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Wednesday
Mar252009

"Freebirthing"

I finally watched the “Freebirthing” show on Discovery Health. It was enlightening.  

I’ve read many of the blog posts and comments around the Blogosphere regarding this show, including when women who were in the show clarified their experiences. I have to say, what I saw wasn’t the same piece UCers (Unassisted Birthers) did – even though the content was exactly the same. As I read their comments, it seemed as if they were squinting, using kaleidoscopes and selectively watching the show about birthing without any care provider present.

Claire, a woman in the United Kingdom, tells us that she is choosing to birth alone because of a negative experience with a midwife the first time. I found it interesting, the language she chooses to use to describe her previous experience. She says the nurse was “intervening” and always looking at the monitor instead of at her. She describes the nurse leaving during the end stages of her labor, only returning when she heard Claire about to give birth. Claire said she still only looked at the monitor and then rang the emergency bell and she describes chaos that included whisking the baby to the isolette even though the baby was screaming. She says she kept telling them, “Give me my baby. Give me my baby,” but they continued ignoring her. 

You see, from this vantage point, there are parts of the story missing, parts that are pretty easy to fill in, although without the chart (or accurate eyewitness accounts) the whole story won’t be known. When the nurse left Claire earlier in labor, isn’t that what Claire would have wanted? Why was she so concerned about the nurse leaving when she, the next time, didn’t have anyone present? Then, when the nurse returned, she heard the baby’s low heart beat, went to look at the monitor strip to see how long it had been low and she called for help. Perhaps there was meconium and that is why the baby was whisked away to the isolette (not that I agree that this should have happened, but I am hypothetically filling in the gaping holes). 

During the pregnancy being filmed, Claire was getting prenatal care at the local hospital, but (I’m assuming) once she tried to bring the film crew in it came out that she was planning a UC. (Otherwise, why would she have told them?) She was released from the hospital’s care, including not being given the free “birthing kit” (that I assume comes along for the homebirth midwife). As Claire tells the audience about the distasteful visit saying at one point, “It’s kind of all or nothing.” Um... by your CHOICE! Question for Claire: If the hospital care was good enough to help you discover problems during the pregnancy, how did they become totally inept once you are birthing? (A question I will ask several times...) Was the “experience” of the birth more important than the health and safety of you and your child? For you, it seems it was. Does the idea of telling a good story, strutting around in on-line groups or shocking the family weigh more than death? 

Does it sound like I am playing the Dead Baby card? I am. And also the Dead Mother card. If a UCer doesn’t take these issues into account, she isn’t making an informed and complete decision.

Much is said about the crappy care women get in the hospital system. Having witnessed horrendous “care”, I understand the issue. I understand and sympathize with women who have experienced birth trauma, been birthraped or have been birth abused. I do believe hospitals, doctors and nurses are not the most wonderful places to birth when someone is having a normal pregnancy and birth. I believe a huge overhaul of The System must be done lest more and more women turn their backs on some of the very people who might save their lives. I believe the Internet is changing the ratio of women birthing at home and birthing unassisted. While the percentage of women birthing at home hasn’t changed in nearly 40 years, I believe that with the Net and with extremely popular movies like “The Business of Being Born,” more women are exploring a different way to birth. While “the experience” shouldn’t be THE reason women choose to birth outside of the hospital, it IS vitally important in helping a woman feel safe as she births her children.

As a midwife, I have also witnessed terrible midwives at work – disrespectful, manipulative and liars. But, happily, these are but a few in the (not-enough) bounty of midwives. 

As such, I can understand the drive for some women to birth unassisted. I am a pro-choice woman who can empathize with the pro-lifers. I understand when women do everything in their power to remain safe and healthy with a homebirth care provider and yet feel betrayed, assaulted and terrified. I also understand women hearing these horror stories don’t want to go there, so choose an unassisted first birth. 

I know the myriad of reasons women choose to UC: “No one will allow me to have a VBAmC”; “I can’t find a midwife that will do a VBAC at home”; “No one does breeches around here”; “I want my twins to be born vaginally”; etc. 

