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Sunday
Mar142010

The UC Oxymoron

The Trust Birth Conference is going on as I write this. Throughout the year, I was asked if I was going to attend since it was so close to my San Diego home. No. Still feel “trusting birth” is asking for being disappointed –or worse. I continue “Respecting Birth” –understanding that birth has a power of her own, but that power can be unpredictable and wild at times. That unpredictability is why midwives are hired to attend births. I suppose if you trust birth, especially, implicitly, you could merrily skip through your pregnancy and birth without a midwife. 

Pamela Hines-Powell, SageFemme, spoke at the conference about how midwives can help UCers. (UC = Unassisted Childbirth) After her session, she put her UC Contract up on her blog and it was this contract that has gotten my knickers in a twist. Mind you, I respect Pamela very much and enjoy her blog, yet her thoughts and beliefs definitely move me to think and write more. 

Pamela writes in part: “A non-refundable midwifery care deposit of $500 ensures that Pamela Hines-Powell will be available to answer questions or concerns, order desired labs or ultrasound, collaborate with other healthcare providers during the course of pregnancy, birth and postpartum. This fee also ensures that she will be on call for the birth, whether or not she attends the birth.” She goes on to outline different circumstances where she might attend the birth at the client’s request or even transfer to the hospital with them if that was needed. I’m glad she has a limitation that says, “If an emergency arises and the midwife feels the safest option when consulted is a transport to the hospital, she has the right to refuse to attend the birth at home.” 

Over the last week, the NIH VBAC Conference stated new guidelines to increase VBACs, yet the reality is docs and hospitals continue limiting them (refusing them) to a significant portion of women. A woman’s right to birth how and where she wants to have been in the forefront of the discussion. Intertwined with the issues have been references to reproductive rights, a woman’s sole choice of who touches her body (even if the baby is in danger) and what would constitute informed consent (and who defines it). 

The UC supporters embrace these same considerations; that women have a right to birth alone, even if it endangers the baby, they decide who touches their bodies and one cannot be pro-choice without being pro-UC. It’s an interesting concept and one that certainly makes me pause, trying to wrap my mind around that logic. 

I think I could squint and see my way to agree that autonomy and choice are valid reasons to UC (not that anyone cares if I think they are “valid” or not), but where I get perturbed is when UCers pull midwives into their autonomous world. 

I just cannot figure out for the life of me how a UCer can call themselves a UCer if they consult with a midwife. Pamela equates consulting with a midwife as if a homebirthing woman needed to consult with an OB, say, for antibiotics. That she still is a homebirthing woman, but needs outside information/help to keep them on their path towards their goal. 

But, the U in UC is unassisted. Un. NOT, assisted. No help. No one assisting. No one helping. Not, U-except-when-I-need-the-help-of-a-midwife-C; that would be called assisted. I don’t care if all the midwife does is tell a woman who calls herself a UCer how to listen to heart tones, that’s giving assistance. But, if a UCer calls a midwife in the throes of labor? If the midwife comes to deliver the placenta? To suture? How is that considered unassisted? Is it merely a badge of honor to say you birthed unassisted? That the midwife sat in the other room, on the porch, in her car, in her house? 

And what of a midwife who joins in this game of semantics? Is she the UCer’s midwife? Is she the UCer’s consultant that just happens to be a midwife? Is she the Un-Midwife? 

Why is a midwife smart enough, skilled enough and experienced enough to consult with, but not cool enough to have at the birth? How come “trusting birth” comes with the parentheses “unless I need a midwife to pull me out of danger or fear.” 

(Sometimes I don’t like it when all I do is ask questions, but asking and getting answers helps me formulate my own answers.) 

Recently, I’ve written that I serve women. That that is my role/job/calling: I serve women. But do I really serve women? All women? If I can help a woman find help terminating a pregnancy, be a doula at abortions and sit for hours with a woman having a miscarriage, why is it such a stretch for me to reach out to the UC community? Why does it sound like I want to punish the UCer for making her choice to birth alone? 

Why am I being so black & white about this issue when I can so easily see the gray in almost any other? 

I’m sure that part of it has to do with many UCer’s arrogance about their knowledge and abilities to avert complications or use wishful thinking to eliminate anything negative from happening at all. The puffed out chests, bragging that they don’t need anybody sours my desire to offer assistance – because I am “anybody.” So, if they don’t need anybody, don’t need anybody! 

Caveats abound. “I don’t need anybody until I need: to know my blood type/to see if I have a UTI/to get antibiotics/to order an ultrasound/to see if my water broke/to determine the baby’s position/to check that my 40-hour labor is still normal/to help me decide if I should go to the hospital/to come help with my not-nursing baby/to deliver my placenta/to sew up my torn vagina/to do the newborn screen/ad forever.” This isn’t not needing anybody. This is needing somebody; apparently, a midwife. 

I’ve been told it’s my ego that pushes me to be so hard-assed against UC. That I need to be needed, want to be wanted and revered as The Midwife. I’ve looked deeply, trying to make sure it isn’t an ego thing and, (perhaps egotistically), I just don’t see it. For me, it is wanting others to be true to their word, to accept the responsibility they swear they want and to live with the consequences they promise they are willing to live with. That UCers lure midwives into their worries and complications, dumping them over the midwife’s head and walking away squeaky clean annoys me terribly. 

I guess, in the end, I have a real hard time with taking advantage of a situation and a relationship, using it for a one-sided benefit and expecting the other person, the midwife, to welcome them with open arms and then being banished when she is no longer needed or wanted. But, when she’s needed again, she’s expected to smile and offer her skills and experience (and license). Over and over, I see a midwife’s exploitation, her very name being maligned, but her love and attention wanted… at the UCer’s beck and call. 

It's that dichotomy that bugs me the most. Be true to your word. Do what you say you're going to do. Walk in integrity, not half-truths. I promise to keep doing the same.

 

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Reader Comments (76)

I so appreciate your thoughts and your honesty, Barb. Honestly.

I think the last paragraph resounds within me on this subject:

Be true to your word. Do what you say you're going to do. Walk in integrity, not half-truths. I promise to keep doing the same.

And I think that is what I always do. I always try to do. I'm not in competition to be "cool" or "more hands off" or more "trusting". I have limitations and I am honest about those. I work hard to stay in integrity. I appreciate that there are comfort levels that women are willing to talk about.

I'd much rather have a midwife state what you've said than to be uncomfortable and say she's ok with this arrangement and end up feeling used and misled...and vice versa.

I'm judicious about who I take on in this role. Then again, as I write all this out, I know none of this is a surprise. It's ok that some people don't agree. I get it. I really do. I find truth in all opinions - even from Dr Amy at times. I get it.

xo

March 14, 2010 | Unregistered Commenterpamela

Thank you for not having cow patties that I used your blog as the springboard. It was perfect! Thank you for that. You push my mind more than many others; I really, really respect you for that. And I'm glad we both can embrace each others' opinions, even as they have gaping differences. That means tons, too.

*huge smile*

March 14, 2010 | Registered CommenterNavelgazing Midwife

Personally, I think that someone can still consider their birth to be unassisted even if they consult with a midwife during their pregnancy. Otherwise, it would be an unassisted pregnancy AND unassisted birth. I think it's a good thing that women who feel that they need to consult with someone do so, instead of stubbornly refusing, just to say it was all completely unassisted, just for the sake of using the term.

I have had a UP/UC, and if I ever were to get pregnant again, I would feel comfortable consulting with Pamela (who is nearby me, yay!) about some health issues I have now, and possibly reconsider another UC because of that. I think that it's great that Pamela is a resource for UCers in this area, because as a woman who chose that route for my second birth, I was completely shunned and berated by everyone. I know how lonely it can be, just because your birth choices don't fit into the hospital/birth center/homebirth box.

For me, and other UCers I've talked with, I don't think it really feels like a competition about who can have the most unassisted UC ever. To me, it just felt like finding the right way to birth for us as a family. I know there can be women out there who feel like they have to be the crunchiest and best mom, but that hasn't been something I've come across personally.

