Monday, March 23, 2009

birthing alone

[The following is an edited version. This post was taken down for a few days out of respect for a family whose baby was stillborn.]

A major article 'Home deliveries' appeared in the Sunday Age yesterday.

The article focuses on the issue of 'free birth', and one proponent in particular. Comments by representatives of the College of Midwives, Homebirth Australia, a public hospital maternity service, a homebirth mother-lawyer, and an independent midwife are sandwiched between the sensationalist story about and comments by a woman who prefers to be an "autonomous care provider".

There are many points in this article that would be worth discussing further. The fear that home births are being pushed underground has been explored by midwife academic Jenny Cameron. The victims of restrictive government policies that force women into the care of unregulated and sometimes unscrupulous operators are women and their families. Midwives offer excellent primary maternity services in communities, working with women in complex ways to promote physiologically normal births, with the wellbeing of mother and baby being central to all professional guidance and advice.

The woman is reported to believe "that nothing bad happened quickly in labour and that there would be time to get to hospital if things went wrong." A person who believes that is simply uninformed.

The issue of birthing alone, by choice, is one that questions the very foundations of midwifery. What has brought women to the place where they believe it's best to DIY? Is this the ultimate adrenaline rush; the ultimate search for meaning?

I have been told that there are variations of the 'solo' birthing phenomenon. Often the woman's partner is present, having been instructed ahead of time as to what is expected. There may also be an unregistered birth attendant. That person may have been present for a number of births, and there may be an expectation that she would act to help if there was a need.

Someone suggested that the partner could do a first aid course in resuscitation of a baby. Resuscitation is only ever needed if a baby is unable to breathe unassisted, and this is a true emergency.

Most people would not like their tooth filled by someone who had gone along to an evening class to learn about dentistry. How much more important is the newborn child, than a tooth needing to be drilled and filled?

In many parts of Australia the only way to access midwifery services for homebirth is privately. The obvious pun on 'free' birthing is that you don't pay a midwife's fee - which may be from around $2000 for one midwife to around $5000 for two, who provide a package of professional services through the pregnancy, birth, and postnatal period. In fact, 'free' births may not be free. Lay birth attendants may charge around $1000 for a prenatal chat and the labour.

We do not know how many planned unattended home births there are. Of the planned homebirths, some are born before the midwife arrives. In my practice alone, I might see one or two a year. There are many more unplanned 'out of hospital' births - the babies that come quickly, before the mother has got to the hospital: in the bathroom at home; in the car; on the freeway ....

Some authorities claim that most planned unattended births are that way because the woman has no access to a midwife who is able to attend birth in the home. I don't think anyone really knows, but that has not been the case in the planned 'free' births I have heard about lately.

Midwife means 'with woman'. Since women began having babies, other women have been 'with' them, and out of this phenomenon the professional midwife has evolved. Something has gone very wrong when a woman believes she is better without any skilled professional attendant. I grieve for that woman. A true midwife will be with woman, while at the same time supporting her desire to be free. It is expressed beautifully in the ancient statement attributed to Tao Te Ching, about 2000 years ago,

You are a midwife.
You are assisting at someone else's birth.
Do good without show or fuss.
Facilitate what is happening
rather than what you think ought to be happening.
If you must, take the lead.
Lead so that the mother is helped, yet still free and in charge.
When the babe is born the mother will rightly say
"We did it ourselves".


Rachael said...

I can say that for myself, I honestly would consider going it alone if I did not have access to midwifery services in my home.

It's a terrible choice to have to make though, if in the event, something does go wrong.

No one said...

But Joy, so much of planned freebirth is about proving to other people, if not yourself, that you TRUST your body to "get it right" without someone professional "watching over".

The proponents of freebirth are motivated by the apparently undeniable truth that Nature doesn't get it wrong, and that the body, the woman will "know innately" how to birth.

This can only be "proven" if the woman eschews any and all "trained" birth practioners - paid or otherwise. The mere presence - even with absolutely no intervention - of a trained practioner proves that the woman does not trust herself or the process (and is therefore somehow feeble and co-opted by modern society).

