Unassisted Childbirth

I wrote this post about ten years ago ... nothing much has changed in the system, but we are seeing a growing number of women choosing to birth outside the medical system.

Back in the good old days, when I was a subsistence farmer in paradise, I had a friend who told me her birth story. This was before I started working with birth, but not before I had already started studying and learning, and listening to women's stories.

 

Friends Sharing Birth Stories

My friend's first baby had been a breech who did not want to get her head down. The policy at that time in Italy, as in many places, was to deliver breech babies by cesarean section, especially if the woman was a primipara.

So, my friend had a c-section, and she did not feel good about that birth at all. She thought that it was probably possible to give birth to a breech baby vaginally, and she felt pushed into making a decision that did not feel right to her. She decided she didn't want to go back to the hospital again to give birth.

She became pregnant again, and decided to stay at home this time and give birth on her own terms. She looked for a homebirth midwife but at that time in Italy they were a rare breed, especially if you were living in the hills as all us organic subsistence farmers did. She prepared by reading about natural birth, and she made sure she had methergine in the house - they always had it on hand for the goats.

Labor started and she sent her husband and child out for the day. She didn't want her daughter present for what she knew was going to be an intense and possibly scary event.
This was before cell phones, and they didn't have a phone, so he planned to come back around suppertime. She labored on her own and late in the afternoon, gave birth to a healthy baby.
"Were you scared?"
"Yes, I really wanted to have someone else around. I remember when I started pushing, and I felt a cervical lip, and I gently pushed it out of the way - I really wanted someone to be there with me. But I knew everything would be okay - I had a feeling. And if it wasn't ok, then it wasn't. I did it my way."

There is a growing movement that promotes unassisted childbirth as a way to regain control over your own birth, and there are many valid reasons for not wanting anyone at all from outside your circle of family and loved ones to be present at the birth of your child. It is, after all, a natural event, more like lovemaking than like a medical procedure. The presence of a stranger, even a well-liked one, can change and disturb the process. Midwives can be regulated by laws that perhaps don't agree with a woman's perception of how she wants her birth to proceed. 

I often get calls from women who are planning to give birth without attendants. They want information, or they want to find someone to be a "fly on the wall" - who can be there "just in case". Most of these women are women who have not been able to find a registered midwife - either they didn't call early enough, or they live in the wrong area, or they are considered too high risk for a homebirth. They don't really want an unassisted birth, but they are committed to not wanting to go to the hospital unless they really have to, so they are left with unassisted birth as their only option. Because we Canadians are used to free health care, cost is also a consideration. Unregistered midwives charge around $2000 for prenatal, birth, and postpartum care (that works out to about $10.73 an hour, in case you're wondering). Many women do not feel that this amount is an option, and, again, make the choice to give birth "unassisted".

I firmly believe in a woman's right to choose what's best for her body, and for her life. If a woman chooses to give birth on her own, or just with her partner, or her sister, in her own home, then power to her! She is making an adult choice, and she is accepting responsibility. But I do feel sad when women want to have the care of a midwife and cannot.

No woman should have to give birth on her own if she doesn't want to. Midwifery care should be available, really available, to any woman. Homebirth should be an option for us all. Unassisted homebirth is only one option, but it should be an option that is actively chosen and not decided on for lack of other plans. Equally, hospital birth is only one option. Health women carrying healthy babies should not have to go to the hospital to give birth unless they actively want to. Informed choice should be a reality - it should be informed, that is, women should educate themselves and each other, and they should ask for informtaion from their care providers. And choice should be a real choice with real options - unassisted, home birth, midwifery care, hospital birth.

Let's work together to bring the woman and child back to the center of maternity care!

COVID19 in-house Day 22: Birth and Choice

My dear friend Syd reminded me of something the other day when she suggested we all stop talking about "lockdown". Lockdown is something that happens is prisons. It's a scary situation when all of your freedoms are taken away. What we in Canada are living through now, most of us anyway, isn't that. It's scary and several of our taken-for-granted freedoms have been curtailed, but we are not in "lockdown".

I would like to take a minute to think about all the people who have had their lives deeply shaken by this pandemic: some people have lost their lives, others have lost loved ones. Some people's futures are changed beyond recognition, other people's present lives are changing as quickly as thought. In some countries, the biggest risk is starvation because there's no way to get out to get food and no way to make a living. In others, people are struggling to get by on what little they have.

But all of us in this world, together, are living through this historical event, whether we like it or not. We all have to figure out creative ways to live, to rise up to the new challenges we are faced with. Here in Montreal, most of the people I know are staying home, except for the health workers amongst them. Those brave souls are out in the hospitals and clinics, keeping us healthy, providing for the sick, and juggling their own lives and families with the needs of others.

I worked as a birth attendant for twenty years, and I trained doulas for fifteen of those years. One of the qualities I always valued in a student doula was flexibility. If a doula has that quality of making virtue of necessity; if she can take a challenging situation and make the best of it, then I am confident that she will provide the very best care for her clients. It's tough, sometimes, when a client wants her birth to go a certain way, and you as her doula know that it's unlikely that it's going to go that way. It's tough when your client is going to birth in a hospital where you know that the protocols don't "fit" with her beliefs about birth, or when things take a turn and interventions are needed. In these situations, I teach my doula students a few main lessons.

The first one is: when you and your client enter into the hospital, you are entering someone else's home. In the hospital, you don't make the rules. When you're in someone else's "home", you follow their rules. When your client is in labor is not the time to try to change the rules. A birthing woman should not have to spend her labor time battling with her attendants. She should have a realistic idea of what will happen. If she doesn't agree with the rules, then she should make other arrangements.