Sorry - this may be scatterbrained. We are moving out of our house right now, and so I'm just taking a quick break to add my own opinion :)

March 14, 2010 | Unregistered CommenterNicole Murray

Ok, why is it that there has to be some one fits all definition to what it means to UC? Your definition of UC and mine may be totally different then mine or someone else's. Not only that what does it really matter? Its a label, nothing more. And I for one am so happy to see Pamela offering and trying to find a way to support those"UCer" who may at some point in time need assistance or even just some encouragement. I know that for me, this would be perfect. When I have another child I would LOVE to go UC. I need to be alone, not to having people watching me, bringing in their own baggage or fears into my laboring space, BUT due to my own issues/feelings that my body is broken, I would love to have a midwife who would be willing to asses, advise and support me. Someone who has seen birth, up close and knows what it is suppose to be like to tell me I AM NORMAL and I for one think that is a huge thing midwives could do to help those who truly want and feel they need to UC.

Sorry, but the oxymorons abound. How can a midwife be all supportive and help you know your body is perfect in one breath and then a complete nuisance the next? Isn't that a tad selfish?

March 14, 2010 | Registered CommenterNavelgazing Midwife

AMEN, and AMEN! You have said way MORE than I mouthful, and I only wish I had written it! Kim.

March 14, 2010 | Unregistered CommenterKim Mosny, CPM, LM [VA]

As a proud UC'er(yep I'm claiming it), I was so appreciative of the 2 midwives who came and helped me to have my UC. I quit my midwife at 22 weeks after much though about how I did and didn't want my pregnancy and birth to be. I had pondered all the outcomes I could imagine, I had even made myself ok with the potential increased death risk from not monitoring myself or baby.

What happened, the reason I called in midwives after 2 days of being ruptured and 7 hours of being completely dilated, was not something I ever considered. I had an arrest of labor. My baby was in a direct OP position and was not coming down. I was the first person to realize that if I still wanted the homebirth I'd planned, I needed some help. Help to simply turn my baby. It would've been great if my baby would've helped earlier, but he was pretty comfy where he was. He was not in distress, I was hardly in labor, even able to sleep in between my 45 min apart contractions. I just need a knowledgeable source of support.

When my sweet friend, who happened to be a midwife with birth tub in tow, arrived, she helped me in every way I needed and wanted, and not one bit more. I know some midwives who would transport for women in my situation. Not her. Once we determined the baby was turning, she even left, with a smile on her face and deep understanding of what I wanted my experience to be. 3 hours later, my baby (and placenta) was born, with only my partner there to catch him.

I did not take advantage of my her. In fact we deepened our bond a thousand times over when she helped renewed my trust in my birthing abilities.

As a refuser of many standard practices, I feel the need for a midwife less than more. I'd rather her be there when I need her, and ready to be there if I need her. But I don't want to need her in the first place. I don't want to make her uncomfortable by being there not doing things she feels she needs to do. I don't want her telling me what I need to do. It may not qualify as UC, but then what do would you call it ? Just like with anything else, you are more than within your right to refuse to care for these women and babies when asked. I am thankful that some midwives are pleased to assist if and only if called on.

March 14, 2010 | Unregistered CommenterKW

I feel very similarly. I am not comfortable with being on call for someone when we have had a limited opportunity to establish a trusting relationship and when I've had little awareness about risk factors, etc. Once I am more experienced I may feel differently, but for now I intend to stick to a more traditional role as a midwife. Thanks for sharing your thoughts!

Gina--brand new CPM in Colorado

March 14, 2010 | Unregistered CommenterGina

I sense that you're getting hung up on the word "unassisted." I really don't think that's the best word, or even a mildly good one, to describe what UCers are doing. Too much focus on labels and definitions. Can birth be more than one way at one time? (To ask a rhetorical question in response to your rhetorical questions!) I understand that you want women to stay "true to their word," but doesn't that squish them even further into a conceptual box--making them even more ideologically rigid? I'd much prefer flexibility and responsiveness to individual situations, than women rigidly UCing no matter what, because "that's what UC is." Make sense?

Having had a great UC and a great midwife-attended home birth, the anti-midwife rhetoric does drive me batty. I do get that some women really can't labor well with any outsiders present. I discovered that I can. Of course it helped that I was in denial for so long that the midwife didn't arrive until 30 minutes before the birth! I really enjoyed and valued the interaction I had with my midwife. The birth was really a very, very minor part of it.

I find myself becoming more critical (is that the right word?) of a lot of what's going on in the UC community. I follow several UC groups still and the discussions often make me want to bang my head against a wall. Lots of uneducated, misinformed stuff going on. Of course not everyone is like that, but the overall tone of the discussions really scares me at times. Is it because I've changed? Because the spirit of UC has changed as it's become more of a movement/thing/entity?

March 14, 2010 | Unregistered CommenterRixa

Something about the way UCers talk about midwives would make me feel like a Shabbat goy.

March 14, 2010 | Unregistered CommenterChristie

@Rixa: Can I smother your face and head with kisses? Can I hug you until you holler "Uncle!"?

I have tears that you, of all people, have an inkling of what I am talking about. I am not nearly as eloquent as you and Pamela (and so many others)... I'm kind of a clomping cow in the dining room... but do like to be understood. In FB threads, I've said that, of course, I don't know *all* UCers, but have, what I believe, is a pretty decent understanding of the community... knowing women, reading around the Net, and, having had one myself -I tap into that arrogant memory.

To me, the community is not changing much. Some vocal folks are tighter in their definitions (like me?), but I haven't seen the community harden much... more softening than hardening. I see some UCers embracing what Pamela offers. When I spoke pro-UC in 2005, the room was filled to capacity, so there is a call, at least from a portion of UCers, to keep the midwife in the education arsenal part of their births.

It's simply baffling to me how valuable a midwife can be, how brilliant she is, how gifted her hands are on the one hand, but the hell if she's going to watch my baby slide into the world. I don't know if that will ever make sense (and I wonder if I should stop trying).

Thank you a million times, Rixa, for writing. Why aren't we FB friends, eh?

March 14, 2010 | Registered CommenterNavelgazing Midwife

My goal was not "UC for the sake of UC" but to leave myself open to my instincts and have the least interventionist birth possible in my circumstance.

I called for assistance (and I don't call my birth "unassisted" but the midwife did NOT catch the baby) when my labor just stopped, because my body was giving confusing signals. The midwife confirmed that yes, what I was feeling was accurate, and once I decided to take castor oil, I felt more comfortable having someone check the heart rate now and then.

What the midwife allowed me to do was to give birth on my own terms, with exactly the level of intervention I was comfortable with and felt appropriate for the situation. I felt like she respected me 100% and did not push me into ANY intervention.

I interviewed several other midwives before I went with her, letting them know that I did not know if I would call them for the birth, and that I understood the various risks and benefits and concerns, but that ultimately I needed to feel safe, respected and that if I could have complete privacy for my birth, I would prefer it that way.

Each midwife immediately told me a dead baby story. I'd miscarried days before, I knew the worst that could happen, I've had many friends miscarry and have stillborn babies, I KNOW that birth is not always safe. Life isn't always safe either.

But I also know I'm VERY capable of asking for help when I need it, and I'm a very good judge of when I need help and how much help I need. The midwife I finally went with was the ONLY midwife who said, "I trust your judgment, and I honor your right to choose how you birth. I know you know the risks and benefits, I'm here to answer any questions you might have and if things happen where you need to ask for help, I'm okay with being the help you ask for."

The attitude that, "Well, you want an unassisted birth, so why are you asking for help?" seems to me contrary to the goal of respecting women's instincts and creating safe, healthy birth environments. It speaks to a fundamental difference in attitude toward maternal care... are you her mother? Running the show? Or are you her colleague, working with her on her terms to create the best result for her, regardless of your own ego about what constitutes "necessary" in birth?

