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Unassisted Childbirth

Believe it or not, some people do this on purpose.  They give birth at home, with no trained professionals helping them.  I think this trend is largely a reaction to our prevailing culture surrounding birth, where women go to the doctor, do what s/he says, give birth in a hospital, and probably have at least one medical intervention along the way.  This setup leaves a lot to be desired, and there is a counter-movement that celebrates birth as a normal function, and emphasizes respect for the mother.  This school of thought argues that birth has been over-medicalized, doctors treat pregnancy and childbirth as a disease, technology and intervention are revered (even when research shows that they cause more harm than good), and women are treated as dangerous baby-vessels from whom the fetus must be rescued, often resulting in contemptuous treatment of laboring mothers, sometimes even going so far as performing medical procedures without informed consent.

To a very large extent, I agree with this backlash against hospital birth.  I’m a big believer in free-standing birth centers, where practitioners tend to be more aware of evidence-based practice and more respectful of women.  I also think states should have straightforward processes for licensing and regulating midwives who attend home births.  For low risk pregnancies, particularly for women who have already given birth at least once, home birth is just as safe as hospital birth, and is preferable for many families.

My sense is that unassisted childbirth may often be prompted by a mother’s reluctance to subject herself to the standard practices at a hospital, combined with a lack of other options.  I suspect a good portion of mothers who chose UC would be happy to birth at home with a midwife, if that option were available.

But it also seems that some people have just reacted so strongly against the medicalized version of birth that they’ve landed in La-la Land, where birth is a breathlessly venerated spiritual experience, labor and delivery can be risk-free if only you eat right and exercise during pregnancy, and the presence of any person who wasn’t there when the baby was made is unacceptably interventionist, invasive, and disruptive to the natural process.  This is where it gets dangerous.  Birth may be a normal function, but especially in humans, it is a time of crisis, when things can and do go wrong.  Humans are unique in that our pelvic openings are only barely big enough to allow our babies through.  Pregnancy isn’t a disease, but it is a burden on the mother’s body.  Labor doesn’t have to be an emergency, but it does present health challenges to mother and baby that can become emergencies.

There isn’t a lot of research on unassisted childbirth, because it’s so fringe that there aren’t populations to study.  There’s some data on a religious sect that practiced UC, and of course there’s information from developing countries where women simply don’t have access to healthcare.  In both cases, lack of medical care during pregnancy and childbirth are associated with much higher levels of maternal and infant mortality.  UC proponents argue that these situations aren’t analogous because  good nutrition and healthy practices during pregnancy make UC safe.  However, at least one review of historical data shows that poverty and nutrition had almost no effect on maternal mortality rates in childbirth, and the WHO urges better access to medical care as the best way to save the lives of women and babies in underdeveloped areas.

Some UC supporters say, “birth is safe and normal, otherwise our species wouldn’t be here!”  But they’re profoundly misunderstanding evolution, which only requires a process to be good enough to pass along genes.  Natural selection has resulted in a system where women can get pregnant very frequently, so that despite the peril that an upright stance and a big brain causes, enough babies survive to carry on the species.  I don’t know about you, but “a lot of babies die, but enough survive” isn’t an ambitious enough goal for me.

Some supporters of unassisted childbirth claim that it’s unnatural to have birth attendants.  Aside from engaging in the naturalistic fallacy, this argument fails because it’s just not true.  As far as we’ve been able to determine, mothers have sought help from others during birth for as long as we’ve been a distinct species.  For humans, having birth attendants is what’s natural, while closing oneself up in a separate dwelling and giving birth in the presence of only one’s husband is profoundly unnatural – a behavior emerging only in our modern culture.

Now, I consider UC to be overly risky and poorly rationalized, but I still think women have the right to do it.  Just as I’m pro-choice regarding abortion, I believe that a woman has a right to decide what kind of medical care she will receive, and to reject medical interventions, even if others would find her decision foolish.  I do have an issue with parents UCing and then failing to have the newborn checked out by a medical professional, though.  In some jurisdictions this might even fall under child neglect laws, and regardless I don’t feel comfortable with parents simply looking at a newborn and saying, “Gee, she looks like she’s doing OK.”  Again, birth is a tough process that can introduce a lot of life-threatening conditions, some of which will not be apparent to a layperson.  I remember when a friend had her baby a little early, we were all remarking how chubby and healthy she looked – we were sure she was just fine – only to find out that she had some kidney problems that required immediate intervention.

In the end, that is the biggest problem with UC – hubris.  People look at the few areas where doctors have embraced stupid birth practices that aren’t supported by the evidence, and take away the message that parents are just as capable of coping with the crisis of birth as any hospital.  Often their gamble turns out OK – the birth will be a normal, complication-free event, and no particular knowledge or expertise in medicine will be required.  But the problem is that no one can predict with certainty which births will become problematic, and if you have no one present who has training in recognizing and dealing with such situations, you’re headed for disaster.

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