Understanding Unassisted Childbirth as a Choice

by Sheri McCaskill

            In order to understand why women choose unassisted childbirth (UC) we must first define what the term unassisted childbirth means. In some situations, and reference materials UC is also called free birth, autonomous birth or unhindered birth. (Miller) For the purposes of this project, I am looking to understand only planned out of hospital births without the assistance of a medically trained birth attendant. In some cases, the women who choose UC are trained in attending births in some way, if they were the only trained medical professional in attendance, I still count this as an UC. Women are rarely actually alone for UC and may have family and friends present. (Freeze, 2008)

                    My aim is to understand what motivates women to choose this option, and what kinds of obstacles they may encounter in doing so. Women seem to have many options when it comes to the birth experience in America, yet relatively few choose non-normative, out of hospital births. We have very little data concerning women who choose to give birth without the assistance of a medical professional in the United States (Miller and Schriver, 2012) and I would like to gain a greater depth of understanding into who they are and why some mothers choose something so outside of what the current culture in our country dictates as normal.

                    I believe that women who choose UC do so for a number of reasons. Many of the primary reasons are due to previously negative experiences in hospitals or with medical care providers. Others are personal, spiritual or religious beliefs. Much of the data surrounding the choice in UA is unrecorded or inaccurate due to women feeling stigmatized or judged for their decisions, particularly with medical professional. I believe there will be trends among women who make this choice, not only in previous experience, but in other choices they make regarding their own and their child’s health beyond birth. I believe there is an upward trend in making the choice to birth without medical assistance, and I believe it is important for the medical community as well as the community as a whole to understand more thoroughly the reality of the risks associated with birthing at home and how to best understand the choices women make in a non-judgmental and compassionate way.

                    According to Plested less than 1% of women in the United States choose to give birth at home, and less than 1% of those that do choose to do so unassisted. This is interesting to me since birthing outside the home is such a recent trend from a historical perspective. Women most frequently choose homebirth after having one hospital birth (Rossi and Perfumo, 2018) which leads me to consider the possibility that their hospital experience was a factor in their decision. I’d like to explore the key motivating factors for making the choice to birth unassisted, and what they mean. I will delve deeper into several of the most frequently mentioned reasons for choosing UC.

                    Empowerment was a key term that frequently arose in the literature I examined and is a major self-reported marker of why women choose to birth unassisted. Women mentioned that they feel more in control and proud of the accomplishment when they birth without medical assistance. They feel powerful and independent and want others to understand how empowering the experience can be.

            The next major theme explored in choosing UC was a distrust of the medical establishment. Women cited negative previous experiences with both medical professionals and hospitals. Not only did they believe they were undervalued as patients, but they also felt like their requests were not considered when being treated in these situations. Respect is a recurring theme in choices of birthing situations. Miller and Lalonde said that, “improved outcomes, including fewer cesareans, enhanced bonding, improved breastfeeding, decreased reports of stress after birth, and reduced need for operative deliveries, when women had companions during labor and birth, were treated as equals in the birth process, and were allowed to hold and breastfeed their babies immediately after birth.” Women do not feel they are treated as equals when they are in hospitals or birthing with medically trained personal.

                    Religious motivations factored into some accounts of women’s choice to birth unassisted. Either these women felt that their beliefs wouldn’t be respected in a hospital environment or their beliefs dictated limited medical care.

                    One woman I personally spoke with had a confidence in her own knowledge over the knowledge of others. Many women feel they can prepare and educate themselves enough to take control of their own birth experience. This is particularly true of women who had had more than one previous birth. They did not give authoritative knowledge to medical professionals and instead felt that they or their social circles held more authoritative power.

            Some women expressed fear of unnecessary medical intervention and believed that birth with a trained medical professional would put them at higher risk for interventions. In 2016 Plested said “the encounter with maternity services is experienced as stepping into a risk obsessed system driven by fear” Statistics proved that this in fact was the case. Women who give birth in a hospital do have higher rates of unnecessary C-sections and other medically induced complications (citation).

                    Next, I would like to look at factors that may have gone into the decisions that women made on where and how to birth as it applies to UC.

                    It is common for women to feel that others perceive their choice as the wrong one. Women believe that there is a stigma surrounding UC and choose not to tell many people when they do make this decision. They also mention feeling shamed or judged by others as an irresponsible mother by those that don’t understand the reasons behind their choices. Women not specifically that they feel stigmatized by those in the medical community, and they cite this as a reason for choosing not to engage with medical professionals.

                    Lack of medical support factors into the decision-making process. There is some concern among women that if something does go wrong during labor, they could be denied proper medical care when they do choose to seek it or that it will not be available at all.  Because of this, women have hidden still born babies, and have even died from complications rather than seek professional treatment. Women who do consider the choice to birth unassisted but ultimately do not, frequently mention those as a reason for choosing otherwise.

