Thursday, April 15, 2010

Thoughts about unassisted birth: part II

If you had the time to read back through the selected posts listed in part I, you might have noticed a gradual shift in tone. During Zari's pregnancy and immediately after her birth, I was on my "honeymoon" phase in my relationship with unassisted birth: a bit idealistic, breathlessly in love with the idea of undisturbed birth as the pinnacle of the birth experience, enraptured and fascinated with the practice. Now, it was still me writing, which means that my pragmatic and analytical selves were still present even when I was strongly advocating unassisted birth. But compared to how I feel now, after a second pregnancy and birth, I would say that my relationship with unassisted birth has settled into a more mature, complex, and nuanced pattern.

Towards the end of writing my dissertation about unassisted birth, I was already finding myself critical of certain trends I saw emerging in online UC communities--the trend toward dogmatism, the distrust or even demonization of midwifery, the embracing of slogans (trust birth! breech is just a variation of normal! etc.) that mask the complexity of reality. In particular, the abandonment of education and preparation--and of midwives--in favor of "trusting my body/following my intuition."

Here's an excerpt from my dissertation on this topic (from chapter 4):
After years of immersion in UC communities, I have started to notice a trend toward dismissing the necessity of knowledge and preparation, toward emphasizing intuition to the exclusion of almost anything else....I am not sure if this anti-education and risk-denying undercurrent has always existed and just I never noticed until now, or if it really is a new development. This tendency is not universal, but it is prevalent enough that others besides me have noticed it....

Over-reliance on any one type of knowledge can be dangerous. No one source of knowledge about birth is infallible or complete. Even if intuition is believed to be inherently accurate, it is not omniscient or omnipresent. UCers and midwives have separate sets of challenges regarding intuition. As Lucia Roncalli noted, midwives need to incorporate intuition into their clinical training and experience and give it adequate respect. For UCers, the challenges are to sufficiently refine one’s intuitive skills and to balance education and preparation with a trust in intuition. This is a difficult process—walking the knife’s edge of embracing intuition as a “knowledge that matters” without falling into the trap of intuition becoming “the only knowledge that matters.”
To be fair, I wonder if some of the things I'm perceiving is just that--a problem of perception. Since I finished my dissertation, I haven't followed online UC communities as closely as I used to. I'm more of a casual browser/eavesdropper now, rather than regular reader and participant. I know that just dropping in on certain messages might not give me the full context of the larger discussion--just as overhearing bits of a conversation is not the same as participating in it from start to finish. Knowing the full context really does make a difference.

What I am not doing in this post is disavowing unassisted birth. I am just trying to explain that I feel many different ways towards the idea all at the same time. I do feel less comfortable "promoting" UC than I used to. If a woman hires a midwife or a physician, she can shirk the responsibility of education and preparation, and things will probably be okay--in a "everyone comes out alive and relatively healthy" sense--because there is someone else there with extensive knowledge and training and skills to fill the gap (even if we might debate the usefulness of, say, surgical skills for a normal vaginal birth). But with UC, all of the weight is on you and you alone. There's no one else to catch you if you stumble.

I am reminded of one of my favorite professors: ethnobotanist Dr. Paul Cox. He served an LDS mission in Samoa, and his approach when teaching people interested in his church was to talk them out of joining. He wanted them to be 100% sure that they were joining because they had a personal testimony and unwavering belief. If he couldn't talk them out of it, he knew they were really serious. I feel the same way about UC. I think giving birth unassisted is wonderful--but I don't want to talk anyone into it. I don't want to over-romanticize it, or promise women a pain-free ecstatic birth if they just get rid of the midwife/their fears/their doctor/the hospital. I want women to have an undeniable inner knowing that an unassisted birth is right for this baby, this pregnancy. And to have the concomitant desire to do the necessary preparation for giving birth without a care provider present.

I absolutely stand by my decision to give birth to Zari unassisted, just as I do my midwife-attended birth with Dio. If anything, both experiences have taught me to trust that inner voice--call it intuition, divine/spiritual guidance, whatever you like--no matter where it takes me. It might sound airy-fairy for some readers, but nevertheless it was undeniably real for me in both pregnancies. I hope I never need to give birth in a hospital, but if I do feel drawn towards that for a future pregnancy, I hope I can embrace that guidance and move forward with confidence.