Are vaginal exams necessary? Prenatal testing? Heartrate monitoring?

I specifically did not do testing which might have told us my daughter had a chromosome problem. I didn't want to know, and I'm glad I didn't. Our low-tech birth, in water, with very intermittent monitoring (she was always fine), at home, meant that a child who would DEFINITELY have been born by c-section in the hospital and spent 3 weeks in NICU was 100% Kangarooed, breastfed, and not stressed by excessive testing in her first few days of life. I wasn't technically "low risk" and neither was she, yet our outcome was absolutely the best it could have been at home, with such minimal intervention.

We checked urine twice, both at my request. There was, I believe, one vaginal exam, also at my request. We monitored heartrate a couple times during pregnancy for moments at a time, and a couple times during labor for moments at a time. All at my request, when my instincts said, "something is odd about the situation"... and I was right, but the oddity was not causing danger, just preventing labor from continuing without a little help. Because I knew how my body responded to castor oil, I took a total of 4 teaspoons over the course of 24 hours, instead of the 6 oz over 4 hours that is more traditional.

My background was as a doula, childbirth educator and as someone who had been actively involved in a midwifery publication for over 7 years. I'd given birth once, and miscarried once, and been actively involved in 16 births. I was not "cocky"... and I asked for help when I needed it, but it sounds like you would criticize me both for considering that I might go unassisted, AND for asking for assistance when things were out of my comfort zone. That's a bit crazymaking.

Not every pregnant woman has my background or my level of understanding about pregnancy normalcy and complexity. But my experience says that most women who choose unassisted birth do so not for dogmatic reasons, but for pragmatic ones, and making it harder for someone to ask for help if things go out of their comfort zone seems counterproductive.

I never felt like I "failed" something by consulting with my midwife. It just was what we needed to do at the time. I also don't feel like I failed for NOT going the "usual" route for someone with my medical issues... I did what we needed in the way we needed.

March 14, 2010 | Unregistered CommenterJenrose

My computer won't let me log on to FB so it's once in a blue moon that I actually can get on it! Do add me as a friend and next time I'm on someone else's computer, I'll add you.

I have lots more I'd like to say in response. Great discussion. I feel secure enough in both of my birth choices that I don't feel at all threatened or defensive when you bring up these hard issues and "call it as you see it," so to speak.

March 14, 2010 | Unregistered CommenterRixa

I really admire Pamela Hines and Gloria Lemay and all that they do, as well as many of the Trust Birth philosophies. But midwives are so successful in part because of their use of "evidence-based medicine." And doesn't evidence suggest that an unassisted birth is more risky? I'm not saying that women don't have this right, but midwives who have found reason to transport or intervene in unexpected birth situations, and who have saved lives because of their skill, should advise women against this more dangerous choice, shouldn't they?

I also wonder about the liability. I know it's wrong to practice based on that fear, but I would hate to see a midwife assist partially at an otherwise unassisted birth, then something go wrong and the midwife be found liable and have to suffer legal consequences.

Well, for me there are many layers here. I have gotten to the point where I believe that we need to support women in all the choices they make, whether to remain pregnant or not, how many children or not they want, how, when and with whom they deliver. Just as I believe limiting the right to choose is a form of oppression of a woman's right to her autonomy and her body, I to have gotten to the point where a woman's right to deliver as she wishes is on her.

But this is where I see midwife support of UC being tentatively dangerous ground for the midwife, doctors are expected to give care and adequate care and that includes seeing the patient to diagnose and treat. How can a midwife sort of treat a UC and not be held responsible for any bad outcome that comes about because she was not present? I wonder when (or if it has already happened) a midwife will be on the end of a lawsuit for this.

It also has to do with the dance of responsibility, trust, and good care - when a woman refuses it needs to be clear and she needs to know the potential outcomes when she refuses or accepts care, because in the end she's not the only one that pays if she dies or the infant dies, it's all parties involved. Perhaps for you this is the line, you can not feel comfortable being in such a position because you know what could happen and you know the repercussions personally and professionally when they do happen, I know if it were me as the midwife I would be have the responsibility of a death squarely on my shoulders even if I were not there if I collaborated with the mother.

March 14, 2010 | Unregistered CommenterEthel

i also have trouble understanding how a UCer can expect to have a seasoned homebirth midwife on hand if they don't want midwives at their births, isn't this how they gain experience? i know i'm assuming that UCers think all other women should be UCers as well (and i imagine this is not true) but i still think it adds to the contradictions.

it seems to me that the relationship that is built over the length of the pregnancy is usually of great significance during the birth, giving the midwife an idea of the mothers way of dealing with things, how to read her ect. this may come in handy to make the birth more enjoyable for all involved. how do we expect a woman having troubles with her UC to call a midwife she doesn't know and get the same level of care, now the midwife is going blind not only clinically speaking but on a more personal emotional intuitive level as well.

why would we want to toss out the amazing relationships we can build with our midwives and the safety net it puts around us? i understand fully wanting to avoid an unnecessary medical intervention and have control over your own birth- the midwifery model of care leaves much room for this in my opinion.
i guess what i'm saying is - i can see giving up the doctor and all his gadgets to preseve the birth you want- and then dropping by if you need him
but i can't see giving up the midwife and all her encouragement and experience because you just need to be alone.

March 14, 2010 | Unregistered CommenterTorii

First of all, I want to say that I, myself, have absolutely no interest in UCing, that I think you are right to restrict your practice to clients that you feel comfortable with and that I get your frustration with the midwife-bashing that can go on out there. I also share your frustration with a "trust birth" attitude that goes so far as to assume that wishful thinking alone can make everything go right in birth.

Of course, there's a "but' coming.

But ... your rhetoric here reminds me a lot of the way some OBs talk about home birth transfers. "Oh, you think birth is all natural and safe and then when it goes wrong you come running to us to fix your mess." It's an attitude I've never understood because, to me, the midwifery approach is that birth is treated as safe/normal until you see evidence that it's not, Transferring is the responsible thing to do when there is a medical indication. I'd be much more concerned about a midwife who doesn't transfer when it's called for because she is so "committed" to home birth. So I see a UCer consulting a midwife or wanting one on-call as the same thing - being responsible and prepared.

Again, that's not to say that you need to be that midwife, but I don't see it as being so inconsistent.

March 14, 2010 | Unregistered Commenterchingona

I'm not a midwife... perhaps I cannot fully understand your feelings about this. But I see this issue of limited involvement of a midwife in a UC as fraught with the possibility of throwing the poor midwife under the bus if something goes wrong. And by extension, possibly throwing all midwives under the bus. The availabilty of homebirth midwifery is precious and hard-won. It makes me angry to think of UC parents, thinking only of themselves, trying to find a midwife who will agree to attend them without prenatal care or relationship, who will endanger her license if she is called to a train wreck, who will face certain censure if she transports a sick mother or baby whose care should have been transferred during pregnancy had the mother been a full client with whose health she was familiar. I see this as an issue of a particular group, or parts of it, so myopic about their own "rights" that they fail to see their "i want my cake and eat it too" behavior might endanger the rights and well being of others. If a mother wants to have a UC, fine. But she shouldn't take someone else down with her, and endanger the right to midwifery care for a whole lot of other somebody elses.

March 14, 2010 | Unregistered CommenterAna M. Hill

thank you for a very honest blog post. i have been following you for a while, i really appreciate all that you write.

March 14, 2010 | Unregistered Commentersacredma

What really strikes me about what you have written here is how similar it sounds to the complaints of OBs and Hospitals about home birthers. The sense of being taken advantage of when asked for help when it is needed sounds the most similar to me. When docs and hospitals call it a "failed" home birth we reassure a mother that she sought the appropriate help at the appropriate time. Do you think a UC'er that gets consultation is a "failed" UC'er? How is that different from what you are saying?