All of these issues are definitely distressing for women who find themselves in these predicaments. They must really struggle with what to do and where to birth. I wish I had wonderful answers to the questions, but I do not. 

But, how could every UC-wanna-be have no access to quality, respectful care? I don’t believe that is the case. 

Once Claire is “fired” from going to the hospital, she heads over to the local medical supply store to buy “sterile scissors.” The woman behind the counter tells her you can’t buy sterile scissors, you have to do the sterilizing yourself. This is one of many instances typifying the glaring ignorance of NORMAL, ROUTINE midwifery skills/knowledge. In fact, some of the ignorance/ineptness was so painful to watch, I covered my mouth and eyes at the same time. If these women were the cream of the crop of UCers, I shudder knowing the amount of luck UCers must require to keep themselves and their babies safe. It certainly isn’t the Internet or book learning that fills in the gaps. 

Claire goes for a visit with her grandmother and on the way she says she doesn’t want the risks “shouted” at her; she knows the risks. I am of the school that believes UCers should have to answer the questions posited to them. They should have to answer every question from “Why are you doing this?” to “How will you handle the baby’s death if that happens?” 

Once Claire is at Grandma’s, she tells her she is going to birth unassisted. Grandma is appropriately concerned and Claire says off-handedly, “If you think about women across the world, more women have unassisted births than probably any other kind of birth.” She chuckles as she says this, implying how ridiculous it is to be worried about a UC. 

Let’s see what the statistics show.

“According to the United Nations, Sierra Leone has the highest rate of maternal mortality worldwide, and a woman living in the country has a one in eight chance of dying in childbirth. Ireland has the lowest rate, with a one in 48,000 chance of a woman dying in childbirth, while the U.S. has a rate of one in 4,800. High rates of maternal mortality in developing countries often are due to a lack of skilled health care providers, inadequately equipped hospitals and widespread poverty that prevents many families from affording medications.” 

“In most instances, women who die in childbirth experienced at least one of the following three delays: 

- The First Delay is the delay in deciding to seek care for an obstetric complication. This may occur for several reasons, including late recognition that there is a problem, fear of the hospital or the costs that will be incurred there, or the lack of an available decision maker. 

- The Second Delay occurs after the decision to seek care has been made. This delay in actually reaching the care facility and is usually caused by difficulty in transport. Many villages have very limited transportation and poor roads. Some communities have developed innovative ways to address this problem, including pre-payment schemes, community transportation funds and a strengthening of links between community practitioners and the formal health system. 

-The Third Delay is the delay in obtaining care at the facility. This is one of the most tragic issues in maternal mortality. Often women will wait for many hours at the referral centre because of poor staffing, pre-payment policies, or difficulties in obtaining blood supplies, equipment or an operating theatre.”

“(Experts believe) Maternal deaths occurred because of lack of access and non-availability of good reproductive health services and approximately 75 per cent of maternal deaths are preventable, according to officials at the United Nations Population Fund (UNFPA) in Yemen.

UNFPA says that 84 per cent of all births in Yemen take place at home and only 20 per cent of these births have trained attendants present.”

These statistics demonstrate that, for the mother, the risk of dying is extremely elevated when no midwife or doctor is present. None of the above stats even begin to talk about infant mortality that could have been prevented if a trained birth attendant was there. 

The number one requirement, according to the CDC and other highly respected organizations, for lowering infant and maternal mortality and morbidity is providing quality prenatal care to all women. It is the women who fall through the cracks (or who purposefully remove themselves from The System?) that have the worst statistics of all.

We can know our country’s maternal mortality rate should be much lower (and work continues trying to make it so), but a segment of our women, African-Americans, have a far worse death rate than Anglo women; their maternal mortality rate is three times that as for white women! Absolutely atrocious. Experts say the lack of prenatal care, poverty, obesity and the propensity for hypertension and diabetes are the main causes for this increase. Number one is lack of prenatal care. 