If I didn't feel strongly guided one way or another, I'd probably hire the same midwife if I became pregnant again. I really enjoyed our prenatal visits. Her presence at Dio's birth didn't disturb me or interfere with the birth in the least--of course it helps that she arrived only 30 minutes before he was born! And I do like having someone with extensive knowledge and skills that I can call upon. I would not have access to that where I live if I were planning an unassisted birth and doing my own prenatal care. But I also recognize that my unassisted birth with Zari played a huge role in knowing what I wanted from a midwife and in knowing how I labor and birth. If anything, that first unassisted birth gave me more confidence in myself to be able to labor successfully in many different settings.

Stay tuned for part III, in which I respond specifically to Barb Herrera's post The UC Oxymoron.


  1. Rixa, you already know I am a big fan, but two things I have always liked about you (what kept me coming back to read more even when I thought you were CRAZY) was your extensive preparation/education and your relative openness/non-dogmatism.

    As I prepare for my 4th/last birth so differently than my others, I find myself very attracted to pragmatism over philosophy. I like the idea of taking the best knowledge and practices from a wide variety of sources, esp. acknowledging that these may vary by woman and pregnancy.

  2. Expecting mothers can also use hypnotherapy to help prepare for childbirth. Use hypnosis visualization to remain in control of birth experience and move through contractions smoothly.

  3. "I was already finding myself critical of certain trends I saw emerging in online UC communities--the trend toward dogmatism, the distrust or even demonization of midwifery, the embracing of slogans (trust birth! breech is just a variation of normal! etc.) that mask the complexity of reality. In particular, the abandonment of education and preparation--and of midwives--in favor of "trusting my body/following my intuition." "

    I really appreciate what you said here. For me my midwife-attended homebirth was my perfect ideal birth. I did a lot of preparation on my own as well, but having her here was right for me. I have often felt that militant UCers look down on those of us who choose midwives as somehow taking an 'inferior' route through birth. As though UC were the be all and end all of ideal birth. I know for some people it is their ideal, but for some of us it really really isn't. And it's not a matter of fear, or lack of education, or unwillingness to shoulder's a matter of careful thought and choosing what is best for me. It's nice to hear a strong proponent of UC like yourself validate my frustrations with the UC community (as a community).
    I cannot fathom wanting UC for myself, although I respect the choice for those who do choose it. :)

  4. I really appreciate this post. I am a big advocate of educating yourself AND using intuition. A blessing I had when I was pregnant the first time made me wonder what might go wrong with the birth. (The wording really caught my attention.) And it was prayer that confirmed our decision to go to the hospital when we did- a decision that resulted in (an eventually) healthy baby instead of something else.

    The next time I was pregnant it was a fabulous OB that got me a VBAC. It's hard for me to see people labeling ALL OBs as cut-happy, intervention-pushing, and mother-ignoring. For me, spending almost 40 hours in labor meant a patient OB and an epidural were the reasons I didn't have another c-section.

  5. Well I do think that in many ways you lucked out by having such a supportive, hands off midwife.

    Those are not all that commmon, especially in Canada where midwives are licensed and a lay midwives are illegal.

    Canadian midwives must follow certain protocols and rules that are not necessarily in the best interest of the mother at all times, but instead serve the needs of the system.

    No doubt you know of Gloria Lemay,who is just one midwife of many who has chosen not to be regulated so that she can serve women and not the system.

    I don't think it is fair to judge UCers from a privaleged position of choice, a choice that many choosing UC do not have.

    Even finding a midwife in Canada is very difficult. Often you have to call the DAY you concieve to get one, as they are that much in demand and so rare.

    For many it is not about dogma but about lack of choice. You cannot get a la carte care. It is often all or nothing.

    You were able to have an undisturbed birth with a safety net, I think the ideal, really.

    But that is still, in my opinion, quite the rarity.

    As for Barb, I think she misses the whole spirit of UC. I would not want her at my birth if only because she views birth from a much more medicalized lens than I am comfortable with.

    And I tend to disagree with your synopsis that there is a UC dogma that eradicates knowledge.