March 14, 2010 | Unregistered CommenterBeth

I look at the midwife role in the UC birth somewhat like the Dr. Wonderful role in the home birth. I am sure your (and the other) Dr. Wonderful types out there would love to help catch those babies. But they have decided, generously, that these women only want and need them if something unexpected happens, and that being there for that, that one Mom and baby in 100 that needs a bit more, well, that it is worth it. And bless them for it.

Not all docs, even great ones, can be Dr. Wonderfuls for the home birth community. Not everyone has that necessary something. And that is just fine. Everyone has their thing they can do! Because of your background, your feelings, your experience, your skill set, you can't be a "Midwife Wonderful" to the UC community. I am sure that midwifes comfortable in this role are somewhat rare, though not as rare as the Dr. Wonderfuls.

There is nothing wrong with that, and as another post mentioned, it is MUCH better that a midwife be upfront about where she is comfortable than not be upfront and allow those issues into a birth. Part of being a wise practitioner is realizing where your limit is, whatever that may be.

-Amy

March 14, 2010 | Unregistered CommenterAmy

Okay, so you all have really given me a lot to think about. I've been gone for a few hours, expected to come home to "You're evil incarnate and you're going to hell" comments, but look! Well-thought out responses to my emphatic piece. Thank you all.

In my time away, I thought maybe I *am* stuck on the term "unassisted" and immediately softened my stance when I changed the word to "Autonomous Birth." Certainly, the term has been used before, as has Unhindered, but, to me, autonomous speaks to all the goals, reasons and desires women say they want in a UC. Maybe it's time for a name change? (Just for me, of course. ;) )

It is 100% true that we could transpose the words UC with homebirth and UCer with midwife when it comes to the arguments being identical. The words "train wreck," "liability," "blind-sided," and even "scare tactics" can be used interchangably when discussing UCs and homebirths. I think people have mentioned this before, but not quite as kindly as you all here have. It is a LOT to think about.

It makes me wince that I can't be a Midwife Wonderful because I can't be the midwife who embraces everyone. But, just as I don't do breeches or twins, I can refer the woman to someone who does.

March 14, 2010 | Registered CommenterNavelgazing Midwife

I don't consider myself to be pro-UC, but don't you think that a "UC" with a midwife on call and willing to come over and check on the mom and baby after the birth is a lot safer than a totally solo UC? I think it is okay that not all midwives are comfortable doing this, I wouldn't be if I was a midwife. But, I think that by trying to discourage all midwives from doing this makes UC even less safe. If someone is bent on UC'ing, I would rather see them do it in collaboration with a midwife then completely solo. I'd rather people be as safe as possible, even if they aren't calling their experience assisted when portions of it were.

Also, do people really consider a midwife in another room a UC? This is my plan for my upcoming birth, and there is no way that I would consider that a UC. I also don't see that as having the same amount of risk a UC would when the midwife will be just a room away from the birth. I don't see it as offensive to the midwife at all either. I want a midwife present, I want her expertise, I want her apprentice there, I just don't want her near me when the baby is being born. That is not about her at all, it is completely about me. I think my midwife is a competent professional, I just can't personally handle the idea of someone being really hands-on during the birth. I think the best way to ensure that won't happen, and for me to feel comfortable, is to ask them not to be in the room during the birth. This is totally because I am unable to completely trust a provider at this point, not because I think the midwife will suddenly turn on me in labor. I see that the inability to completely trust is my issue, not hers, but this is the way I need it. I am glad she respects that and is willing to work with me anyway, otherwise I may be pushed into a true UC, which I don't feel would be as safe as having the midwife hang out in another room.

March 14, 2010 | Unregistered CommenterJennifer Z.

Thank you for this post. Wonderful points. I have yet to weigh in on UC on my own blog, though I WILL get to it someday . . .

March 14, 2010 | Unregistered CommenterDou-la-la

Aww crap, I wrote this whole long comment and then lost it when I submitted it.

Recap -

I trust birth, I trust it to be unpredictable, volatile, sometimes violent, sometimes peaceful. I trust it will be intrinsic, base, instintual, animalistic, soft, loud, harsh, gentle... I trust it will be NATURE-al. And just like nature, it cannot be contained, predicted, or harnessed. And sometimes, just like anything else natural, it can be naturally disastrous.

I also trust it will always be good. Good, not as our culture believes good to be, but as in commendable, benevolent, upright, of favorable character. It is ALWAYS good, but often times, our choices can make it the best it can possibly be... or less so.

i liken it to CS Lewis' statement in TLTWATW in regards to Aslan, "He is not a tame lion... but he is good!"

OTOH, just as I will support a woman who chooses an EC, I will support a woman who chooses an UC... whether or not I AGREE with it, I will support it.

If I ever have another babe, it will be at home, with a MW present, but not active, unless my birth needs her to be. It's not that I don't trust birth that I have a MW there, its because I DO trust birth that I have a MW there.

March 15, 2010 | Unregistered CommenterNicole D

What Pamela is offering is true choice with assistance the woman needs IF she needs and when she needs it. It's the most reasonable of any offerings. I hope it leads to a new LABEL.

Semantics doesn't change the fact that a growing number of women don't even want a midwife there. And, by "there" I think women don't want the treatment they and their baby get in the first moments. They'll risk it all to not be probbed, prodded, checked, and to be unable, too vulnerable, to tell the midwife to stop talking, to stop watching, to go in another room, stop chewing gum, whatever it is ...but more so, I think, it's to have their baby and their moment without the disruption of the midwife or whoever. How many women go from homebirth with midwife to unassisted? A LOT. WHY is that? Midwives need to ask.

The same research that tells us about the prenatal brain and life and that guides us through infancy, applies to the laboring, birthing baby. Only for some reason, doctors, nurses, and a lot of midwives believe the powers of their being (and education) makes whatever they choose to do, unnecessary interventions, touching, rubbing, bulbing the baby, chatting it up, running the show benign. Even midwives are disrupting the mother-baby experience in the first moments and minutes and hour. I see very few midwifery births where they can leave their hands off the baby for more than 15 seconds. The more instinctual a woman gets the more she wants her baby LEFT ALONE ... hardly ever does a baby need a midwife or doctor or nurse to do anything. They think they need to do something, but they don't. If midwives and nurses and doctors, especially females, would trust the need for the baby and mother to reconnect, for them to have eye contact immediately, for no one else to touch baby unless absolutely necessary I think more women would FEEL safe in the hospital. I think maybe decades from now we'll learn that it is violation and separation of the mother-baby, for no damned good reason, that is the moment that drives much of the chaos. Midwives can provide the support and knowing of what is going on and how to maybe adjust, do something different, fix that lip, flip that cervix back, but when they come into awareness and respect for the mother and baby's reconnection outside the womb, that's when they really become mother focused. When they see this moment as THE MOMENT the mother's been waiting for, seeing, feeling, smelling, kissing her baby ... her baby's HEAD, NOT a hat, when midwives respect this, midwifery will advance. The means of the hospital do not justify the end ... and for some reason the end, the mother-baby relationship is also too often lost, disrupted by midwives. Anyone who attends birth needs to go deeply to figure out why they are there. What are they getting out of it? Why do they have to be the one to touch, view, and do to the baby. Midwives have gone a long way in not cutting cord, not weighting, and some not even bulbing ... take it to next level and ask why you do what you do, and what do you need? WHO do YOU want that baby's first bonding outside the womb to be with, to look like. What does the mother-baby instinctively know and need .. even midwives are disrupting it .... to be doing something, to cover their bases, because they were taught to take a pulse every few minutes. Hats, babies don't need hats. They need mother's hand and it's where she'll put it. Her body temp will lower if baby is too warm. Rise if baby is too cold. The research shows this. Babies do not need to routinely be toweled with rough towels by a stranger. Leave your hands off the baby and let mother and baby have their moment ... there is a pause at the moment of birth ... for mother and for baby. MIDWIVES SHOULD BE THE GUARDIAN OF THIS, not the interloper. Not getting the feeling of the newborn energy for herself. Singing, oohing and ahhhing, chattering about the baby, at that moment, is profoundly disruptive and steals a very sacred bonding moment. Other than money this is what the fight is over between "safety" of doctor vs midwife. One can be a professional, get paid, and get the juice of this moment. Stealing it. It is a moment of awe, deserving of reverence. We all instinctively know this, but most of us have experienced deep, painful, profound disruptions in this moment. Caregivers go frantic, even midwives to be right in there, doing, talking. This is the most important bonding moment for mother-baby and it is annihilated in the hospital. It's sad, but true that many UC birth also had midwifery births that violated this. No one seems to want to look at the violation of the mother-baby in this moment and in minutes and hours after birth as what the fight about .. hospital vs home vs UC.

