Friday, January 23, 2009

Unassisted birth

My last year in college, I went to the Reproductive Rights Conference organized by the Civil Liberties and Public Policy program at Hampshire College. I love this conference - it is impossible to go and not leave energized, inspired, and ready to take on the world. I also love it because they have expanded their focus over time with the recognition that "reproductive rights" is a broad spectrum, and that we cannot fight for abortion rights without addressing the many other social injustices in society. This means that you could spend almost every session, for example, going to a workshop that deals with birth, midwifery, child care and/or other issues around motherhood.

My senior year was the first time I'd attended, and I had just started to get more deeply involved in this whole maternal and child health thing. I was writing my senior thesis on breastfeeding, and via that I was being exposed to a lot of writing about the medicalization of breastfeeding and birth. I don't even remember the exact name or theme of one workshop I attended, but it had to do with birth and one of the women there was a direct-entry midwife. It was my first exposure to some very radical (to me) ideas (the conference is a great place for being exposed to radical new ideas, which is one of the reasons it's so exhilirating. You come out feeling like you've just been through a vigorous stretching workout.)

One was the idea that not all midwives are created equal, and that if you are not careful you can end up with a midwife who practices like the most intervention-happy OB. I was very surprised by this, although my following year as a an AmeriCorps doula, being exposed to many practitioners, taught me the truth of it.

The other idea was that of unassisted birth. The direct-entry midwife there very matter-of-factly said that she considered all her options for birth and when it came down to it, she felt the safest place to deliver her baby was at home with only her husband present. I remember a ruffle of surprise in the room. I know I was surprised; I had never even contemplated the possibility that someone might choose to give birth alone, or only with family present. I thought to myself, "Well, she is a midwife. Maybe it made sense to her that she could take care of herself," but it still seemed...weird. Risky, and definitely inexplicable. Why would you choose to give birth alone when you could have other trained people present? How could it possibly seem safer that way?

Over the years since then, I've become more familiar with the unassisted childbirth (UC) idea (I don't think the woman at the workshop even used the phrase, but I later realized that the term applied.) There have been debates about it on the doula listserv I'm on (is it a good idea? should doulas be willing to attend those births?), I've occasionally skimmed forums for UCers out of curiosity, and I've read accounts and seen videos of UCs. I recently saw an interesting documentary on the Discovery Health channel, "Freebirth" (a term also sometimes used for UC) that followed three women through their choice to UC, process of preparation, and births. I've heard people say that UCers are irresponsible or taking the ultimate responsibility, that they are childish and rebellious, or very brave. I learned that someone I've known for a long time in my hometown, a nurse, gave birth to her first at home with a midwife and her second two at home assisted by only her husband. At the "Orgasmic Birth" screening I went to, there was a woman there who had very recently had a UC. During question-and-answer time, she went on for several challenging minutes about her experience of UCing and the lack of support she felt from the natural/homebirth and midwifery community.

All of those experiences have given me a lot of pieces of the puzzle. But I don't know that anything has given me better insight into the UC phenomenon than this dissertation. Rixa over at Stand and Deliver (formerly The True Face of Birth) has just completed and posted her PhD dissertation on why women choose unassisted birth. Warning: it's a PhD dissertation, so it's long! I stayed up far too late reading it the day she posted it, and was only able to skim the areas I was most interested in. So far I've read a lot of chapters 3, 5, and 6, being very interested in how and why women choose UC, how they conceive of the questions of responsibility, and how medical professionals perceive UC and how it has affected their care practices. If you're curious about what UC is and why it happens, this is a great place to start.


Rixa said...

Thanks for the link and for taking the time to read my dissertation! I'd love to hear any further comments or critiques you have when you're finished.

publichealthdoula said...

I will let you know! I'm really enjoying it so far.