The second rule is: as the doula, you are there to support your client throughout the journey. In every scenario, with whatever tools you have at your disposal. Again, now is not the time to argue with the medical staff. Now is the time to concentrate on accompanying your client as best as you possibly can, so that their experience will be positive.

The third rule is: love your clients, love the staff, love the birth experience, love the baby. The more love you can spread around, the better.

Two major maternity wards (also here) in Montreal announced this week that because of Covid19, patients giving birth would not be allowed to bring anyone into the birth room. Not a doula, not a partner, not a mother. This has sparked a huge controversy and many people are angry, many are worried about how their birth will unfold, and petitions and news articles are all over the social media.

I do understand how scary it is to give birth alone. I've done it, in a foreign country, and it's not pleasant. (Actually, that's an understatement. It's traumatic and awful. But I didn't have a doula, and I didn't speak the language.) I believe that the maternity care system here in Quebec is broken: it's been broken for a long time - there aren't enough midwives; the laws around midwifery care were badly conceived; the maternity wards are understaffed and overly restrictive. In twenty years, I've heard many, many awful stories about giving birth in Quebec.

But this is the worst time to start to fix it. The worst time to try to change it. The worst time to push against a policy that actually will save lives.

It's a difficult time to give birth. It's a difficult time to stay alive. It's even a difficult time to die, as funerals are restricted. But this is a time when we can use all the resources we have to make our experiences better. So, doulas, I am calling out to you to do your very best work, and prepare your clients with love and compassion so that they can look forward to their birth with joy, and they can enter the hospital knowing that, yes, they will be cared for. The nurses are in fact there to care. You will be FaceTiming them from your home, guiding your client with your voice, letting them know that you love them, that they're doing a great job... using all the skills and creative tools at your disposal in the trying times.

After this is over, let's fight together for decent maternity care! Let's make a note that, yes, maybe hospitals should be for sick people and birth belongs somewhere else. Let's fight for more midwives, for more birthing centres, for an understanding of pregnancy as a normal, healthy event. But let's save that fight for later. For now, let's try to live together, with love. Doulas, be creative! Use your voice to provide support for your clients, where they are.

In these complicated and challenging times, let's pool our resources to work together! Spread the love!

Unassisted Childbirth

Back in the good old days, when I was a subsistence farmer in paradise, I had a friend who told me her birth story. This was before I started working with birth, but not before I had already started studying and learning, and listening to women's stories.

Friends Sharing Birth Stories

 My friend's first baby had been a breech who did not want to get her head down. The policy at that time in Italy, as in many places, was to deliver breech babies by cesarean section, especially if the woman was a primipara.

So, my friend had a c-section, and she did not feel good about that birth at all. She thought that it was probably possible to give birth to a breech baby vaginally, and she felt pushed into making a decision that did not feel right to her. She decided she didn't want to go back to the hospital again to give birth.

She became pregnant again, and decided to stay at home this time and give birth on her own terms. She looked for a homebirth midwife but at that time in Italy they were a rare breed, especially if you were living in the hills as all us organic subsistence farmers did. She prepared by reading about natural birth, and she made sure she had methergine in the house - they always had it on hand for the goats.

Labor started and she sent her husband and child out for the day. She didn't want her daughter present for what she knew was going to be an intense and possibly scary event.
This was before cell phones, and they didn't have a phone, so he planned to come back around suppertime. She labored on her own and late in the afternoon, gave birth to a healthy baby.
"Were you scared?"
"Yes, I really wanted to have someone else around. I remember when I started pushing, and I felt a cervical lip, and I gently pushed it out of the way - I really wanted someone to be there with me. But I knew everything would be okay - I had a feeling. And if it wasn't ok, then it wasn't. I did it my way."

There is a growing movement that promotes unassisted childbirth as a way to regain control over your own birth, and there are many valid reasons for not wanting anyone at all from outside your circle of family and loved ones to be present at the birth of your child. It is, after all, a natural event, more like lovemaking than like a medical procedure. The presence of a stranger, even a well-liked one, can change and disturb the process. Midwives can be regulated by laws that perhaps don't agree with a woman's perception of how she wants her birth to proceed. This site provides some interesting information about unassisted childbirth:UC

I often get calls from women who are planning to give birth without attendants. They want information, or they want to find someone to be a "fly on the wall" - who can be there "just in case". Most of these women are women who have not been able to find a registered midwife - either they didn't call early enough, or they live in the wrong area, or they are considered too high risk for a homebirth. They don't really want an unassisted birth, but they are committed to not wanting to go to the hospital unless they really have to, so they are left with unassisted birth as their only option. Because we Canadians are used to free health care, cost is also a consideration. Unregistered midwives charge around $2000 for prenatal, birth, and postpartum care (that works out to about $10.73 an hour, in case you're wondering). Many women do not feel that this amount is an option, and, again, make the choice to give birth "unassisted".

I firmly believe in a woman's right to choose what's best for her body, and for her life. If a woman chooses to give birth on her own, or just with her partner, or her sister, in her own home, then power to her! She is making an adult choice, and she is accepting responsibility. But I do feel sad when women want to have the care of a midwife and cannot.

No woman should have to give birth on her own if she doesn't want to. Midwifery care should be available, really available, to any woman. Homebirth should be an option for us all. Unassisted homebirth is only one option, but it should be an option that is actively chosen and not decided on for lack of other plans. Equally, hospital birth is only one option. Health women carrying healthy babies should not have to go to the hospital to give birth unless they actively want to. Informed choice should be a reality - it should be informed, that is, women should educate themselves and each other, and they should ask for informtaion from their care providers. And choice should be a real choice with real options - unassisted, home birth, midwifery care, hospital birth.

Let's work together to bring the woman and child back to the center of maternity care!