Unassisted childbirth refers to the process of intentionally giving birth without the assistance of a medical or professional birth attendant.It is also known as freebirth, DIY (do-it-yourself) birth, unhindered birth, unassisted home birth, and couples birth.
Several years ago, I was asked to attend a home birth but to promise that I would do nothing no mater what happened. I clarified, “Even if the baby is in trouble and is not breathing?” The answer was “Yes.” I said no.
Earlier this week, I was interviewed by someone who was looking for a midwife who would agree to do no prenatal care, order no blood tests or ultrasounds but agree to come to the birth, “just in case”. I said no.
While I have an intellectual understanding of why some are drawn to these things, I choose to not participate. As a planned home birth midwife, I choose to participate in prenatal, birth and postpartum care with my clients.
At my practice, Local Care Midwifery, PLLC, these are standard:
Hour long prenatal visits
Telephone access to me 24 hours a day, 7 days a week
A NYS licensed midwife and a midwife-assistant attend labor, birth and the immediate postpartum
Midwifery supplies brought to every birth
Newborn exam and care, including lactation support
Three homevisits in the first week after birth
Birth Certificate filled out, signed and turned in
Prenatal, birth and newborn records made available for pediatric provider
Office visits at two and six weeks after birth, plus another at four weeks for first time moms
Prenatal visits include education and lots conversation. There are blood pressure checks and urine dips. We assess an unborn baby’s position with Leopold’s maneuvers. We order and review tests such bloodwork, cultures and ultrasounds. Prenatal care includes discussions about evidence based care, community standard for prenatal care as well as a client’s preferences, dreams and heartfelt desires. A chart is kept, updated and electronically shared with the client. A lot of work goes into prenatal care.
Birth care includes providing active labor support and monitoring of mother and baby. We bring ourselves, our training and our supplies. We bring midwifery bags filled with comfort measures as well as sterile instruments, emergency medications/equipment, We sit quiet when appropriate, and intervene when necessary. An assistant and midwife attend the birth of the baby and soon after, the birth of the placenta. We perform a head to toe exam of the newborn. We check mom for tearing or unusual bleeding (and again, intervene if needed). We straighten up, generally even start a load of laundry. We fill out paperwork. We stay for hours after the birth, not leaving until things are copacetic. Planned home birth care is a lot of work.
In my practice, postpartum care involves at least three home visits in the first week after birth. Babies are admired, weighed, checked for jaundice. Nursing is observed and supported. The NYS Newborn screen is done while the baby is cradled, comforted and nursed. The physical, emotional and social transitions of mom, baby and family are observed and supported. Visits in the office are provided at two weeks, six weeks and sometimes in between. Return to fertility is discussed and addressed as needed. Health records are shared. Birth certificates are filed. Blog posts are made. Postpartum care is a lot of work.
That said, I believe that I some my best work occurs when I have done the least: when I sit quiet and attentive while a partner rubs a laboring woman’s back, while a new mother bears down, easing her baby into the world, while a baby roots around, finds the breast and begins to suckle.
The following is from the American College of Nurse Midwives Core Competencies:
Hallmarks of Midwifery
The art and science of midwifery are characterized by these hallmarks:
A. Recognition of pregnancy, birth, and menopause as normal physiologic and developmental processes
B. Advocacy of non-intervention in the absence of complications
C. Incorporation of scientific evidence into clinical practice
D. Promotion of family-centered care
E. Empowerment of women as partners in health care
F. Facilitation of healthy family and interpersonal relationships
G. Promotion of continuity of care
H. Health promotion, disease prevention, and health education
I. Promotion of a public health care perspective
J. Care to vulnerable populations
K. Advocacy for informed choice, shared decision-making, and the right to self-determination
L. Cultural competence
M. Evaluation and incorporation of complementary and alternative therapies in education
N. Skillful communication, guidance, and counseling
O. Therapeutic value of human presence
P. Collaboration with other members of the health care team
ACNM goes on to define midwifery management:
The midwifery management process consists of seven sequential steps:
A. Investigate by obtaining all necessary data for the complete evaluation of the woman or newborn.
B. Identify problems or diagnoses and health care needs based on correct interpretation of the subjective and objective data.
C. Anticipate other potential problems or diagnoses that may be expected based on the identified problems or diagnoses.
D. Evaluate the need for immediate midwife or physician intervention and/or consultation or collaborative management with other health care team members, as dictated by the condition of the woman or newborn.
E. Develop, in partnership with the woman, a comprehensive plan of care that is supported by valid rationale and is based on the preceding steps.
F. Assume responsibility for the safe and efficient implementation of the plan of care.
G. Evaluate the effectiveness of the care given, recycling appropriately through the
management process for any aspect of care that has been ineffective.
I believe that both the rather theoretical Hallmarks of Midwifery and the more concrete Midwifery Management Process are integral to excellent midwifery care. It is important for me to be a therapeutic presence (Hallmarks of Midwifery, O): I cultivate this presence through training, practice and prayer. It is also important that I recognize and appropriately respond to complications and emergencies (Midwifery Management A-G). I cultivate these skills through training, certification and peer review.
Some women choose to have their pregnancies and births unfettered by prenatal care, tests, care providers or any medical interventions. I wish them the best. Truly, I wish them, their babies and their families the very best. But when I am asked to use half my skills, to be present but to not act, even if the health of a mother or baby if in jeopardy, I say no.
May all babies be born into loving hands