    I have never met a single woman interested in a UC that has not done months, if not years, of research and education, self-growth, and mental as well as spiritual and bodily preparation.

    And most of the UC women I have spoken with agreed that in an ideal world, they would prefer a hands off midwife in the next room.

    But we don't live in an ideal world, do we? So we each have to make our own choices given what we have.

  6. I want women to have an undeniable inner knowing that an unassisted birth is right for this baby, this pregnancy. And to have the concomitant desire to do the necessary preparation for giving birth without a care provider present.

    I hear you, Rixa. And while I appreciate your thoughtfulness and your desire, I am also glad that no one--not even you--gets to decide if I meet their criteria to UC!

    IMO, each mother needs to decide what is right for HER--not her OB, not her midwife, not her friends/family/partner and certainly not anyone she meets online, no matter how experienced.

    And what might qualify for inner knowing and preparation for my UC birth, may not even come close to what you imagine I should feel and do. I do love diversity!

    I also love your writing and your birth stories because they are a perfect match for the unique woman that you are.

    I love all the different birth stories, UC or not, that for me are reflections of each of those mothers--at that particular time in their life journey.

    After 3 years in the Bornfree online community, I have yet to experience the generalizations that you and Barb make about the UC community--so maybe it IS a matter of perception.

    Thanks for your wonderful writing--it is a real gift and a great inspiration for me!

  7. Rixa, you're the bomb. I read your words and think, "I scribble with crayons while she swirls with callifgraphy!" You write so beautifully; I am jehh-luss.

    I've inhaled your process, it seeming to mirror much of my own, the expanding of definitions, ideas and, eventually, beliefs about how women can and do have babies in our culture. You're just much more graceful than I. Such a gift you are.

    I look forward to Part III... we can have (friendly) Dueling BlogPosts back and forth.

    Because I often feel alone in voicing my opinions, I am selfishly thrilled to hear you questioning the slogans and mantras of the ultra-dogmatic birth community. My (tender) ego wipes a tear of relief that I really am not a (complete) nut that doesn't deserve to be a part of the birth world. (Yeah, I know... there's therapy for that sort of thing. *laughing*)

    Anyway, this is magnificent and I can't thank you enough for your words, your insights and your bravery in voicing your Truth(s), even as they transform from what you once thought they were.

    I actually believe that, unless there *is* a constant shift in our seats, we might have atrophied our asses to some old belief system that might not even really exist anymore. Even if we don't 100% agree, which would be scary freaky if we did, your words are causing me to wiggle in my chair once again. Thank you for that.

  8. I loved reading this, many of it resounds within me, some of it I may not wholly agree with, but overall it really moved me.

    Love to you. I'm so glad there is room for flexibility, reflection and movement in life.

  9. This may seem a bit off-topic, but I feel the exact same mix of "complex and nuanced" feelings towards the homeschooling vs radical unschooling camps, as well as the authoritarian vs power-with parenting. I'm coming from an upbringing that tried to be less strict than the one before, but still engaged in tons of control tactics, punishment and authoritarianism. So, my pendulum wanted to swing towards "love will conquer all." Only, you get kids sometimes who are impulsive beyond measure, *don't* want to emulate only my good side, and need more structure than I seem capable of offering. ;) I've had to deeply ponder my love of certain ideals, compare them to what I *don't* want to do as a parent, mix in what that child actually needs to thrive and grow up, and go from there.

    The moral of this story is to have respect for choices - others' and our own, especially when they deviate from what we'd expect.

    btw, did Dr Larry spam you? lol

  10. Great post! I agree agree agree. I will admit UC does make me a little squirmy (but not yours, for whatever reason).

    I concur on the hands off midwife. :) Mine were a little more hands on at the birth, but still did not arrive until 45 minutes prior and that was just perfect in my book.

  11. Do you remember when I started to feel this way about UC? I really struggled with many of these same concepts. I saw women walking blindly or naively into really serious situations. I saw women transporting after birth for simple complications that a midwife could have easily treated and then being thrust into an ugly and harmful situation. I saw babies coming to harm. And while I do believe that birth is normal, bodies give birth just fine, women are safe, midwives meddle too much (seen it with my own eyes I have), etc....I do think there is a proper time and place to seek outside assistance.

