Pregnancy and childbirth are every day occurrences, and the medical care that mothers and their new-borns receive gets better and better all the time. Despite that, more and more people are opting for an unassisted childbirth, which can range from a homebirth with no medical practitioner present to a complete separation from the medical world, including no doctors, no midwives, no pregnancy check-ups, and no scans. It’s still relatively rare, but since the mid-1990s, the popularity of unassisted childbirth has been on the rise and it’s now at its highest since 1975[1]. Those who choose an unassisted birth, however, face the backlash of medical organisations all around the world who warn of the dangers of shunning medical advice and assistance. So why are more people opting for it, and is it really as dangerous as medical organisations claim it to be?
What is unassisted childbirth and why are people opting for it?
It’s worth noting that unassisted childbirth is different to a homebirth which includes an attending medical practitioner, be it a doctor, nurse, or midwife. Unassisted births are more about ‘going back to nature’ and are usually attended by a non-medical birthing partner or family and close friends only[2]. Also called ‘freebirth’, as coined by Pavrati Baker[3], the notion of unassisted childbirth grew out of the Natural Childbirth movement fronted by, among others, Grantly Dick, that promoted the idea of childbirth without medical intervention and in particular, without anaesthesia[4]. Dr. Amos Grunebaum, the director of obstetrics at the New York Presbyterian Hospital and Weill Cornell Medical College explains that homebirths have risen in popularity by 79% in recent years, and of those 140,000 homebirths per year, approximately one third of them are unassisted[5].
The arguments that pro-unassisted childbirthers make are surprisingly simple. The medical system is negative and sterile, many say, and an unassisted pregnancy and birth is more exciting, more loving[6]. Women have been giving birth since the dawn of human existence and all this medical intervention is relatively recent occurrence, others argue. If women could do it before, why not now? After all, childbirth is not a medical emergency – it’s not an illness or disease or injury – so why is a hospital required[7]? Marilyn A Moran, a proponent of unassisted childbirth argues that childbirth is an inherently private and sexual matter[8] and Laura Kaplan Shanley argues that “birth is sexual and spiritual, magical and miraculous – but not when it’s managed, controlled, and manipulated by the medical establishment”[9]. Ultimately, then, the desire for unassisted childbirth arises from a disillusionment with the medical world, and a desire to stay as natural as possible.
The dangers of unassisted childbirth
Despite that, many medical organisations around the world have issued stark warnings against unassisted childbirth, including:
· The Society of Obstetricians and Gynaecologists of Canada
· The American College of Obstetricians and Gynaecologists
· The Royal Australian and New Zealand Obstetricians and Gynaecologists
· The Royal College of Midwives
· The American College of Nurse-Midwives
They claim that out of every 1,000 unassisted births, there are around four deaths and that approximately 15% of all births have potentially fatal complications[10]. The medical establishment, they argue, may not be as natural as an unassisted birth, but the death rates of both mothers and their babies has dropped dramatically since the development of modern medicine, and still, around 500,000 women around the world die in childbirth every single year. To give birth without medical assistance, they claim, is extremely dangerous.
“There are many things that could go wrong with birth,” Whitney C. Harris explains. “Ruptured membranes, an unexpected breech baby, placental abruptions, the list goes on”[11]. In fact, the risk of a baby dying during childbirth, 1-2 in every 1,000 births, is higher than the chance of him or her dying in a car accident, which is only 1 in 50,000[12]. What’s more, Science Daily argues that paleoanthropologists claim assisted childbirth is actually more natural than the alternative and that it is a central evolutionary aspect of humanity[13].
The dangers of not having an unassisted childbirth
Freebirth advocates fight back against the medical establishment with facts of their own, though. Your baby can’t be stolen or mixed up in the hospital, some argue, and your baby won’t be exposed to the dangerous pathogens that exist in hospitals either[14]. Moreover, scientists Gupta et al. demonstrated that the lithotomy position so often used for childbirth in hospitals (lying on back with legs in stirrups) is neither natural nor conducive to childbirth, as it is shown too complicate labor and narrow the birthing passage, ultimately causing more difficulties and more pain[15]. Squatting or kneeling is more effective. Furthermore, although unassisted births have increased, their risk factors have decreased since 2004[16], and many argue that the reason mortality rates have improved is not so much due to the development of modern medicine but more to do with increased hygiene, better nutrition, and more understanding of self-care[17].
Like everything in life, however, both the advocates and the opponents of freebirth make a good case. Ultimately though, the only people who can truly decide are those involved, and what is right will be different for each and every family. If an unassisted birth is something that interests you, gather as much information as you can and be aware of the dangers. Consider enlisting medical help if you are carrying multiple babies, if you have a pre-existing illness or disorder, or if you’ve had problems with previous pregnancies. Be ready, too, to call on help if and when you need it – there is no rule that says you can’t change your mind mid-pregnancy or even mid-birth. Most of all though, whatever you decide, stay informed, stay safe, and stay healthy.
[1] National Center for Health Statistics (2104), Trends in Out-of-Hospital Births in the United States, 1990-2012, available at: https://www.cdc.gov/nchs/data/databriefs/db144.htm, [accessed 04.29.2017]
[2] Lacey Haynes (2017), Experience: I had a free birth, available at: https://www.theguardian.com/lifeandstyle/2017/apr/28/experience-i-had-a-free-birth [accessed 04.29.17]
[3] Wikipedia (2017), Unassisted Childbirth, available at: https://en.wikipedia.org/wiki/Unassisted_childbirth [accessed 04.29.2017]
[4] Wikipedia, ibid.
[5] Whitney C. Harris (2017), The Dangers of an Unassisted Home Birth, available at: https://www.fitpregnancy.com/pregnancy/labor-delivery/dangers-unassisted-home-birth, [accessed 04.29.2017]
[6] Lacey Hayne, ibid.
[7] Wikipedia, op. cit.
[8] Ibid.
[9] Laura Kaplan Shanley (2017), Unassisted Childbirth, available at: http://www.unassistedchildbirth.com/, [accessed 04.29.2017]
[10] Wikipedia, op. cit.
[11] Harris, op. cit.
[12] Ibid.
[13] Wikipedia, op. cit.
[14] Lisa Barrett (2008), Homebirth vs. Hospital: Statistics to Die for, available at: http://www.homebirth.net.au/2008/06/homebirth-vs-hospital-statistics-to-die.html [accessed 04.29.17]
[15] Gupta JK et al. (2012), Position in the second stage of labour for women without epidural anaesthesia, available at: http://www.cochrane.org/CD002006/PREG_position-in-the-second-stage-of-labour-for-women-without-epidural-anaesthesia [accessed 05.01.2017]
[16] National Center for Health Statistics, op. cit.
[17] Ibid.