Am I making you think? Pissing you off? Good.

Claire has a new partner, a girlfriend named Yasmin. Snarkily I say, “Oh, honey, I know we’ve only been together for 6 weeks, but will you be the assistant at my unassisted birth? It’ll be a great third date.” That Claire brings in 1) a total stranger who would blindly go along with something she probably never heard of 2) someone who gets a mere few weeks of information about what to do in an emergency 3) a woman she can all of a sudden lean on – tells us of Claire’s mental state: not healthy! 

Continuing, Claire and Yasmin are seen at a Red Cross CPR class where the man is giving them a private lesson. He forgets they're birthing alone for a moment and then stresses how vital the first few minutes are. Yasmin is seen standing off to the side looking like a deer in the headlights. 

Once labor begins, it is only a couple of hours long. No fetoscope or doppler is seen and Yasmin’s job seems to be videotaping. When Claire is birthing the baby, she is on hands and knees with Yasmin behind her holding a towel. You can see Yasmin grab a blanket and wipe down, getting the poop off of Claire’s rectum. (Wiping should always be up so the baby doesn’t get the bowel movement on him/her. Basic knowledge.) As the baby is being born, Yasmin tries to touch the baby, but Claire tells her to stop and at the same time begins hollering, “I’m scared! I’m scared!” Yasmin does nothing to reassure her. In fact, Yasmin looks totally out of her element, uncoordinated in her actions and superfluous to the whole affair. 

The birthing of the placenta isn’t shown or talked about. 

In the piece at one point, Claire discloses that she knows she will be “in a limited capacity” during the labor and birth. Was she depending on Yasmin to be her midwife?

And so we meet Heather, a twenty-two year old American woman, when she is a couple of weeks away from birthing. As her story unfolds, we see she is also UPing (getting no prenatal care). She listens to her baby with a fetoscope and checks her blood pressure at the local pharmacy. A concern of hers is there might be a low-lying placenta; she can hear it with the fetoscope. 

Now, I have to tell you how incredibly amazed I am that this woman who has never heard a heartbeat, a cord pulsating or a placenta through the uterus can tell she has a low-lying placenta (possible placenta previa or a partial placenta previa). It can take midwives years to be able to tell the difference between the cord and the placenta’s woosh. 

At a gathering of Freebirthers that Laura Shanley brings together, Heather tells us that she’s choosing to UC because her first birth was so awful... that her pushing stage was only ten minutes long, yet they were hollering at her to push with all her might. When hospital people implore a woman to push like that, it is because the baby is in serious trouble. In fact, she says they told her if she didn’t push the baby out immediately, she was going to have a cesarean. Proof to me, without even seeing her chart, that the baby was having a very hard time. Why doesn’t Heather talk about that aspect of the birth? Why does she demonize the hospital people instead of offering a balanced view of the previous birth? I don’t believe most UCers are able to do that. I wish for all of them a course in re-framing (there isn’t one; I should do one) so they can comprehend and accept why their births were the way they were. Again, I know birth abuse happens, but listening to two of the three stories, the medical people had horns growing out of their skull according to the women telling them. 

Even though Heather thinks she has a low-lying placenta, she does not go get an ultrasound. Instead, she brings in Karen Strange, CPM, to teach her a crash course in Neonatal Resuscitation. Interestingly, Heather is alone as she learns. Is she the one who will perform the rescue on the baby? If she does, indeed, have the placenta previa, who will do NRP on the baby as mom hemorrhages to death? 

As Heather is talking to Karen, she inquires, “How long, um, would the baby have to go without oxygen for it to....” (uncomfortable moment) (Karen states) “Die?” (Heather) “Yeah... like you don’t really know... is it like twenty minutes?” (?!?!?!?!?!?!) Karen tells her she doesn’t have twenty minutes. “Ten minutes?” “No, you don’t have ten minutes.” 

