether or not they intend that outcome. Instead of defending themselves, midwives need to be asking, "How can I practice my art in a way that interferes the least?"

Why would midwives spend time worrying about women who are not even their clients? Perhaps they should be preparing all of their clients to be ready to birth unassisted if necessary? After all, any birth has the potential to be unassisted. Every woman should realize that she could do it without a midwife if she had to. There is no need for midwives to adopt the notion that no birth should ever happen without her or that dire consequenses are in store for those moms and babies that she doesn't attend. And that is the sentiment being subtly conveyed by the OP.

Generations, I am sorry for the delay in responding to your posts.  I have to be completely honest and say that your words left me feeling hurt.  Clearly, I have no idea if that was your intention, language is often a subjective medium.  So, I wanted to take some time to really ponder your words and form a coherent response not based entirely on emotion.

When I posted my OP (I think that means Original Post?), I was literally "thinking" about these issues and did not in fact state an opinion.  My opinions on unassisted birth are rather complex and are something that ebb and flow.  The way in which you chose to respond came across, to me, as very negative and demeaning.  As an example, the statement;"A woman who is attended by a professional tends to slip into a state of near helplessness, as she is depending upon others to tell her whether things are normal or not." (a quote from your first response), whether you meant it or not,  this is demeaning and describing women as helpless is an insult.  It is also, whether you meant it or not, is a gross form of stereotyping.  We must be so careful as women, not to attack each other for our choices.  I strongly believe that all women need to be empowered to make truly informed decisions based on facts.  For some women, that may mean an elective cesarean, a midwife attended home birth or an unassisted birth.  I will support a woman in any of these decisions...as long as they are made from a place of knowledge and true understanding of the facts, both good and bad.  (This also brings up another little pet peeve of mine.  We as out of hospital, "alternative", birth workers need to stop tearing each other down and instead build each other up.  We have enough struggles without adding to the problem, but I digress).

Again, these are my interpretations and I do not know the inner workings of your intentions.  I will be honest again and say that your words, in both responses, have come across, to me, as accusatory and hostile.  I do not know if that was your intention, but it was the end result for me.  I am sure that you are a nice woman, one who is passionate about her work and who supports women.  If we were sitting down over a cup of coffee, the communication of our thoughts may be different.  I apologize for any hurt that my words may inadvertently cause you.  I must, however, state my bias....I am a midwife, a midwife who chooses to support and be with women outside the hospital.  I have emminent respect for women, thier bodies, babies and the birth process.  I have a firm belief that birth works, that we are made as women, to traverse the incredible journey that it is.  However, that does not mean that this faith is blind...sometimes women and babies need help.  Of course, many times the woman can and does help herself, as the baby also can and does help itself.  One of my most important duties is to get out of the way and let the process happen, but also to observe for potential complications a guide the MotherBaby through them. 

This is a valuable and informative discussion and I hope it will continue.  We have to honor every woman's choice in birthing.  We must as midwives and women stop judging each other and offer true support.  I think our biggest job is to make sure information is available for women so they then can make their choices.  Then we must make sure choice is universal. Then women must take responsibility for their choice. Blame and judgement have no place in birth.

 Whenever the topic of unassisted birth comes up, I agree that it sounds "risky" because of the "what-ifs".  Then I remind myself that is what hospital-birthers say about home birth with a trained midwife--"what if you need a c-section, your baby could die!"  Personal choice and personal responsiblity trumps anyone else's fears.  I believe home birth with a trained birth assistant is the best, but who am I to tell others what to do?  With 10 years as an L&D RN and 12 years as a home birth midwife, I've often said, "What if that happened unassisted, etc. etc."  All that doesn't matter.  Women deserve the birth that they desire.  I was once asked, "How many times as a midwife do you think your presence made a difference in the outcome?"  What a great question!  In all my years, I suspected only 4 or 5 times out of 600 births! That brought me back to earth.  So often, we midwives, think we are indespendable, but are we really?