The fact that "nature" works on the basis of "near enough is good enough", that is - if 70% survive birth and life long enough to reproduce at least once then that's FANTASTIC just doesn't factor in - so long as you've PROVEN yourself to yourself and whomever else is "following" you on the net...

As for women choosing freebirth due to a lack of midwives, well, that truly is a sad reflection of unmet demand and should be considered seperately to the case of women just trying to prove themselves.

TulipGirl said...

Unassisted homebirths are. . . while not exactly common in the US, seem to definitely more common than you report them to be in Australia.

For many reasons I believe it is wiser to have a midwife attended birth, however, an unassisted birth I believe is within the freedom of a mother's decision to make.

Similarly, two friends quickly come to mind who have birthed with only their husbands and children present, and was good from them.

Hub said...

""Something has gone very wrong when a woman believes she is better without any skilled professional attendant. I grieve for that woman""

Maybe we should think more on a case by case level, rather than trying to lump everyone together.
Afterall, the hospitals and authorities are trying to lump everyone together, and those of us who are pro homebirth and screaming back not to.

They assume they know what is best for the masses. Here you are assuming you know what is best for those who birth at home.

Here is a crazy notion. We listen to each individual woman. Follow her lead, with what she needs and wants.
We leave our own shit at the door and treat each mother as her own person, her own capabilities.

I personally know of 15 women who freebirthed last year in my state alone. Everyone of them did so because of previous trauma from 'professionals' and that is including independant midwives. They were let down by their care provider.

Sif, I am actually shocked and appalled you would say that so much about freebirthers ir proving to other people....if not the women herself, the she trusts her body to 'get it right' without someone there.
What a load of shit! Have you ever spoken to a freebirther? Asked her about her birth journey? Asked her how she came to the decision to birth without a medical professional there?

What is her life story that lead her here?

The choice to birth at home to start with is often ridiculed. Sometimes by women who then go on themselves to have a homebirth. I was one of those women.
So when another person tells me their plans to birth at home I listen to her. How it came about.

Why do people 'assume' to know what freebirthers are thinking, without even asking them?

This post is based on assumptions. How about we all focus on what is really important here. Supporting the individual women. It is after all about her and her body and baby.
It is NOT about the rest of us and what we 'think' others should or shouldn't do.

I am also disgusted you would mention the cost of birthing at home. As if that is a main reason a woman would chose not to have a midwife present. Do you even listen to what mothers say? What they want? What they need? Women are saying it loud and clear, but no one cares to listen.

Is it an us and them situation now, where the sole purpose of birth and the mother is lost amongst all the 'professionals' who think they know what we want without asking us??

Treat women as their own person, with respect for our own unique journeys.

Joy Johnston said...

I have accepted the comment from 'The Husband' reluctantly, as the tone is angry and could offend some. This Blogger program allows me only to accept or reject the whole comment.

A question has been asked,
"Do you even listen to what mothers say? What they want? What they need?"

Indeed, I hope every midwife listens to what mothers say. We seek to develop a partnership based on reciprocity and trust, so that if difficult decision points arise at any time in the professional care relationship, the mother and her midwife are able to work well together. That partnership is of enormous value.

But a midwife cannot be expected to be directed by the mother at times when professional skill and judgment are needed, and time is of the essence.
The mother's voice is not the only one - we must listen to our own inner voice, and to the voice of our peers and our society.

Laws that regulate professional education and registration are intended to protect the public from practitioners who are incompetent, ignorant, negligent, burnt out, inebriated, or otherwise incapacitated. Unfortunately the regulatory authorities do not congratulate a midwife for all the healthy mothers and babies in her care; they pay attention only when adverse outcomes or complaints arise.

I am happy to accept different opinions, and I have attempted in this blog to explore my own thoughts on a phenomenon that I am concerned about, for the reasons I stated. Thankyou to those who have taken the time to explore it with me.

Sarah said...

*claps The Husband*

The territoriality over women's bodies inherent to this post is incredibly depressing, especially coming from someone who is supposedly a "with-woman". It reeks of the same sort of "don't steal my business!" attitude obstetricians have against IMs!