HEY HEATHER, YOU HAVE ABOUT FOUR MINUTES BEFORE BRAIN DAMAGE OCCURS AND ABOUT SIX MINUTES BEFORE DEATH.

Relieved, Heather says the ambulance is only five minutes away. Really, there is no way for Heather to know how long it will take an ambulance to get to her. They could be across town after another call as they drive the six or seven minutes to her house. They will come in and assess. Time is ticking all the while. 

Heather learned a lot of her information from the Internet. 

Do women who learn about birth on the Internet consider newsgroups and on-line support groups as their education process an adequate midwifery substitute? Why/How is it okay to take advice from on-line women no one has met in real life, yet turn their backs on real life licensed midwives who have much more information than those on-line friends? Even real-life midwives do not have the information needed to offer advice over the Internet and any of the people offering advice carry the weight of the outcome of the unseen women and babies. It disgusts me to watch as women tell pregnant women to do such and such or thus and so... everything from not showing up for inductions, dismissing NSTs, believing any number of ills are because of a) seeking medical/midwifery care b) not believing in the normalcy of labor and birth c) still being brainwashed and disbelieving of natural remedies and the ability to self-heal any complication. 

Watching the UCers, I see that they try to gather information they will need for their births, almost literally becoming their own midwives (or having someone else fulfill the role). What is baffling is they think the information is really important, yet won’t bring the person who’s really great at retaining it into their circle during birth! 

Just because one can learn the information, does that mean she has to learn it? Do we know how the engineer builds our cars? Do we care how the telephone works? Do we make (all of) our own clothes? Grow (all of) our own food? Do we stand next to the car mechanic and ask “Why are you doing that?” when they are fixing our brakes? Don’t we know why? Don’t we accept that some people are better at some things than others? Heck, I am terrible at math, but writing comes fairly easily to me. You wouldn’t want me doing your taxes, but I’d be okay creating a brochure. Shouldn’t we be able to tap into the variety of skills around us without becoming an expert at everything? If we aren’t very good at something, could we ever even BE an expert at it? 

Laura Shanley, a woman who says she just wants women to be “empowered” no matter where they give birth, is the guru of the Freebirthing movement. Her information and support are partially/muchly responsible for any negative outcomes that occur because of her advice. If women take the advice of those strangers over the Internet, those strangers also carry the burden of the brain damaged and dead babies that have happened with Freebirthing. We have learned of several on Mothering.com; what happens to the women who vanish, the ones who are humiliated they listened to such bullshit advice that their babies are dead? 

Just yesterday, Mothering.com (finally!) put a disclaimer up. It reads: 

“The opinions offered at Mothering.com, MotheringDotCommunity and the UC forum are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your midwife, physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking care because of something you have read here.” 

The moderators at MDC typically edit dissenting comments, many times removing them from the boards. Did something make them come to their senses? Did something happen (again) in the UC boards? This statement is a good beginning, but allowing balanced commentary would be a much better avenue for them to follow.

During Heather’s pregnancy, she says, “I haven’t really thought a whole lot about if I lost the baby or if I died. And that’s the one thing that I don’t think much on, but when I do think on them, those are the really scary things.” 

How can any sane person say this woman should give birth alone? She won’t even confront the most basic issues of possible tragedy. She says she doesn't want to “make a big thing out of little things.” She does say that if something goes wrong, “I only have myself to blame.” 

During the birth, she is seen pushing in a couple of locations; she ends up on the bed, on her back (I thought that was pretty interesting). As the baby is born, she’s giving directions to her husband, to pull on the baby so he will be born. As he pulls, she says to stop, but you can see him pulling on the baby’s head to get him out. I shuddered. If she’d have had a midwife, she would have allowed the baby to be born much more gently, not pulling on the head, stretching the neck and possibly causing harm. When she gets the baby in her arms, she apologizes to him, saying she knows he doesn’t feel good. Not after that entrance into the world! 