March 15, 2010 | Unregistered Commenterjanel

I think it is totally fair for someone to not want any assistance until... This I believe is how many of us live our normal everyday life. If you feel nauseated you really don't need assistance... you will probably just take care of yourself and get better. However, it could become something more, you could get sicker until... yes, you decide you need assistance, and you go to the hospital. That's kind of normal right? I think it is good and normal to try things unassisted, should you decide to after consideration. And it is normal to decide that you want to do some parts alone, but need help with other aspects. If you are building a shelf, perhaps you can cut the wood alone, you can sand and paint alone, but you don't have a hammer, so you can ask for help, or try to hammer with your hand or something. I think it is better to realize where your limits are and ask for help when you need. Does this mean, because you must borrow a hammer from a friend, that you should just hire a carpenter? Does it mean that just because you might get dehydrated with a stomach bug and need the hospital that you should just go there right away at the first sing of nausea? No, that would be silly.

Trying things on our own, to the extent we are able, is empowering. Knowing our limits is empowering.

I admire these midwifes who offer a package for UCers. This is because I believe that honesty and clarity are very important. Both midwife and client must be truthful about what their needs and concerns are, and convey these thoughts to the other, and an arrangement that works for both parties can be worked out. If the terms of the agreement don't work for you, for whatever reason, that's okay, just don't sing the contract! You are aloud to have limits! Midwifes can say "I can't be your midwife unless..." Or "you can't hire me at all unless you are looking for a total midwife experience, I don't support UC" and that's okay. Just be kind with your words, and truthful with yourself and others, and there should be no problem.

There is always a spot out there for every type of person and birth, I think you hit the nail on the head when you talked about "black and white" as clearly this issue too has lots and lots of gray area.

March 15, 2010 | Unregistered Commenterferndoula

so what i really want to do is right an incredibly long response to this...dealing with all the complexities of the issues, the potential for hypocrisy on all sides of the debate, etc. etc. but i have promised myself no blogging til april, so instead i will limit myself to some simple statements.
--i come to birth work from a reproductive justice (different from reproductive rights) perspective. so that informs who i work with and how. (you wont see ppl who look or live like my clients in mothering magazine...)
--i think that midwives need to be emotionally honest about what level of responsibility they are willing to take on. if you dont want to deal with legal liability or the potential of death for your clients and/or their babies, be upfront or honest about that. it is much more harmful to the family, for you to make a claim a la 'trust birth' and then not follow through. it is manipulative and lays the foundation for birth trauma. ppl in pregnancy and labor have the right to change their minds about their care. midwives though need to be clear and consistent.
--i have known a couple of midwives (and i am sure there are a lot more) who took on clients, because they wanted to 'cool' points and then freaked out when 'complications' arose. (this happened to me. i was the 'cool' radical woc transnational activist/artist who was very clear about what she wanted and looking back i can see that my midwife was dishonest about her comfort with risk. but said what she thought i wanted to hear so that she could be THE MIDWIFE who had the cool birth story...fucking not helpful at all...)
--every person is different. they have different needs. their bodies are different. their histories and instincts and cultural legacies are different. evidence based care deals in statistics and generalities. and while those are helpful in terms of giving us guidelines, imho (and most folks dont agree w/ me on this...shrug...) only the pregnant/laboring person can decide what is best for them. and my role, as i have defined it, is to provide the space for information and support their decisions for their life. cause as much responsibility as i take for the consequences of supporting their decisions, in the end, they are making life and death choices for themselves and their families. the worst that will probably happen to me is jail. and ive already been there...
--birth is not all happy fairies and rainbows and midwives who present it as such are being dishonest.
--and looking at the historical and continuing evidence of medical violence agaisnt marginalized women, for many women having a uc can *still* be safer than dealing with the medical est or homebirth midwives. i wish this wasnt true. but what do we offer women for whom birth professionals pose a greater risk than uc? damned if you and damned if you dont...
ok. im going to stop. when i start blogging again...i will probably go deeper into the professionalization of midwifery, the colonialist violence against community-oriented health practices, the intersections of race, class, language, nationality and access to 'choice', and middle class ladies thinking that having a career in midwifery should not put their social privileges in danger...and more of my favorite topics...
xxooxo

March 15, 2010 | Unregistered Commentermai'a

Barb, I don't at all begrudge you your right to have your own belief system and philosophy of life, and to base your own choices on that. You have absolutely no responsibility to serve people whose own choices you don't support and don't understand, and I'm not sure why you feel the need to keep defending your decision not to. But you do have some misconceptions which you proclaim as if they are objective truth, and that is not okay. You do not and cannot speak for the UC community as if it is a homogeneous entity and that you are privy to any UCer's deepest motivations and rationalizations. That is frankly stupid and it is harmful.

"[UC supporters believe that] one cannot be pro-choice without being pro-UC."

Wrong. First, this is a generalization. I can't say that nobody believes that (people believe all sorts of strange things) but it is not as if it is some essential UC doctrine. Second, it's illogical. To be supportive of the *right* to choose does not imply one's endorsement of that choice, whatever it may be. For instance, I do not endorse elective cesarean section and in fact believe that in general it is a bad idea, but I think people have the right to decide for themselves.

"[...]where I get perturbed is when UCers pull midwives into their autonomous world. [...] That UCers lure midwives into their worries and complications, dumping them over the midwife’s head and walking away squeaky clean annoys me terribly."

Midwives have free will, and in fact some of them choose of their volition to be involved in the UC movement. And for that matter some midwives are UCers themselves. To frame this as something that UCers do to midwives, somehow manipulating them into this awful thing, is absurd and insulting to the midwives who believe in and love the work that they do.

"I just cannot figure out for the life of me how a UCer can call themselves a UCer if they consult with a midwife. [...] But, the U in UC is unassisted. Un. NOT, assisted. No help. No one assisting. No one helping."

Okay. But this is a semantical issue. "Unassisted" is a euphemism that stands for more than its literal meaning; the word itself does not carry with it the incredible spectrum of unique needs and desires and actions of birthing women that choose to give birth without a medical professional's direct involvement. We-you use it because we have a poverty of language, not because it is, in itself, perfect and ultimate in defining us. Taken literally, it's actually a pretty poor descriptor, because even when a medical professional is not directly involved, the woman may still be assisted in a myriad of ways. Nor does the word or the choice imply or necessitate the lack of desire for *any* professional involvement of any kind, nor an absoluteness or extremism. What is it that makes you want to box people in? Why do you feel that if a person decides that one aspect of traditional care does not serve her, she must reject or be denied other aspects of it? In my own case, although I did choose to give birth in privacy and so would be considered a "UCer", I also chose to be midwifed (by my own definition) in other respects, as it became apparent that it would serve my needs. I appreciate that there were those who were not insistent on staying within the strict arbitrary confines of a traditional box themselves. And it worked. And in the end, for me, that is what matters, not whether a word used to describe me is actually literally accurate.

"Is it merely a badge of honor to say you birthed unassisted?"

No. It's a popular statement to put out there in the debate, and is nothing more than an ad hominem attack based on a straw man. And wow, is it ever offensive.

"And what of a midwife who joins in this game of semantics? Is she the UCer’s midwife? Is she the UCer’s consultant that just happens to be a midwife? Is she the Un-Midwife?"

Why exactly does it matter?