A woman's decision to birth at home without a midwife is her own to make, and if an independent midwife can't respect that then the birthing woman definitely made the right choice to keep her away!

FYI I have never met a freebirther whose choice had anything to do with money! What an insulting assumption to make!

No one said...

"The Husband" your response made its own assumptions and seemed to come from a place of fear (persecution?), so I'm responding only to say I do know a few women, personally, who have freebirthed. One did so without the need for acknowledgement from others. One because she truly was unable to access a midwife and could not bear to use the local hospital service, and a couple because they needed to be accepted by a community, and be celebrated in that community for having achieved the "ultimate birth experience". though these women themselves would not admit that much.

Yes, I am absolutely making assumptions but I do have a very keen understanding of what motivates individuals - even when they themselves seem unaware of what motivates them. It comes from observing human behaviour closely - maybe it's the writer in me :).

I don't expect you to accept this on face value.

Unknown said...

It really disappoints me to hear a midwife disrespecting womens choices in birth. Surely it should be for no-one but the woman to decide. If you think that women should not freebirth, you're no different to the obstetricians who think women should not homebirth. How about just supporting women instead of pushing your own agenda.

Joy Johnston said...

I don't understand how what I have said is "disrespecting womens choices".
I disagree with some choices people make in health care, for reasons that are linked to my understanding of health. I respect the person, while disagreeing (not disrespecting) their choice.
My understanding of my professional duty of care as a midwife includes the promotion of normal birth, knowing how to work in harmony with the natural processes in birth, and knowing my limits.

Stacey said...

I absolutely agree with The Husband, and I don't find her comments angry or offensive at all, but I can see how they might be challenging.

This comment "Something has gone very wrong when a woman believes she is better without any skilled professional attendant. I grieve for that woman." Perhaps we should look at where midwifery might be failing, for women to make this choice. I'm sure the woman has no need for your grief, except perhaps in her past history that has opened her eyes to the realities of midwifery. Not all midwives put their clients interests first. I've been treated badly by 2 midwives, and thus had a freebirth for my second as I desperately needed a safe space to give birth. I don't paint all midwives with the same brush but each woman has different needs in different births.

Perhaps instead of criticising freebirthing women, take some time to understand where they are coming from. You talk about laws and regulations, peer pressure... as a birthing woman I don't want your decisions that are shaped by regulations or peers negatively affecting my births! I can understand midwives who feel constrained by such things and I would rather not hire them than run the risk of a traumatic experience. FWIW I did have quite an instinctive understanding of my second labour and baby's birth, and when something DID go wrong I accepted the need to transfer (something that would have happened no matter my attendant or place of birth). The difference was that I was able to decide MYSELF that it was necessary without being pressured by someone else.

Trust is a huge thing in birth (Sif's sarcasm aside) and I urge women not to hire a midwife if they can't 100% trust her... and that's trusting that she will support you, rather than direct you in birth.

Alice and Mother said...

Oh for goodness sake. Janet Fraser isn't a "free birth proponent" she is a CONSUMER proponent! Both midwives and obstetricians seem to miss that point.

Sarah said...

I'm wondering why you are not hesitant to post Sif's sarcastic, aggressive, presumptious, discriminatory comments but you hesitated to publish The Husband's?

I don't understand why you are getting so upset about this issue, Sif? If it's not for you, kudos, but it is for other women. And for some strange reason this really seems to annoy you *shrug*

Anastacia said: "You talk about laws and regulations, peer pressure... as a birthing woman I don't want your decisions that are shaped by regulations or peers negatively affecting my births! I can understand midwives who feel constrained by such things and I would rather not hire them than run the risk of a traumatic experience."

Since there is so much confusion for those who don't like freebirth about what motivates a woman to choose freebirth here are some links for you:

Why UC?

Why we chose homebirth without a midwife

Homebirth without a midwife

Why Freebirth?

Woman's Choice

No one said...

Sazz, you're projecting your own upset onto me. I'm not upset :). Neither did I think I was being aggressive. Then again, when you agree with a strong statement, it'll be perceived as assertive, and when you disagree it'll be aggressive, I guess.