 Thank you Joy and April, you both made important points.  All women should have the support and autonomy to make the best decisions for them and thier families and these choices should be universal.  We should be able to educate and give truly informed consent to all women and have faith in thier ability to make the best choice for them.  I hope that I was not too harsh in my previous response to Generations and that I have not offended her and that she will continue to join this discussion....

I do not take offense. I believe this is important to discuss and I think we must all take care not to take offense where none is intended. My words about women being "helpless" in birth were not judgments about the abiilty of those women to birth, but rather an observation of what appears to be their state of mind.  They are not helpless at all, but they feel helpless, or rather immobile, as if they are waiting for permission or commands. This is a genuine observation that I have had. Additionally, as I am a student midwife and currently devouring every book on the subject of birth upon which I can lay my hands, I have found this same attitude exposed my reading.

Here is a quote from Elizabeth Davis, "The mother may also want complete privacy but be unable to say so. Women are so accustomed to accomodating the needs and wishes of others that they may equate the desire to be alone with selfishness. Or they could be afraid of hurting their partner's (or midwife's) feelings. Make the suggestion and see how the mother responds."  (Heart and Hands pg. 144)

Is it demeaning to suggest that a mother is "unable" to say, "I want to be alone. Go away."? Is it demeaning to state that the midwife has to suggest to a woman what her desires are? I don't believe Ms. Davis is insulting women at all, she is just relating what she has observed.

And here is another: "On the other hand, some midwives are too little involved and in the name of nonintervention allow the mother to languish in an ineffectual position or struggle futilely with labor sensations, negatively affecting her strength and self-confidence. Try to find the balance between the mother's need to find her own pace in labor and your need to make responsible assessments and keep things on track." (Heart and Hands pg. 114)

Here Ms. Davis is suggesting that a woman might not know what to do in labor, or that she might not know how to find an effective position. That is not demeaning. It is a simple observation.

Making the contrast between a woman who births with an attendant and that same woman birthing without one, she may very well experience what Elizabeth Davis is describing while being observed by her midwife, but have no fears and no struggle or languishing while birthing alone. I know this describes my own experinece as well as the experience of other women with whom I've discussed the issue.

It is neither divisive nor is it tearing each other down to ponder these observations and ask ourselves what we are seeing.

I am at a loss as to the intent of the original poster in this thread. I am sorry that you were hurt by my comments, although I'm not sure how they were hurtful. The thread is titled "Unassisted Birth?..." which seems to suggest that your experience at this birth with its multiple complications makes unassisted birth a questionable issue. And I would agree. I don't know that midwives need to question it unless they are considering it for themselves, but certainly birthing mothers need to ask the right questions in order to make an informed choice. If your intent is not to question the appropriateness of unassisted birth, what exactly is the intent? Perhaps you could reframe the question?

Good post Teri,

 Maybe I can throw one  response  out to this, "I don't know that midwives need to question it unless they are considering it for themselves, but certainly birthing mothers need to ask the right questions in order to make an informed choice. If your intent is not to question the appropriateness of unassisted birth, what exactly is the intent?" 

I know I examine freebirthing myself because there have been numerous times over the years where a mama has seen me in pregnancy, with a decision to birth unassisted but want my support in one way or another or perhaps my back up during birth.  It does put us midwives in a gray zone when we support, 100% a woman's choice, but then have to make choices regarding caring for the same women and risk to our professional life.  I can speak from experience on this as a woman and midwife who birthed unassisted.  I would have loved another midwife to have attended me but where I was at the time,,there were none, so I chose the support of my family and friends rather than a clinical birth. 

I don't think Aubre's post meant anything other than, hmmm, what would an unassisted mama do here??  That's my interpretation anyway.

 Thanks April for summing up my intention in the original post.  I was simply wondering about that particular birth in regards to unassisted birth.  It is a topic that has recently been discussed in my community.  I think that as birth workers we, of course ponder all the birthing options.  I often think about and analyze hospital, home and birth center birth stories/situations.  This is a pivotal time in our profession and we must be able to discuss all options with our clients and thier families....