"Why is a midwife smart enough, skilled enough and experienced enough to consult with, but not cool enough to have at the birth?"

Seriously? So if I have a use for services at one particular time and not another, from that you infer that it's all about what I consider *cool*?

"How come “trusting birth” comes with the parentheses “unless I need a midwife to pull me out of danger or fear.” "

A valid question, but again this is about semantics. If the words used to describe the choice are not reasonable, it's not an indictment of the choice itself. And I want to point out, too, that the Trust Birth conference isn't about unassisted birth specifically; most of the people who were there are involved in and will continue to be involved in being with women *during* birth. It's about the philosophy and science of how one approaches birth, not a claim that the only good birth is solo birth or the belief that nothing will ever go wrong.

I mean, really, if we are going to get into hissy fits about literal definitions, what about "midwife"? As we all know, it means "with woman". There is nothing in there about how much and what parts she ought to be watching or managing or whether she catches the baby. So how is it that you think you get to decide, for everyone else, what a midwife should be and do for the women she serves?

"Why does it sound like I want to punish the UCer for making her choice to birth alone? [...] I’m sure that part of it has to do with many UCer’s arrogance [,] puffed out chests, bragging [...]."

That's a very human and not uncommon flaw. People like to feel special, don't they. And yes, it's irritating. But that is a problem with those *individuals*, not the philosophy or the choice. Again, it is just basically an ad hominem attack. You are making it personal -- "I don't like their attitude, they are stupid, they are arrogant", etc. -- and acting as if it's relevant to the validity of the philosophy itself, of which there is a movement, in which there just happen to be people with character flaws. It isn't relevant, any more than your own character is a reflection of the validity of midwifery.

March 15, 2010 | Unregistered CommenterLinda Hessel

@Linda - Semantics, sometimes, is all we have. If the word doesn't fit the situation, make up a new one. I already said that, according to the description I hear people say about the UC community, the word *I* would use is "autonomous." I've heard it used before, so, if the central issue *isn't* the midwife (which I would disagree with; I believe it is), then soften the term. I think it's annoying when people blah blah about "it's only a word," or "why do you have to label someone?" Well, it's what our culture does to be able to categorize each other, a verbal/written state flag that people can choose to hang out under or not. I defy *anyone* to demonstrate that they do not label in their lives. The natural birth movement is *filled* with them. If the label doesn't fit, don't try and make everyone pretend there isn't one, change it.

re: "defending" my beliefs, I recently said it was interesting, the topics I tend to write about the most - UC, GDM, shoulder dystocia, fat, etc. I squinted and asked, "Do I not read enough? Should I expand my topic horizons some?" To that, I answered, "Sure, why not!" but it was also pointed out to me that *many* NBAs have a pitbull grip on a faction of the choices we can make. For some, breastfeeding is THE issue for them, for others, it's circumcision. For Janel, we can always depend on her to speak out for the newborn's rights. I don't feel I am defending myself as much as saying something in a new way that readers might enjoy reading or discussing.

Lastly, I speak about the UC community as a whole just like the "midwives" are clumped together as a whole. It would be absurd to think *every* UCer had the same exact thoughts and beliefs... just as absurd that all midwives are the same. Pamela and I are different midwives, but by having the word associated with us, there *are* people who would lump us in the same category. So, when I speak about "the UC community," I am speaking about the UC community that I know, the one that is vocal on message boards, the one that speaks out in blogs and the ones that I talk to on-line. I don't believe I am speaking of the community from a place of total ignorance, as if I made up what it is I say about them. In fact, even Rixa, another UCer, above, said:

"I find myself becoming more critical (is that the right word?) of a lot of what's going on in the UC community. I follow several UC groups still and the discussions often make me want to bang my head against a wall. Lots of uneducated, misinformed stuff going on. Of course not everyone is like that, but the overall tone of the discussions really scares me at times."

So, I am not creatively writing. I am writing what I see. And even if the UC community doesn't see it from this vantage point, others of us do.

March 15, 2010 | Registered CommenterNavelgazing Midwife

I have had 3 UCs, and recieved prenatal care w/ hospital OBs & midwives for each. I saw my prenatal care providers as "backup", much, I expect, like a HB midwife would see thier backup OB. I also see my family Dr as "backup" for most of the common ailments that befall my kids. I go to her for information, support and help deciding (do we treat this with antibiotics or wait it out?) But, what I think is different, and identifying of the UC movement, even when seeking assistance, is the amount of responsibility one delegates to ones care provider. I see my care (and my childrens care) as my primary responsibility, and any care provider I seek assistance from as a hired consultant, NOT the one running the show. Of course there is a huge grey area between this position and the mainstream american hospital birther who takes very little thought or responsibility for her own maternity care, delegating the majority of the responibility to her Dr every step of the way.... As I read all the comments here, I'm convinced that "freebirthing" is a more fittng term, and I think i've been inspired to change my vocabulary (even though I have half a book written using the term "unassisted birth") I've found it hard to change my use of words, for fear of sounding even more "woo woo" than i already do when i say I UC, but Language is important! and thank you for posing Questions, instead of just assuming!

March 16, 2010 | Unregistered CommenterLia Joy

I don't see wanting a midwife to consult with as a a contradiction to wanting to go "unassisted" - I just see that as using a resource and having assistance should you need it.

In other words...why does it make a difference if she is asking the MIDWIFE her opinion, or looking it up online? Must she remain 100% ignorant in order to be "unassisted"? If she looks something up online, is she no longer "unassisted" since she's using the assistance of the internet?

And I understand wanting to know that there is someone to call should you need more than you have right now - I feel very grateful that I have hospitals nearby that I can call if something is going wrong at a birth that needs more than I can offer. Not going to the hospital from the get-go doesn't mean that I am disrespectful of what a hospital can offer or do for me...simply means that I choose not to use their services unless I need to. Same thing for someone wanting to know that there is a midwife they can call if they need to.

I agree that many UC'ers are anti-midwife...and I think that's wrong to lump all midwives into one catagory - and also sad that there are midwives that unfortunately can NOT be trusted to respect the family and treat them with kindness rather than directing the birth and interfering. I think it's a shame that they have lost trust in ALL of us.

I do understand where you are coming from, Barbara....just like I understand a hospital that might become resentful of us homebirth midwives who waltz in with our clients in trouble and expect them to fix it. Of course they don't see the previous 100 births that went fine, they only see us when there's a problem! They think we're crazy for doing it at home, if we want to use their service why don't we just go there for the birth, etc....but while I understand it, may I respectfully disagree. I'm glad that hospitals are there for me if I need them...and I'm glad that UCers have Pamela there for them if they need her.

March 16, 2010 | Unregistered CommenterStephanie S

I agree.

Either hire a midwife for prenatal care and birth or don't.

I don't believe there is a middle ground on this one.

What Pamela is doing would never stand up in court if a family sued. I know UCers are unlikely to sue, but still....

If you want access to the knowledge, skill, and training of a midwife, pay their full fee and hire them. It's the right thing to do.

If you don't want access to the knowledge, skill and training of a midwife, do it all by yourself, and take your self to the local hospital if you run into problems.

Sorry if this sounds harsh, but it is unfair to ask a midwife to put their license, reputation an malpractice insurance coverage at risk.

March 17, 2010 | Unregistered CommenterSamantha McCormick, CNM

Barbara, I feel you are confused about unassisted birth and trust birth, and I hope that you will encounter women who embrace UC in the way that I have so that maybe you can get a grayer picture. It would be really too long for me to explain myself here, and some other commenter are saying what I would say as well anyway (since I am coming in late). I appreciate your honesty though, and it is fine if you never embrace UC. Really, it is :-)

March 17, 2010 | Unregistered Commentermaria

I have read this post and comments with interest. I'd like to add my own thoughts which are possibly not completely relevant to the direction this thread has gone.