The family decides to do a makeshift newborn exam, yet they have words about how to work the scale. Dad wins. When they are shown getting ready to cut the cord, Heather asks, “You don’t think it hurts, does it? Does it hurt the baby to do this?” I am serious. Wouldn’t you think someone who has deemed herself a midwife would know the answer to this? Dad’s answer? “I’m sure it doesn’t because they do it in the hospital.” Priceless! 

So, the baby is doing well and the next scene we see is Heather sitting on the couch, leaning forward saying it is “several hours later” and the placenta has yet to be born. She feels pressure, but it just won’t come. They decide to transfer to the hospital. 

Now, this is my favorite part of the whole show, so sit up in your chairs. 

Heather is in the hospital bed, on her cell phone and telling the nurse she doesn’t want an IV. “Do I have to have an IV?” and then “Do I have to have an IV for a D&C?” The nurse says they don’t even know if she needs a D&C. I am telling you now... if there wasn’t enough ignorance already showing in this girl child, these scenes in the hospital demonstrate it delightfully. A D&C?! How about getting the placenta out. A D&C?! C’mon. Basic knowledge. BASIC knowledge that is missing from Heather. If this is missing, how much else is? 

rubbing hands together and smiling 

Now the doctor is in the room, in a chair leaning back. He says, “What will you allow me to do?” and Heather hems and haws about his getting the placenta out, what will that take? She is alternately directing and meekly questioning, all one right after the other. The doctor again asks what she will let him do and she asks what does he want to do. He says he wants to examine her and she lights up and says okay. 

The doctor said exactly the right thing: What will you allow me to do? Listen UCers, if you go into the hospital for a problem, ALL BETS ARE OFF! You buy the hospital ticket, you go for the hospital ride. Don’t be asses and try to direct things in the hospital. YOU WENT THERE FOR HELP; LET THEM HELP. Sheesh. Interestingly, the baby was examined in the isolette. That is something I would probably have not allowed because the baby isn’t the patient. 

The placenta, it turns out, was right there, in the vaginal vault (they didn’t say that, but the pressure she was feeling demonstrated that) and came out quickly and easily. It was just sitting there, for goodness sake. A midwife would have helped the placenta out nicely and the trip to the hospital would have been avoided altogether. 

In a comment on a UC blog somewhere, Laura Shanley wrote: Heather is now sorry she went into the hospital, as many women that give birth at home deliver the placenta hours (and occasionally days) after the birth with no problems. There really was no reason for concern. Hey Laura! How about not giving out midwifery or medical advice, eh? Some women DO have problems, with bleeding, with an accreta or it could be sitting in the vault like Heather’s and lovely germs can crawl up the cord into the vagina causing sepsis and kill the mom. How about that information along with your flippant pieces of advice? 

(During a scene of Laura Shanley delivering one of her babies, she was also on her back and there were several men in the room. Is this unhindered? Hmmm... some debate about that.) 

Throughout the show, the women continually talk about “the experience” of birth, how they wanted things peaceful. A woman in Wales has her UC so she can have a painless birth (her experience, not the baby’s). When does “the experience” over-shadow the health of the mother and baby? Can’t the experience walk hand-in-hand with the health of both mother and baby? Heather says there are “dangers for my children” if someone was there to help. In fact, she would have avoided that trip out of the house if she'd have had qualified help! 

One of the midwives at the end says these women are “disenfranchised” and she is absolutely correct. Somehow we have to find a way to civilize birth in the hospital and make sure midwives are offering loving care in the home. Experience with safety must be the goal; there must be a way to do this. 

I really loved this piece by a mom who was trying to birth at home, but transferred to the hospital. 

“During my pregnancy, I had dreaded this showdown: The Medical Establishment vs. Sweaty, Agonized Me at the Not-O.K. Corral. But when the moment arrived, it wasn’t a showdown at all. My ob-gyn, a stately woman, entered the room. She wore an unsteady look. I could hear her laying out the reasons why we needed to do an emergency C-section, but I was only half listening. It was her face I watched. It pleaded, Please don’t make me risk your life.

