I was asked how I came to be so against Unassisted (Child)Birth (UC) when I had had a UC for one of my own births. If you’ve read me for awhile, you get the gist of it, but I don’t think I have any one post chronicling the path. Let me see if I can outline it here.
When I had Tristan (in 1982), I had a typical hospital birth with Demerol for pain (epidurals weren’t an option) and a mediolateral episiotomy. At the time, I loved his birth! I loved it so much I wrote letters to the doctor, nurses and hospital President thanking them for such an awesome experience. I didn’t know any better.
Then we moved to Tacoma, Washington and, pregnant with Meghann, I found a Bradley instructor who was also a La Leche League leader and prenatal exercise teacher… Marie Foxton. She was amazing! I glommed onto everything she said, reading anything she offered voraciously. Included in the reading material were newsletters (The New Nativity) from Marilyn Moran, the American mother of UCs. Birth and the Dialogue of Love was Marilyn’s book about husband and wife birthing. Her spin on UCs was that only husbands should be with the woman, no doulas, no friends, no kids; just the man you made the baby with. (Even UCs can have fringe elements!) The idea resonated with me perfectly and I set out to have a, what was called then, Do It Yourself (DiTY) birth. I was supposed to have my baby at the military hospital at Ft. Lewis (Madigan) and continued with prenatal care there. Standing between sheeple and birth anarchist, I had my membranes stripped without my permission (unless taking my pants off designated consent) and contracted for many hours before active labor really kicked in. Not one to just hang out with one man, I’d invited several people to the birth, too. One, Marie’s daughter who took pictures of the event (you can see them here in Meghann’s UC Birth Story) and the other two friends from LLL and my exercise class. Both women had newer babies they brought to the birth as well.
Over the years, I’ve had judgment saying I didn’t really have a UC because there were other people there. That they influenced me and didn’t allow me to listen to my own instincts, which, by the way, would have led me to the hospital. But it was a UC; there was no medical/midwifery provider there. No one listened to fetal heart tones. No vaginal exams. No blood pressure taken. No thought about the baby’s journey, just my own. When I hear UCers talk about their reasons for wanting to have that type of birth, it is rare that anyone even mentions the baby, especially the safety of the baby. They might say they don’t want the baby poked and prodded or they don’t want the baby taken away from them, but those aren’t safety concerns; they’re inconveniences. No one says, “I’m doing this because I don’t want anyone there because I don’t want any neonatal resuscitation or medications for hemorrhage." They honestly don’t believe they will need such things or they will have time to get help if they need it. They are wrong.
Reading Meghann’s birth story, you can see that she was a shoulder dystocia and nearly died. Had I had a midwife there, we wouldn’t have had to call EMS and the transition after birth would have been much more fluid and gentle. Even still, I thought the birth was awesome for many years.
This is where the question comes in: What changed my mind?
Time, distance and experience. When I saw a mother die in 1987, that was a huge sobering experience that profoundly affected my understanding of mortality in birth, both maternal and neonatal. After that, I knew it would be many more years before I was ready to be a midwife. In fact, when I was finally licensed in 2005, my reason for not becoming licensed sooner (despite being in birth work since 1983) was that I had not been spiritually or emotionally mature enough to take two lives in my hands. I wonder if we ever really are.
When I had my UC, I thought I was extremely knowledgeable, having read so many natural birthing books including Spiritual Midwifery and Oxhorn-Foote’s Human Labor & Birth. I studied the second half of Spiritual Midwifery (the technical parts) more than I read the first half with stories. I really did think I knew a lot. But, through the years as a doula, then attending Casa de Nacimiento in 1993, it slowly dawned on me how little I really knew. While I was still very much of the belief that women needed to be protected by their doulas and partners and that technology was mostly out-of-place, I saw experiences in the hospital and birth center that technology never caused. It was clear that sometimes, shit just happened in birth, even when it was left alone… sometimes, because it was left alone.