I am actively planning to be the type of UCer you described in your post. After a traumatic c/s, followed by an amazing hbac attended by two midwives, my future children will be born at home, probably without a midwife in attendance. But I will have a midwife to call on if I need it. If I cannot find one locally I will find one somewhere who will be able to coach me over the phone. That kind of "I want you now ... no, I don't want you anymore" relationship is what I envisage my next births will be like.

But... I do not want to be a UCer. I want my midwives attending me. I have found the ultimate rock and hard place to get stuck between. It's called the Australian government. My midwife is about to become illegal. As of the middle of this year any midwife in Autralia who attends a birthing woman at home can get fined $30,000 or jailed or, pressumably, both.

Hence, I am left with the unenviable choice or returning to those who traumatised, raped, lied, and assulted me, or to spend the next few years becoming educated enough and connected enough to my birthing community to be able to go it alone (with or without an underground midwife). And hope to goodness they don't take my baby away from me for birthing without medical assistance. It wouldn't be the first time that has happened and our new laws aren't even in yet.

Ok, so I realise this isn't where this thread has gone, but please, in all your worry about midwives being used, remember that no midwife should do what she isn't comfortable with. That can never end well. Stay true to what you believe you should be doing. But please understand the place in our hearts those midwives have who are willing to cross lines to be what the birthing woman needs and wants. Some of our midwives have already been villified to the point of leaving the profession, some are planning to go deep underground, and others haven't a clue what to do with the mess we find ourselves in.

I think it is commendable that you know, and are honest about, your limits. I also think it is commendable that some midwives are planning to become UMW (unmidwives) to assist UCers if we want them. We won't have the luxury of proper midwife relationships, and we won't want to put our unmidwife in danger of prosecution unless we feel it is a necessity. If they *then* refuse to help us they will be no better than the OBs who cry and pout because they are called in to assist with a homebirth which requires something more. But they will need to know, and be open about, their limits, as you are.

In the end I will be birthing. Just birthing. Where that happens, who is there, the legal status of those attending, the label given to the birth (UC? HB? UCAC? HBAC?) is all irrelevant in my eyes. I'll be birthing, and I plan to make the best possible decisions I can for the health and safety of myself and my family within and without the law.

Hmm, how off-topic can I get? But perhaps it is good for your US readers to gain an understanding of what is happening across the globe?

March 18, 2010 | Unregistered CommenterTanja

I have had one UK NHS homebirth and i'm planning an independent midwife attended homebirth this summer.

I think a lot about UC, mainly because my first labour (active phase) was 86minutes, and thus if i skip the prodomal/confusion phase (or, more likely, recognise it for what it is, since it won't be my first time) i really MIGHT give birth even faster and my (wonderful, beautiful, fabulous) midwife might not make it here for the actual birth. But for me, that doesn't worry me too much, partly because my first birth was so quick that my (kind, but unknown-to-me and over-worked) midwives only just managed to get their coats off and their gloves on anyway, and DD flew out without any kind of help of any kind, and mainly because i know my midwife's care and attention during my pregnancy WILL make a difference to the safety of my birth. Of course not every possibility can be predicted, but i know if my MW tells me at my 40wk appointment that the babe is still head-down i'm unlikely to have to deal with an unexpected breech in the event of a crazy-fast labour, likewise she is making sure my bloods are good, my baby is growing fine and healthy, and so on. More than any of these things, and so SO important for me, she is giving me more and more confidence as time goes on, in my baby, my body and my ability to birth.

I definitely don't think that ANY midwife should consult with UCers if they don't want to, nor is it any sort of failing to not want to. It would be wonderful if every midwife could provide a great fit for EVERY woman, but it's simply not true or realistic. For every UCer a midwife would be uncomfortable consulting for there are probably 100 scared med-head types who believe they cannot give birth without an epidural and both the doctor's hands inside them for it to be "safe" and a midwife shouldn't be expected to effectively serve EITHER of those women. To expect yourself to be able to open to EVERY sort of person is like thinking you could get on the bus and form a meaningful relationship with EVERY other passenger regardless of personalities!

I know (online) a fair few UCers, and most of them DON'T think "everyone should UC" - just as i homebirth but i don't think everyone should. I believe everyone should have the OPTION, sure, but that's very different. And many of them are coming from places of incredible trauma and pain from past, overly medicalised (and NOT by a midwife!) birth and for some of those women UC is the only kind of C they can contemplate. And as a sexual abuse survivor i can get with that too, sometimes you have to find a way to make it ok, and sometimes that way is going to look unconventional or dangerous.

I realised as i was typing this that i am a huge hypocrite - last year an acquaintance had a very fast labour and ended up giving birth into her mother in law's hands on their back lawn, and later started talking about her "view of homebirth having gone through it" and i remember being really mad and wishing she'd be quiet because me and MIL and the garden is NOT a homebirth to me! It's an unplanned UC, a very unhelpful comparison, and not at all helpful to the cause of helping all women get access to homebirths if they want them. I doubt many would sign up for a homebirth if it was going to be alone with a relative on their lawn!

March 19, 2010 | Unregistered CommenterBeccy

Janel,

I am printing your comment out and giving it to my (amazing) midwife. I thought it was utterly beautiful, and something I hadn't considered before.
Thank you.

March 19, 2010 | Unregistered CommenterCathy

Hello all...

I feel pretty overwhelmed about the UC topic, and have worked to learn what it actually means. But then I get even more confused, as it seems the definition of UC morphs with each person who is using the term.

It means something different to each momma, each midwife, each physician, yada yada yada down the line. I think the important thing to remember is that you've established a relationship (or not) with a client who may ask you for some sort of advice. As the midwife, knowing where you stand about it can be difficult because of the ramifications if you catch/don't catch or give some sort of advice. It's more or less important to know what the definition would be to that person before you could make a relationship happen or not happen.

That's kind of where I stand. Our doula community here has been mulling over the UC stuff a lot lately, and it's hugely individual in every single way how it should be interpreted. I think each doula will need to examine it on an individual client basis and know the consequences of every single action with any client before entering into the relationship.

March 21, 2010 | Unregistered CommenterRHONDA RN

Remember, the people who are most prominent in any subject are usually prominent for being outspoken and yes, with a strong tendency towards the black and white. So if you're thinking about UC in black and white it's probably got a lot to do with who you're talking to. For one thing the definitions of UC are so over the place it's turning into a total wank. And the other, most people who (by someone's definition) are UCers, like me, are not quite so hardcore, which is probably why we're not prominent, so I'd say UC has a great deal of gray area, probably more gray than most things, in fact so much gray I often wonder why people even bother with the word UC. No wonder you're seeing in a lot of black and white, afterall, look at the blogs you mention here, they're pretty black and white too, you can't see shades of gray if the other person will only talk in black and white.

If it makes you feel any better, if we're technical I'm a UCer but I don't really think I am because I feel that the books I read and the people I spoke with gave me a great deal of assistance, even if that assistance wasn't a medical person at my birth. I still think it was assistance, it certainly felt like it was, so I don't think I should go around saying I'm a UCer, anyway, home-birther is a much simpler term and describes almost every birth that didn't take place in a hospital. I prefer things to be simple.

March 22, 2010 | Unregistered CommenterDeTamble

I'm very hung up on the word "unassisted" and what it means when giving birth, contemporary women latching on to the mothering.com fad need to stop using that word, if it means having support or assistance from a midwife or hired doula. Hiring some one to assist you is not
the same as having an "unassisted birth".

Where in the English language does it say unassisted means having midwifery or doula support.


un·as·sist·ed

1 : not assisted : lacking help
2 : made or performed without an assist


1. unassisted - unsupported by other people
single-handed, unbacked- unsupported - not sustained or maintained by nonmaterial aid.

2. Not having assistance; unaided.

March 28, 2010 | Unregistered Commenterdewi

Thank you. I absolutely agree.

March 28, 2010 | Registered CommenterNavelgazing Midwife

If birth is an normal and uneventful as midwives claim then why not UC? It's not a medical event, remember? So what do we need a medical person for?