    I've also seen the dogmatism you're speaking of and I've read 'advice' that is downright dangerous. Women come to online forums with questions-real questions-and get told "what does your gut say?" Well, I think that's important, but obviously her gut said "seek out further information" or she wouldn't be posting.

    I have the same gut reaction to the "hands off midwife" quandry that Barb does. Don't ask a midwife to come and not do her job (being ever watchful for issues that might require more intervention). Now, imho I think how much baseline intervention happens should be between Mom and midwife. But my lovely midwife/future preceptor has often said "a little bit of intervention now can often prevent a lot more later". The whole reason birth at home is so safe is because midwives often see problems coming a mile away. So much time and attention is given at prenatal visits for that exact reason. To totally dismiss that is a bit insane.

    I know an unassisted birth was the correct choice for my fourth baby. I still believe that strongly, to this day. In hospital we would have been in serious trouble. I'm glad I made that choice. I also know the same to be true of my twins' birth. At home unassisted or in hospital we would have been in trouble. Home with my open, receptive midwife--we were golden.

  12. Anonymous wrote: "I have never met a single woman interested in a UC that has not done months, if not years, of research and education, self-growth, and mental as well as spiritual and bodily preparation."

    I have. I've met several individuals and families who clung to the dogma without a grounded sense of the responsibility UC in the process alone won't stop a hemorrhage or resuscitate a baby.

    I do fully support a family's right to UC. It is a fabulous choice if made with conscious awareness. But be aware people ARE reading the UC message boards and birthing in abject ignorance.

  13. The first time around, UCing was like this powerful urge in me. I don't know how to explain it. I really felt we should UC. And going past 42 weeks, even the most hands-off midwife I know in the area would have been pushing for cohosh and castor oil inductions. After 42 and a half weeks, I don't know if she would have touched me with a 10 foot pole. UCing meant preventing an unnecessary induction and possibly being labelled as "failure to progress."

    I do know a midwife would have been helpful in some ways: maybe she would have suggested positions to be in to shorten the long back labor and it would have been nice to have a midwife for stitches, but at 43 weeks, you don't have those options because you're a walking time bomb.

    This time around, I don't feel so strongly. We're going with UC because it's our default choice. We'll be moving out of state at 30 weeks and we don't know what sort of insurance we'll have access to- and looking for a midwife who's not already booked up to the brim at that point will be almost impossible. It's still an option to go looking for someone at that point, but for the sake of planning and getting into the "mindset" we're assuming this birth will be unassisted.

    Margaret's birth was very life-changing for me. And so far in this pregnancy, I haven't run into anything that would indicate that a UC wouldn't be a good idea again. I have done extra reading about positioning and I'm definitely taking better care of myself nutritionally this time around. I'm still up in the air about what to do if I need stitches. I'm not sure if prenatal perineal massage will help or not, so I haven't done anything yet. Hmm... Guess I should get thinking about that.

  14. "Listening to one's instinct" would work quite well most of the time, if only people knew how to do it. However after a life time of being trained to give away our power to authority figures, most people can't tell the difference between their ideals, instincts and their fears.

    But that doesn't mean that someone who is truly honed in on their instincts shouldn't listen to them.

    My baby was born compound and sideways. Only I knew of exactly the right position to take so that she would be birthed safely as she was stuck for a while. After the birth, I read from Anne Frye's Holistic Midwifery that I took exactly the right position (half kneel half squat). How am I to really trust a midwife to know that?

    Had she told me what position to take, there likely would have been complications and trouble.

    I don't think UC is for everyone, but for you to dismiss a mother who is truly in tune with her body and who knows her body and baby better than anyone else in the world - that is not right. Just because majority of the women in our culture have lost those instincts doesn't mean you should dump on them.