As I used the term proponent of free birth, I guess the reference Sazz made was to me. Why assume I was referring directly to Janet Fraser, or only to her? Fear seems to be driving most of the responses here, fear of not being validated for one's own choice.

In case it isn't clear, this latest comment of mine is not written in aggression, presumption, sarcasm or discrimiation, metely observation.

Joy Johnston said...

Adding to the complex discussion about the freebirth issue is Herald Sun columnist and blogger Andrew Bolt.,21985,25315240-5000117,00.html [Sorry I can't work out how to make a hyperlink from the comments section so you will need to copy and paste it into the url line if you want to go there]
Bolt's comments include good sense and utter nonsense, adding to what he refers to as "a growing tide of irrationality." He acknowledges the vast difference between homebirth attended by a midwife, and freebirth, yet his parting shots include "Just pray now that the Rudd Government's maternal services review will at least refuse demands that home births be covered by Medicare."

I am once more convinced that the Alice in Wonderland story is about maternity.

midwife and daydreamer said...

Joy - thanks for your comment on my post and I am happy to discover your blog, as well. There have been many things said and written on this topic - my hope is that all of us will figure out where we stand and how best to understand unassisted birth. blessing!

sangga said...

I post this comment reluctantly, as I don't want to add fuel to this fire. But I support Joy's understandings of freebirthing, and the assumptions that go with them. Perhaps it is worth considering that, when women come to birth their babies, the attitude should not be only about having the woman's voice heard, but also about hearing the voice of her baby. Birthing isn't only about 'my voice, my body, my decisions' – the voice of the child speaks softly but demandingly, too, about matters of safety, preparation for every eventuality, the reality that things can and sometimes do stray from the ideal path. The scary moment of transition in labour, when all our vulnerabilities are exposed, brings us back to the realization that birthing is not about having an ultimate experience, or expressing our ideologies/philosophies/convictions through the medium of birth. Birth is, in and of itself, and it is a condition and experience totally beyond our control. Its power takes our breath away – and for that reason it is why we usually have a guide, a helper, someone who is completely focussed on being there to strengthen and support us as we find the way to shore, and to provide experienced aid if necessary. It's sometimes a fine line between 'supporting' and 'managing', but most homebirth midwives that I know walk that line very capably. After four homebirths, I have never encountered a homebirth midwife who was not respectful of my choices, or who did not listen carefully to my informed decisions. But a good midwife listens to the baby's voice as well, and is always mindful of the reality – that the best outcome isn't just 'a good birth' but 'a healthy baby, a healthy mother'.

Unknown said...

I guess I am another perspective. I am not a midwife, freebirther, nor do I know anyone who has had a freebirth. But I am pregnant. I am a behavioural scientist, and I am highly tuned in to my instincts.

I see the value of both perspectives. Sometimes, "rough" treatment from medical professionals is very threatening in our vulnerable condition (I've ranted endlessly about it on my blog). Yet, if we are to lump all medical assistance like that, and all women as instinctively capable of birthing, we are looking at things in such black and white, that we have decided, and will only be able to see things that agree with our perspective.

I know many people who speak of having instinctive wisdom, yet may act differently under stress. We may refuse to acknowledge stress, but stress comes with your first menstruation too. It is simply a new milestone in life for which we have no reference point. Whoever says animals do it instinctively and without stress, either can't read animal body language, or are just dumping their heads in the sand.

I had a filly who birthed at three years old, and was so unnerved by it, that she refused to let the newborn suckle, till an older mare nudged her and mimiced the body position repeatedly till she got the idea. She wouldn't let humans come close, but this older mare guided her through the experience. Till then, she just stood there shivering and shaking, and curious about the baby, but unwilling to let it close. There you go - instinct - this hurts. Keep it away!!!

Sure, we need to respect a woman's choices, but what about the human instinct for interdependence that has allowed us to flourish so well?

We shop around till we find brands we like, but give up on medical practitioners after one or two bad experiences by clubbing them as a whole as insensitive or harmful. How strange is that?