Friday, December 28, 2012

The Risk of Unassisted or Unattended birth

The Risk of Unassisted Birth By Martha Artyomenko

Peace. Intimacy. Family Togetherness. This sounds like the ideal picture of what your dream birth could be. When you are researching and choosing this way to give birth, you may know someone that had a beautiful birth story they share with you on how peaceful and lovely it was, having an unattended birth. There was no medical interference and they raved about it. You think back on previous births and think perhaps that the midwife/doctor didn’t actually do that much. Maybe you barely made it to the hospital before the baby was born or the baby came so fast, the midwife or doctor missed the birth altogether.

The stories you do not hear as frequently are the stories with the poor outcomes. They really are often seen as scare tactics or simply something that happens to other people and not you. Imagine that peaceful scene, laboring quietly with your husband, suddenly becoming as busy as an accident scene, complete with ambulances, EMT’s, and police. That is not what anyone wants for her birthing scene, but while birth is a normal and natural process, it is also one that carries risk. Women, without the medical inventions that even home birth midwives utilize, often have a higher risk of waiting until they are beyond minimal intervention and instead run the risk of serious medical intervention. These stories below are fictitious, but could be true based on true stories that I know.

Penny was planning a hospital birth. She has received prenatal care from a local OB, but the OB is not satisfying her need for hands off care. She makes the decision to just gather a few supplies and wait at home until the last minute before heading to the hospital, hoping to actually have the baby before heading to the hospital or be on the cusp when she arrived. “Women have been doing this for generations! I have had 3 healthy babies that I had no issues with, why would this one be different?” Penny goes into labor and when she starts to notice a lot of pressure below, decides to head to the hospital. Arriving, she gives birth to a healthy baby boy 5 minutes later. She starts to question the need for any kind of care during labor. It had been so peaceful at home; she could easily just buy some supplies and have her husband help her next time. Pregnant for the 5th time, a year later, she decides to plan infrequent prenatal visits to a local midwife, and lets her know that she is not planning on using her for the delivery. While the midwife warns her of the risks, she shrugs her shoulders. “How risky can it actually be?” she asks her husband. “ I almost did it before without anyone, why would this be different?” She enjoys the hands off approach and when the time comes to give birth, she gives birth in her bedroom, kneeling next to her bed. Everything was beautiful. She notices when she goes to the bathroom that there is a lot of blood. She couldn’t remember if that was normal or not, but sits down and rests with her baby. She feels a little shaky and asks for some food. She wonders if she should call the midwife and finally does, but is not even able to recall why she was worried. Her tongue feels thick and hard to speak. Her husband speaks to the midwife, whom encourages him to call an ambulance. When the ambulance arrives, she has already lost a lot of blood. They did have the correct medications to stop a hemorrhage on board the ambulance and rush her to the hospital, while hydrating her with an I.V. She comes back home, weakened from her severe blood loss, highly anemic and works for months to regain her strength. She struggles with breastfeeding because of the traumatic start and wonders why her body failed her. She would have been more of a woman if she could have done it without anyone, right?

Alice has had her previous babies at home with a midwife. She has had no complications, but resents the amount of payment she has to pay to the midwife. She is well informed, researches everything widely and feels that she is almost as educated as her midwife. She prepares her house for birth, and while, she knows that there can be emergencies, she has not experienced one. She decides that her husband and her will deliver this one and they commence on reading up more on the topic. She asks her husband to read Emergency childbirth and when she goes into labor, all is peaceful and well. The labor is longer than normal, she listens to the heartbeat sometimes with the Doppler she bought off of eBay and thinks everything is fine. “Isn’t this nice?” she comments to her husband. “Just the way God created it to be, with just you and I.” When the pushing stage comes, something feels weird and as the baby is born, they realize that the baby is not in a good position. They try multiple things, attempting to get the baby to come down and out, but she is so tired, she cannot remember what her midwife used to do in that situation. Her husband is starting to worry and talking about the hospital. There is green fluid appearing now, and she remembers that was not a good sign. She talks herself into pushing the baby out and with some mighty pushes; the baby is born. She is limp and unresponsive, and finally with much stimulation, gives some weak cries. Her color is bad, and her husband calls the ambulance. The baby is whisked away, leaving the mother alone at home. She follows shortly in a car, to find out upon examination, she has torn quite badly. “I had no idea! I thought it was supposed to hurt awhile after having a baby.” She exclaims to the doctors. The baby is struggling to breathe and has to spend 2 weeks in the hospital for meconium aspiration and an infection. She is thankful when she gets to take her home, but has to wonder to herself if she had the midwife there, letting her know, maybe they could have prevented this.

As I said previously, these stories are fictitious. They are based on many, many true stories of things that happen in birth, labor and delivery. Home birth is a wonderful thing for a low risk mother. Statistics have not proven it unsafe under the right criteria, but without a trained professional to recognize the signs that something is going downhill and the need for the transfer for care, things can go badly in a matter of minutes. You may choose to have an unassisted birth and it may go swimmingly for you. You may also choose to have a birth assisted by a doctor or midwife and have complications. There are things that happen with both, but while there are not many studies done on the difference between unassisted birth and midwife-assisted homebirth, the informal studies prove that there are more complications with unassisted birth because of not recognizing simple things before they turn into major issues.

When you are deciding your birth strategy, please consider the risks you are taking as well as the overall risk you are taking in endangering the legality of homebirth as well. Licensed midwives fight for your right to give birth where you choose, but that does mean they have protocols to follow to make it as safe as possible. When you operate outside those perimeters, you are adding a risk to your home birth to begin with, adding the lack of a care giver with proper equipment, can lead to an experience that both of you can regret. The statistics are not readily available to us because of the nature of this, often unassisted births are not reported as such, but in informal survey’s the risks of having an attended home birth with trained professionals versus an unattended home birth without extra hands of any kind or even with a person that believes they have knowledge of birth attending are so vastly different they should be in a whole separate category.

Please consider before choosing to have an unassisted birth the repercussions if something does go wrong, and ask yourself if the risk is worth it. Ask yourself why you truly desire this for yourself and if there are other options available, why you shouldn’t use them.


  1. Thanks for this post. It has given me some needed perspective on this subject.

  2. I was searching for ways to make unassisted home birth safer, and found this. All I get from this article is: be on the lookout for hemorrhage, don't try to give birth unassisted if the baby is breech, and go to the hospital sooner rather than later if things start to go wrong. OK, will do. It's still worth it, to me, to leave the "paid pessimists" out of it unless there is a medical emergency. I've had some fairly traumatic experiences with normal hospital births that I don't intend to repeat, if I can avoid it.

    1. Traumatic hospital births are really hard!! I would just recommend that you look into all your options before thinking that unassisted birth is your only other option. A home birth with a certified midwife can be very peaceful, and the way you want it often, without the risk that an unassisted birth carries. I had two unassisted births myself, and two with care providers, all out of the hospital and none of them were "paid pessimists". A care provider that is trained to know how to handle a circumstance out of the hospital will know more what to look for. Be wise, use caution and make sure that you do not have another traumatic experience out of the hospital as well!