  15. So how do we know which women *really* know themselves and those that *really* don't? Is there a litmus test?

    @TopHat - My (midwife-experienced) opinion is to NOT do perineal massage. I've seen far more tearing in women who've manipulated their perineums than those that leave her alone. I'm pretty sure women in the jungle don't hang around doing perineal massage. ;)

    But, since I am in the "enemy camp" - take that for what it's worth. *laughingwink*

  16. I'm hesitant to post, because I don't really feel qualified. I have birthed five children, all unmedicated, and w/ no interventions*, but all in the hospital, more or less Bradley style. One birth was unassisted, though at the time, I didn't even know such a thing really existed in the US. He was born with no doctor nor even any nurse present because the attending nurse did not believe me when I sent my friend to tell the nurse that the baby was coming: "I just checked her and she was at a 7. I'll be back in 20 minutes or so." My baby was born less than 10 minutes later.

    The thing that I want to suggest is that -- no matter what the reason -- some women's intuition tells them the wrong thing. I had to figure this out after THREE births. I reach the pushing stage, and something robotic takes over, and I feel compelled to PUSH like a madwoman, push when I'm contracting, push when I'm not contracting, push with all sorts of strength that might be admirable because of my ability to literally push out a 10 lb baby in three pushes. HOWEVER, that led to that first doctor (see below) thinking I needed an episiotomy likely so I wouldn't tear, because my uber-pushing was surely assaulting my perineum. The unassisted birth, I tore fairly badly -- 2nd degree; I'm surprised it wasn't worse.

    After those three births, when pg w/ my 4th, I thought, "There must be a better way." I had to seek out the information (which I did obtain from an acquaintance who is a UC'er), and confirm it with my OB that it was possible that I "instinctively" feel TOO STRONG of an urge to push. With my 4th birth, I submitted -- literally -- to the gentle suggestions of the attending OB, who, in his words, "milked" out my baby by carefully attending to my perineum and letting me know -- not WHEN to push; I still directed that -- but how hard. Using the self-control to follow his guidance was hard, but successful, as I ended up with nary a tear, no stitches needed, with both #4 & #5, my self-controlled births.

    So, all that is to say, unless, perhaps, you're in a situation as described above by the first anonymous, and feel cornered into a UC, it does come down to what's right for the baby, and what's right for the mother, and NOT every woman's intuition -- for whatever reason -- works to the benefit of herself and/or her baby.

    If we have a 6th (looking unlikely at this point), I would like to have a midwife-attended hands-off delivery at home... Even though, among my circle, I know the most about birthing, there are a lot of gaps in my knowledge, and having someone with emergency knowledge would be helpful, both for the work she could do, and for my own state of mind.


    *Except with my first, I had an unconsented episiotomy, and with my 2nd, I consented to it, because as my water broke when I was pushing, it became apparent that my baby had let go his meconium, and the attending CNM suggested it to speed up birth. He did aspirate the meconium, but had no complications...

  17. Rixa I agree with you. I have been in the UC community for four years and it has changed. What was once a forum for thoughts, suggestions, and the sharing of knowledge has now become "Trust yourself" or a link to an old post because they don't want to take the time to answer the question. There is a lot of dogma creeping in. There are many more transfers now than four years ago. If you suggest that someone may be approaching something unsafe and might want to ask for an outside opinion then you get jumped on. It's not what it once was.

  18. You should try the Canadian Forem - no dogma there.

  19. i am probably one of those seen as dogmatic and dangerous.

    foremost, i do not believe that UC is for everyone or every pregnancy, but i do tend to see the underlying philosophy of UC ("trust birth and trust yourself" as opposed to "congratulations on your pregnancy! go see a doctor/midwife!") to be an important factor in having diverse birth options.

    second, i have a different perspective of women in general, than some of those espoused here. i believe that women are inherently intelligent, seek the information that they require, and ultimately are thoughtful and caring about themselves and their children. essentially, it's not just that i "trust birth" it's that i "trust women."

    my experience online has taught me that i never have a complete picture of someone. heck, even in real life, i don't always have a complete picture of someone. i just have what they tell me and what i perceive of them.

    like me, people with hold information about themselves for whatever reason. which means that, in my communications with them (IRL or OL), i simply have to trust that whatever "gaps" i may see in the communication are "gaps" that the woman has filled herself in some way, not that i *must* fill those gaps for her.

    third, i agree with Sondra, too, about what is "necessary" education for an individual. I do not know what is "necessary" for anyone else. I can only know it for myself.

    so, while i agree that i want women to be certain of their birth plan (regardless of unassisted or assisted) and educated as much as they can, i cannot dictate what "adequate" education is in order for them to UC.