And yes, most of all substitute Midwife and Doctor for Ucer and Midwife. If it's not wrong for you to take on things that go south and dump expect someone higher up the foodchain to be at your beck and call, then why is it wrong for UCers do it?

It not a failed UC. It is a UCer overseeing a birth, a non-medical natural process that sometimes goes wrong and when it does she sought medical help!

The UC thing. It's the biggeset threat to midwifery. One, they have lower death rates at home than do women with midwives. So, it looks like their assessmentof danger is better. And two, it highlights midwifery's true motives -- to control birth and women.

April 3, 2010 | Unregistered Commenter,

While it was a challenge to figure out what you were saying... interesting sentence structure and all... I *think* you're saying that UCing is safer than having a midwife at a birth and that midwives want to control birth and women.

Hmmm. Interesting comments. Neither of which is remotely true.

But, it's not worth the energy to try to enlighten you because it is painfully obvious, you couldn't care less what the truth is; you see what you want to see.

UC isn't the biggest threat to midwives; UC is the biggest threat to healthy babies.

April 3, 2010 | Registered CommenterNavelgazing Midwife

Thinking about your words, anonymous poster, I thought I'd address a couple of things now that I've had some sleep.

Substituting UC and midwife for midwife and doctor is very different because the UCer is claiming complete autonomy, no need for anyone in her birth -and, often, even in her pregnancy (UPing). A midwife, otoh, acknowledges that things can fall out of the realm of normal and might need a more experienced/skilled/able-to-do-surgery-or-write-a-prescription person involved.

I am right there with Dewi above saying that Unassisted *means* UN-ASSISTED. No help. By *anyone*. If anyone helps, it is no longer UN-ASSISTED, no matter how benign or fleeting that "help" is.

And to all those who say I am obsessing about the word, that the word seems to be causing me problems, it is. The word doesn't fit.

Find another one.

April 4, 2010 | Registered CommenterNavelgazing Midwife

So, I've been reading over this post and comments, nodding my head in some places, pondering with my chin in my hand in other places. Very interesting. I wasn't even planning on commenting, until I got to the last comment of yours, Barb.

And all I can think to say is, So what?

Really, so what?

I understand you are determined to think of this as literally as possible. Yes, unassisted, means no one is there, yadda yadda. But, so what if a UCer decides she needs outside help, whether it be consult during pregnancy, some prenatal test, a midwife on call during birth, a transfer for retained placenta, stitches, whatever? Why does that matter? You have talked a lot here and in the past about UCers wearing their birth like a badge of honor, how it's soooooo important to have the UC-iest UC ever, and yeah, I see a lot of that kind of stuff happening and it's pretty weird and annoying. But for all your irritation with those who strive for that UC trophy, you seem dead set on keeping all UCers in that box that some of them do indeed make for themselves. "No! You're not allowed to consult with a midwife! Bad UCer! Bad!" I don't understand.

I had concurrent care with the hospital midwives during my last pregnancy. I had a homebirth, but does that mean I'm not a homebirther because the hospital midwives did tests on me? I took my baby to the hospital to get his hearing test and PKU done, does that mean he wasn't really caught by a midwife because the hospital cared for him too? I know this sounds silly and you probably think I'm badgering you, but honestly. That's what your post sounds like to me. I still wanted a homebirth. I still wanted my homebirth midwife to attend me. So what if I needed somethign out of the scope of her care, like an ultrasound? So what?

As you and others have said, it's all just semantics. I don't even think it's word unassisted itself that is causing the problem. Autonomous could be the same. "Ahhh, you asked a midwife to monitor heart tones, you're not REALLY autonomous!" So what?

I think you are incorrect in your last comment. I think UC and midwife can switch very well for midwife and doctor in this situation. Sure there are the die-hard UCers out there who are doing exactly what you are ranting about here: insisting on having no outside care ever no matter what. But that doesn't mean EVERY UCer does that. Just like EVERY homebirther wouldn't insist on birthing at home no matter what. Just like EVERY hospital birther wouldn't, I dunno, insist on an epidural no matter what (or something).

I wish I could understand why this is bothering you so much. I know UC is your number one hot button issue. Like you said, we all have them. I just wish I knew why it made you so angry. I know you are looking out for babies' best interests and UC has a higher death rate, but I think it goes deeper than that. I wish I understood it, because I like you and respect you, but your thoughts on UC always leave me cold.

April 10, 2010 | Unregistered CommenterJill P.

Women have been helping women since the beginning of time in the birthing process. Why are so many so fixed on doing it alone when labor, brith, and postpartum has been done with women supporting each other for thousands of years?

I'm just saying, go back to the root of labor and birth and you'll find women supporting women.

April 10, 2010 | Unregistered CommenterRN to be CNM

Well said! I've often pondered similar thoughts and you have summed them up really well. I think some of the UC philosophy is about the woman choosing the best care provider for her at any given time, and choosing what care she'll accept. Therefore in the UCer's mind, it's ok to go to a dr or a midwife when the woman believes it is necessary, so long as it is on the woman's terms.

April 12, 2010 | Unregistered CommenterMelissa Maimann

This is very interesting. I've heard a number of terms used and qualifiers along with each term (i.e. "I had an unassisted pregnancy, but a midwife-attended birth" or "I had an assisted pregnancy, a monitored labor, but an unassisted birth," etc.). If it's important enough for ME to know which part of what was unassisted, I would just ask if they were attended by a provider. Here in Nebraska, the words you use may be used to determine whether you're delivering legally at home, or not (since CNM-assisted deliveries at home are illegal).

I didn't get to attend Trust Birth, but I wish I had the opportunity to attend the session called Unassisted vs. Unattended Childbirth. I have a number of friends who had a midwife present during their labor who did nothing but sit off in another room or in a dark corner somewhere in the event that something went wrong. I suppose some could say their labor was assisted simply because someone attended their home. During their actual birth there was no touching, no talking, no instructions, nothing. Was this an unattended birth? No way. Can they call it an unassisted BIRTH? I'm not sure why not. The qualifiers seem to make all the different...what was unassisted (pregnancy, labor, birth, etc.) and what was unattended?

I want to clarify that I haven't been part of these discussions before, so I'm the total newbie here. My first two births were c-sections and my third was a CNM-assisted home birth (across two state lines). I'm now 12 weeks pregnant and having trouble finding a midwife who will deliver me in my own home due to our restrictive laws. I'm in a very rural area and if I go to the hospital, VBAC is not allowed. It's a pretty horrible situation to be in and I do have a couple nearby friends who only UC (no one in attendance) and several who birth with DEMs (but they have to publicize it as UC). Because of our circumstances, most moms in my area don't worry over the correct terminology except to protect the midwives who serve them.

April 12, 2010 | Unregistered CommenterShaye

I will just say that this is a fascinating post and comment thread. Like some commentors I also felt the original post was very much like many OBs think of midwife attended homebirths. As I have some sympathy for those views, I have sympathy for Barb's views as well. Its an amazing world where some folks want labor in a hospital with monitoring, some want labor in a birth center with a midwife, some want labor at home with a midwife, and some just want everybody to leave them alone. Fortunately everybody can have their way.

April 12, 2010 | Unregistered CommenterNIcholas Fogelson, MD

I promote unassisted childbirth and was mentored by Jeannine Parvati Baker during my fifth pregnancy. I paid her a hundred bucks to provide "on call" prenatal care if I needed it. I never called. She was my spiritual midwife before, during, and after my sons unassisted birth.

No big deal.

Barb, some of us in the UC community do not like the idea of a Lesbian giving us a vaginal exam, I am one of them. At the back of my mind I would always be wondering if you were "enjoying" it too much. This is not to say you don't have valuable skills to offer to any mother who hires you to help. But it is an issue for some of us who want birth to be a husband/wife thing.

Jeannine was very clear about the sanctity of the husband/wife sexual relationship and how this is interfered with during midwife attended homebirth. I happen to agree with her.

Jenny Hatch

April 14, 2010 | Unregistered CommenterJenny Hatch

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