Unassisted Birth - revisited

LotusEater · #1 (**permalink**) 07-Jun-2008, 15:19

There were some thought-provoking articles on Unassisted births in TPM this month and it has stirred some curiosity in me. Without going to deep into it now, how would you feel as a midwife if you were asked to be present at a birth but not carrying out any clinical observations like fh, temp, bp etc? Or even asked to sit in another room?

I understand that unassisted birth is not actually having a midwife present at all but I have heard of women requesting that midwives do nothing unless it is necessary.

What are your personal feelings about unassisted births? Would you consider one yourself and why? Do you think a little bit of knowledge goes a long way or would you say that women would be better off just following their instincts?

Kentish Spitfire · #2 (**permalink**) 08-Jun-2008, 16:34

This is a very interesting topic and one that I cannot make a decision over. Part of me feels that women have been having babies for centuries without the human race dying out. However, another part of me thinks of the CEMACH reports and the number of lives that are lost and wonder if this is a backward step.
Perhaps the best way forward is for a compromise where minimal observations are carried out and no interventions unless they are medically necessary, but that a trusting relationship is built up with the midwife so that if she explains to the woman that she needs to listen into baby (for instance - if mec is present) the woman will trust her to do so only when necessary.
As I haven't qualified and practiced autonomously yet, I will reserve judgement until I have a better insight into the practice.
KS x

LotusEater · #3 (**permalink**) 08-Jun-2008, 20:50

No, I can't decide either. It is such an individual thing. What I do have to say is that when I do visit certain unassisted childbirth forums, I am astounded (sorry, it's my word of the week - astounded - it will pass) by how little understanding of physiology and mechanism and practicalities of dealing with bleeding some of these women have, but then I was struck by my arrogance in assuming that my knowledge base is the only valid way of knowing.

Kentish Spitfire · #4 (**permalink**) 09-Jun-2008, 07:39

But that's just my point LE, I have had four kids of my own, but I didn't 'know' about childbirth until I started my midwifery. As a parent, you are looking at a different aspect from a midwife - but which is right and which is wrong? Who knows, maybe there isn't a right or wrong!
KS x

TallPoppy · #5 (**permalink**) 09-Jun-2008, 10:25

Originally Posted by Kentish Spitfire

Perhaps the best way forward is for a compromise where minimal observations are carried out and no interventions unless they are medically necessary, but that a trusting relationship is built up with the midwife so that if she explains to the woman that she needs to listen into baby (for instance - if mec is present) the woman will trust her to do so only when necessary.
KS x

Thats what we do anyway isnt it?

Freebirthing to me is where no midwives are present and women go ahead and birth at home/anywhere they want. 'Knowledge is power' as the great Karl Marx said and even if the women feel they are knowledgable enough to birth without the support of professional help then I still do not think its advisable.

My reasoning is the 'what if's?' - yes yes we all know that what if can be taken to extremes but what if the baby doesnt breathe? even the most practised resuscitator may not function optimally if it is their baby they are working on, what if the woman has a PPH? she may know how to manage a PPH but thats no good to her if she is bleeding so heavily that the supply to her brain is lessened so she cant think properly.. I could go on spouting the potential horrors of childbirth but you all know them.

My point is women have been attending women for centuries and the most experienced and knowledgable women are the ones called for first - the wise women bringing their herbs, tinctures and the reassurance that someone is present who can act as is neccessary to ensure the best outcome for mum and baby.

However with units morphing into birth centres and obstetric units now being miles and miles away from alot of women, we will see more women taking their chances with freebirthing as they feel its the only way they get what they want. The only problem is they may get more than they bargained for.

Kentish Spitfire · #6 (**permalink**) 09-Jun-2008, 15:32

Yes J, that is what we do now, but that is not what happens at a freebirth - as you say, they have no input from midwives or others. That is why we need to educate everyone more.

Surely it isn't unreasonable to have a homebirth (or wherever) with a midwive in attendance who isn't going to interfere unless absolutely necessary. What experiences have these women had to make them refuse basic care?

It's such a shame. I had a home birth and had a great time with the midwives. We had a laugh and played games. One did my ironing for me and answered the phone, made tea and sandwiches etc. We were like friends and it was wonderful. She didn't do anything I didn't want her to and she respected me to let her know when things were changing. That's the way birth should be - a celebration of life and a womans power!

KS x

Shoshana · #7 (**permalink**) 09-Jun-2008, 16:15

My view on this is that if women wish to give birth without a midwife present, then let them! BUT they must be prepared to face the possible consequences. If they are prepared to accept that situations such as mal-presentation, fetal distress, pre-eclampsia etc. may go un-noticed, then that is fine.

Personally, I would not be happy to be the midwife "on-hand", should something go wrong. I would imagine that women who are so passionate about free-birthing as to not want a midwife actively involved, would hold-off 'til the last possible moment in requesting for help. This then puts the midwife in an emergency situation, which could potentially have been avoided. Had the midwife been involved throughout the woman's labour and built up her trust, using her knowledge and instincts, she may have been able to anticipate complications and taken the appropriate action.

Dory · #8 (**permalink**) 09-Jun-2008, 16:40

Originally Posted by Shoshana

My view on this is that if women wish to give birth without a midwife present, then let them! BUT they must be prepared to face the possible consequences. If they are prepared to accept that situations such as mal-presentation, fetal distress, pre-eclampsia etc. may go un-noticed, then that is fine.

I think that one of the big difficulties of our job is that people (not just the women) want to have freedom of choice, but are not prepared to accept that any decision in life comes with consequences. It's part of being a grown up.

Kentish Spitfire · #9 (**permalink**) 09-Jun-2008, 17:31

Originally Posted by Shoshana

My view on this is that if women wish to give birth without a midwife present, then let them! BUT they must be prepared to face the possible consequences. If they are prepared to accept that situations such as mal-presentation, fetal distress, pre-eclampsia etc. may go un-noticed, then that is fine.

Personally, I would not be happy to be the midwife "on-hand", should something go wrong. I would imagine that women who are so passionate about free-birthing as to not want a midwife actively involved, would hold-off 'til the last possible moment in requesting for help. This then puts the midwife in an emergency situation, which could potentially have been avoided. Had the midwife been involved throughout the woman's labour and built up her trust, using her knowledge and instincts, she may have been able to anticipate complications and taken the appropriate action.

That's an interesting point of view and one I had not considered. Thank you for sharing it.
KS x

nappysack · #10 (**permalink**) 09-Jun-2008, 19:28

I agree Shoshana - we all should be prepared to take responsibilty for the decisions we make and in my experience women (and their partners) rarely do. I have witnessed several situations where aspects of care have been declined and then, when our warnings come true the parents throw up their hands and say; "why didn't you tell me this would happen? You must have done something wrong!"
It is then the poor midwife who has to justify herself and live with the feelings of @i should have done more'

Similar Threads
Thread	Thread Starter	Forum	Replies	Last Post
Birth Attendant Statistics	TallPoppy	Articles & Links	0	18-Jul-2008 12:24
Orgasmic Birth Film	Shoshana	Study Days & Workshops	0	17-May-2008 07:24

		MidwiferyWorld.NET > MidwiferyWorld.NET Community > Midwifery News and Debate
Unassisted Birth - revisited

Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)