    And luckily, no one has to ask for "permission" from anyone else to UC or to be "good enough" to UC. I'm certainly not going to tell someone, or simply assume, that they are "too ignorant" to UC.

    At the end of the day, i trust women to know what they need to know, to get the information that they need, and to act in accordance with their own intelligence and intuition.

  20. I had a UC for my first birth. I had my own standard of when I would seek help or not, my gut never told me too. It went perfectly. A few months later, my friend lost her baby after seeking a UC. However, when they finally got baby out, they could never determine a cause of death. My gut told me something was wrong for her but everyone told her over and over to trust nature. Nature took her baby. So, so sad. She wouldn't try UC again even though the death couldn't be blamed on it. So it is hard to say. I get nervous now thinking about UC but at the time it was perfect for me, though next time we might have more help around. I'm going to go read your link now about the paradox.

    My story is on


  21. It's been so enriching to read your thought processes throughout your birthing journeys. I find that mine are similar to yours.

    I absolutely 100% support UC as a reasonable choice for birthing a child. That said, I don't think it's always the wisest choice. Each birth is as unique as the woman bringing forth her child.

    I also fully agree with your suggestion that we need to balance intuition with knowledge. We were blessed with the tools to access both for a reason. It's quite a balancing act at times, yes, but I believe it's necessary in every aspect of our lives. I feel that it enables us to reach our maximum potential.

    Good thoughts, here, I'll be chewing on them for a while.

  22. I just wanted to pipe up here, too. I frequent many of the uc lists myself (I actually help to moderate one of them) and I have seen what you're talking about: the dogma, the fear of medwives, the stigmata of the entire birthing "industry".

    And I *have* met AND worked with more than one woman who wanted a uc whose ENTIRE attitude was "trust and all will be well". I've known women whose only birth preparation was to research just what they wanted to hear or needed to find to appease a partner! (this is true for every birth choice, ime, UCers are certainly not exempt from being human). I will say that in my experience, UCers TEND to be much, much better educated about birth, their own bodies and the potential hazards of birthing a child. But that doesn't mean they all are.

    I think it's important to acknowledge that there are people within the uc "movement" that are just as uneducated and nonchalant about the challenges of birth as women in the mainstream of society. I don't mean to say that they are foolish, just that they have a very idealistic perspective. I find this is particularly true of mothers who have not given birth before or who are very new to and excited about the concept of freebirthing.

    I will say, though, that anonymous isn't entire incorrect. I have been deeply immersed in the uc internet culture for the last five years and the truly ignorant, willy-nilly birthers are rare, ime. In general, if a woman is seeking out uc lists, she's already walked a long way down that path to self-discovery in the world of birthing.

  23. Wait, really? Three years in the bornfree community specifically and you can't think of a single case that mirrors what she's talking about?! I admit it's rare but as a mod for the sister group (On yahoo) of that community I have to say that's just not fair, lol. Though in the last two years the group has *really* mellowed out. We've lost a lot of our really militant voices and gained instead a wave of mothers choosing mw assisted births and midwives, too. It's been really interesting to watch the "community" evolve.

    Still, I can't help but feel like there is a little "rose-colored lenses" going on in the comments section, here.

  24. I think there are a few 'schools's of UC. There most certainly is a belief among some UCers that intuition is the only way, but for the most part big preparation is key. Me, I follow both. I believe in preparation and in following the spirit. I too, after many years am not the convert all to UC type. There is only one thing I wish every mother would do and that is research her options and decide after study and thought. I don't think UC is right for everyone or every birth. Thank goodness it has been right for all 4 of my births so far and I plan it for all the rest.

    I must admit that I do like the 'breech is a variation of normal' however :) Especially since SO many caregivers are so deadly afraid of it that too many breech babies are born via c-section without any need.

    I don't believe in demonising midwives or doctors either but I don't believe in placing all my trust in any one person be he a doctor or a midwife or any other human being.

    I have been in the UC community for about 12 years or more now, though, like Rixa, not as much as the first few years.


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