In 2003 (or so), I started writing an updated Emergency Childbirth for UCers, a manual that talked about what to do with emergencies when alone, whether accidently or on purpose. I wanted to market it to those who might get stuck at home in snowstorms or for after an earthquake and submitted chapters, but no one bit.
In 2005, I helped put on a conference with the California Association of Midwives, International Cesarean Awareness Network and Birth Resource Network and became a speaker for a workshop on UCs. (I can’t remember the name I gave it, sorry.) I loved the workshop and really felt I gave great information about how to overcome emergencies during an Unassisted Birth. I talked about shoulder dystocia, hemorrhage and surprise breech among other less emergent issues. I talked about what to do with tears and how to get a birth certificate as well. After the presentation, I was talking with the participants and one very pregnant woman came up to me and said she was going to UC, but wanted to know if she needed anything, could she call me… like for suturing. Absolutely! I would be more than glad to offer whatever I can, even if it’s just phone help. She thanked me and then we moved on with the rest of the conference.
A few months later, there was a buzz in the community about a UC death, the baby died during a shoulder dystocia. Immediately, I thought about the woman at the conference and wondered if it was her. It was. A few months after hearing about the birth/death, the woman contacted me and we began a several week processing of her experience. (I have permission to talk about this.) This mom was as connected to her body and fearless as anyone I’d ever met; it was stunning she lost her 8-pound baby during a shoulder dystocia. While we talked, she off-handedly said, “Barbara, I did everything you said to do, but my baby still died.” And it was in that second that I realized what I said and did as a midwife could make the difference between life and death… even if I wasn’t at the birth. She meant nothing unkind, no blaming or anything, but I took what she said and beat myself up for years, worried I’d done or said something that encouraged her to go through with the UC. I know intellectually that she made her own decision and that she was going to UC no matter if we’d ever met or not, but maybe what I said bolstered her belief that she could handle any complication. I now feel I gave completely false hope that complications could be handled alone, without medical or midwifery assistance. My heart still aches about the lost baby.
Other parts about that birth come into play, too, because the hospital didn’t treat the death with all the gentleness they should have. Mom never got a photo of her baby, no lock of hair, no blanket… nothing. She can’t remember what he looked like when he was born because they didn’t respect the protocol of what to do when a baby dies. We’ll never know if she was punished because of the UC, but I still cry that she never got a picture of her precious son.
So, after this experience, I did a 180° change.
Shortly after, a dear Netfriend also lost her baby during a UC, a cord prolapse in second stage that was mismanaged by the 911 operator. Had a midwife been there, the baby would, almost certainly, have been alive.
I got my midwifery license in 2005 and worked hard to be a midwife for as many on the fringe as possible. I met a woman at an ICAN meeting who was going to UC and I begged her to please let me attend. A horrific shoulder dystocia of an 11+ pound VBAC baby and subsequent hemorrhage shook all of us up so much, my anti-UC stance was solidified. Every one of us, including the mother, knows if we’d have not been there, both mother and baby would probably not be here. Shook me to the core; I still have nightmares about that birth.
Earlier, before the conference, I’d become Netfriends with Janet Fraser. I was incredibly distressed to learn she lost her baby during her UC. I was also angry as hell. I wrote a piece called “An Open Letter to Janet Fraser” that was harsh and extremely angry. A few years later, I removed it and apologized for the crudeness of my words. I still feel angry that she lost a baby that didn’t need to die because of dogma.
So, there you have it; my transformation from pro-UC to anti-UC. Believe me, I understand that some women have limited to no choices about some aspects of their births, whether they are VBACs or breeches or twins or midwifery isn’t legal or there are no midwives in the area, but I feel so strongly that women should have an attendant that if there is no way to have a midwife (or doctor) at the home for the birth, they need to be in the hospital. I know that seems mean, but it’s far worse to offer condolences because of a dead baby.