That’s when I got it. That I could die here today. That I could leave my baby without a mother. Or worse, I could take my baby with me and leave my husband mired in grief.”

Somewhere I read: “Unassisted Childbirth was and is the answer for any couple that honestly wants to have a peak experience welcoming their own children into their lives.”

This is exactly the sentiment that must be dispelled. Birth isn’t just about obtaining a peak experience. The experience must be combined with the health and safety of mother and baby. Now THAT translates into a peak experience!

References (6)

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Reader Comments (56)

Well let me just say as a UCer that we are more educated about birth than this. As I think most women are.

Your disdain for UC is obvious. But maybe you should give the women a chance who have decided to birth this way. NOT ALL women have chosen this route for the silly reasons you listed. Some of us just want to give birth the way we conceived...privately and quietly in our own homes with no interventions and interruptions.

And most of us have read and studied birth WAY BEYOND what this show highlighted. I havent seen it...but it seems to put a bad light on UC instead of helping it.

June 13, 2009 | Unregistered CommenterMichelle

Your attitude discusts me.

July 5, 2009 | Unregistered Commenterpete

Your spelling amuses me.

July 6, 2009 | Registered CommenterNavelgazing Midwife

My skin CRAWLS reading about the extreme actions some women are taking with unassisted birthing. I could hardly get through this article for the cringe factor I felt with reference to the stupid, irresponsible actions some women are taking with the lives of such precious little beings; a new miraculous life overlooked ENTIRELY for an EXPERIENCE....???? As a mum to two precious children, I don't think so. No birth experience of mine would ever be worth a trade in my children's health and wellbeing.

Women in third world countries who don't have access to the levels of pre & post-natal care we do would either laugh or cry at the stupidity of some of these womens actions. Do you (as the 'educated' unassisted birthers you claim to be) seriously think women living in impoverished conditions would decline such care if it was made available? They don't AIM to drop their babies in rice paddies. It's simply that there's NOT AN ALTERNATIVE.

As a physiological process, birth IS potentially with its complications. This applies to ANY CREATURE IN THE ANIMAL KINGDOM. Cows, dogs, elephants, HUMANS...................... This is NOT a distrustful mentality on my part but definitely a realistic one!

January 28, 2010 | Unregistered CommenterUnbelievable...

You said the only babies you were aware of that died in the hospital had anomalies.

I am aware of a baby, full term, without anomalies, who died in the hospital. His mother works where I work. Her father is an older OB, and the one who brought fetal monitoring to this area. He wasn't her doctor, but he was there during her labor. Her theory is that her own doctors were inhibited by his presence: if HE didn't think there was anything wrong with her strips... meanwhile his judgment was affected because his daughter was involved. She is also a nurse who has worked L&D and she had obtained the monitor record and gone over and over it and was convinced it showed the baby was distressed and that she should have been sectioned. She told me she would have been "better off having my baby in a barn" because they went on giving her pitocin at a high rate despite what she says were signs of distress. She had an epidural, and didn't feel how hard these contractions were. am not clear exactly what it was that caused the distress beyond the strong contractions. And I can't vouch for her grief driven interpretations of the monitor strips. But her baby was born so brain damaged that it needed to be on life support which they had to make the decision to stop after a few days because of lack of brain activity.

When she had another baby she had a planned C section. That was the only way her husband would consent to their having another child.

I am not saying this as an argument against having a midwife at one's birth. I am just pointing out that it is possible for someone to take what she believes is every precaution and still have a disastrous outcome.

Susan Peterson

August 30, 2010 | Unregistered CommenterSusan Peterson

By the way, here is an old post from someone who agrees with you! His is just a common sense opinion, from a lay person who appreciates the midwives who helped at his wife's births. I thought you might like this. NOT from a birth related blog. From back in 2007:

http://cumecclesia.blogspot.com/2007/05/freebirthing-my-recommendation-go-with.html

HIs recommendation, go with a homebirth with a midwife!

Susan Peterson

August 30, 2010 | Unregistered CommenterSusan Peterson

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