                    It seems that women who are aware of this option in birthing but do not consider it, say that they lack personal knowledge or authoritative knowledge about birth. They also say that they fear complications and emergency situations arising. (Plested, 2016)

                    We do not have enough data on this type of birth due to many of the above-mentioned factors, and there is no way for women to self-report UC outcomes and experiences. Only by continuing an open dialogue can we understand the motivating factors for their choices. If the medical establishment has failed to provide what women want and need in their birthing experience, I believe they will continue to make choices that do not include doctors and hospitals. We also must allow women the freedom to choose what is best for themselves, without stigma or shame.

Citations:

1. Miller, Amy Chasteen, and Thomas E. Shriver. “Women’s Childbirth Preferences and Practices in the United States.” Social Science and Medicine 75, no. 4 (2012): 709–16. https://doi.org/10.1016/j.socscimed.2012.03.051.
2. Rossi, A. Cristina, and Federico Prefumo. “Planned Home versus Planned Hospital Births in Women at Low-Risk Pregnancy: A Systematic Review with Meta-Analysis.” European Journal of Obstetrics Gynecology and Reproductive Biology, 2018. https://doi.org/10.1016/j.ejogrb.2018.01.016.
3. Van Der Hulst, Leonie A.M., Edwin R. Van Teijlingen, Gouke J. Bonsel, Martine Eskes, and Otto P. Bleker. “Does a Pregnant Woman’s Intended Place of Birth Influence Her Attitudes toward and Occurrence of Obstetric Interventions?” Birth, 2004. https://doi.org/10.1111/j.0730-7659.2004.0271.x.
4. Dannaway, Jasan, and Hans Peter Dietz. “Unassisted Childbirth: Why Mothers Are Leaving the System.” Journal of Medical Ethics 40, no. 12 (December 2014): 817–20. https://doi.org/10.1136/medethics-2012-101150.
5. Chasteen, Amy, and Thomas E Shriver. “Social Science & Medicine Women’s Childbirth Preferences and Practices in the United States.” SSM 75, no. 4 (2012): 709–16. https://doi.org/10.1016/j.socscimed.2012.03.051.
6. Freeze, Rixa Ann Spencer. “Born Free: Unassisted Childbirth in North America.” ProQuest Dissertations and Theses. The University of Iowa, 2008. https://search.proquest.com/docview/287924589?accountid=10223.
7. Snowden, Jonathan M., Ellen L. Tilden, Janice Snyder, Brian Quigley, Aaron B. Caughey, and Yvonne W. Cheng. “Planned Out-of-Hospital Birth and Birth Outcomes.” New England Journal of Medicine 373, no. 27 (2015): 2642–53. https://doi.org/10.1056/NEJMsa1501738.
8. Plested, Mariamni, and Mavis Kirkham. “Risk and Fear in the Lived Experience of Birth without a Midwife.” Midwifery 38 (July 2016): 29–34. https://doi.org/10.1016/j.midw.2016.02.009.
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10. Wax, Joseph R., F. Lee Lucas, Maryanne Lamont, Michael G. Pinette, Angelina Cartin, and Jacquelyn Blackstone. “Maternal and Newborn Outcomes in Planned Home Birth vs Planned Hospital Births: A Metaanalysis.” American Journal of Obstetrics and Gynecology, 2010. https://doi.org/10.1016/j.ajog.2010.05.028.
11. Miller, Suellen, and Andre Lalonde. “The Global Epidemic of Abuse and Disrespect during Childbirth: History, Evidence, Interventions, and FIGO’s Mother-Baby Friendly Birthing Facilities Initiative.” International Journal of Gynecology and Obstetrics 131 (2015). https://doi.org/10.1016/j.ijgo.2015.02.005.
12. Barker-Williams, Kerry. “A Systematic Review to Examine the Evidence Regarding Discussions by Midwives, with Women, around Their Options for Where to Give Birth.” Practising Midwife, 2017.
13. Feeley, Claire, and Gill Thomson. “Tensions and Conflicts in ‘Choice’: Womens’ Experiences of Freebirthing in the UK.” Midwifery 41 (October 2016): 16–21. https://doi.org/10.1016/j.midw.2016.07.014.
14. Feeley, Claire, and Gill Thomson. “Why Do Some Women Choose to Freebirth in the UK. An Interpretative Phenomenological Study.” BMC Pregnancy and Childbirth 16, no. 1 (December 21, 2016): 59. https://doi.org/10.1186/s12884-016-0847-6.
15. Jackson, Melanie Kathleen. “Birthing Outside the System : Wanting the Best and Safest Women to Choose a High-Risk Homebirth Or,” no. July (2014). https://search.proquest.com/docview/1948832128?pq-origsite=primo.
16. Gibson, Erica. “Women, Birth Practitioners, and Models of Pregnancy and Birth—Does Consensus Exist?” Health Care for Women International 35, no. 2 (February 2, 2014): 149–74. https://doi.org/10.1080/07399332.2013.810219.
17. Cameron, Heather Jean. “Expert on Her Own Body: Contested Framings of Risk and Expertise in Discourses on Unassisted Childbirth.” ProQuest Dissertations and Theses. Lakehead University (Canada), 2012. https://search.proquest.com/docview/1758020391?accountid=10223.