The scene presents one of the more common archetypes of modern childbirth: a woman and her partner, unable to get to the hospital on time, deliver their baby at home or in the car, alone and with no help arriving until after the fact. For most pregnant women, the thought of finding themselves in such a situation is a troubling, even frightening one. However, a growing number of women are actually planning to give birth alone at home, without any type of medical assistance or professional midwifery care. Instead, these mothers are choosing an option which has come to be known as "freebirth," "couples birthing," or most commonly, simply as "unassisted childbirth" (UC). For these mothers, a quiet, peaceful birth at home, with complete privacy and perhaps shared intimacy with their partner and other children, is the only way they can imagine bringing a newborn into the world.
Laura Kaplan Shanley of Boulder, Colorado is a poet, the mother of four, and the author of the seminal book on this topic, Unassisted Childbirth (Bergin and Garvey, 1994). Through her book, which the Houston Chronicle declared as having "the most dangerous book title of 1994," and her Web site, The Unassisted Childbirth Page at: http://www.childbirth.org/bornfree/index.htm, Shanley has become something of a guru to women all over the world who are themselves choosing to have unassisted birth experiences. Shanley gave birth to each of her children at home without assistance. Her husband David "caught" her first baby, but Shanley chose to be completely alone for her next three births.
"Just as the ordinary house cat knows how to give birth on her own, so too do we," says Shanley. "Many midwives and even some doctors can help us reconnect with the intuitive mind that guides us in birth, but ultimately, we have the power to do it ourselves. As the great mystic Jane Roberts once wrote, 'Miracles are nature unimpeded.' When we stop impeding our natural, creative abilities, birth, and indeed life, become truly miraculous."
Emily (who, like several of the women interviewed for this article, chose not to use her last name due to what she perceives as a lack of understanding of her philosophy of childbirth) is a twenty-nine-year-old mother of two from Boston, Massachusetts who gave birth to her first child in a traditional hospital setting. However, after reading Shanley's book and communicating with other unassisted birthing families on a UC email list, she chose to have an unassisted birth with her now-seven-month-old baby. She says that her extreme unhappiness with the way her first birth went sent her in search of "a better way."
"We planned to have an unmedicated birth in the water at a very progressive birthing center within a hospital. We thought that this would give us the best of both worlds," says Emily. "But nothing turned out as we planned. I was in good, strong labor when we arrived at the hospital, but being around all the unfamiliar faces and people in and out of the room caused my contractions to slow and then stop. Eventually I agreed to a pitocin drip and then an epidural. I barely avoided a C-section."
Emily says that she suffered depression over her unsatisfying first birth experience for months afterwards. Then she heard another mother talking about Shanley's book at a new mothers' discussion group. Intrigued, Emily ordered the book and says that she read it from cover to cover in one sitting.
"I knew immediately to the depths of my being that giving birth alone, in a loving embrace with my husband and without distractions from strangers, was what I needed. It took very little convincing to get my husband to agree. Once he read the book, he was convinced too."
When Emily became pregnant again, she decided to see a homebirth midwife for all of her prenatal care, but she told the midwife from their first contact that she and her husband only planned to call during the actual birth if they felt they really needed assistance. When the big day arrived, Emily says that they never considered calling anyone.
"I went into labor almost as soon as my toddler fell asleep for the night. It was a really cozy, starry night and we sat on the porch swing for several hours as things got more intense. Labor is such a private time. It's not something I want to share with anyone except the people I know very, very well. Eventually I told my husband that I wanted to be in the dark, warm bathroom, so he lit some candles and turned on the heater in there. He left me alone and I ended up having the baby in the bathtub. I just sat and held her on my belly for a long time before I called out for Steve to come see. It was a magical moment," remembers Emily.
Shanley says that, like Emily, many women turn to UC after a traumatic hospital birth experience. "Often women who have had unecessary C-sections are drawn to unassisted birth," says Shanley.
Dana Marsten of Seattle, Washington became an enthusiastic advocate of unassisted childbirth by accident. Marsten, age thirty-two, had her first baby in the hospital, but her second birth--which was also supposed to take place at the hospital-- happened so quickly that she ended up giving birth at home in her own bed with only her husband present.
"After the excitement of what had just happened was over and I was lying there nursing the baby, we thought about calling 911, but we just looked at each other and thought, 'Nah!' The baby looked really healthy, obviously healthy, and the last thing I felt like doing was packing up and going to a hospital at that point," explains Marsten. "So we got out one of our books on childbirth and read up on what to do in the case of 'emergency childbirth' and we just followed the instructions. We cut and tied off the cord and waited for my placenta to come out. Everything went fine."
Marsten says that from that experience, she feels certain that when she becomes pregnant again, she and her husband will plan an unassisted childbirth with a midwife on call.
Despite many women's positive experiences with unassisted birth, there are obvious questions regarding the safety for both mother and child of giving birth without a skilled doctor or midwife in attendance. Although the fact that planned, midwife-attended homebirth is actually statistically safer than hospital birth has been well-established in the research literature, no studies have yet looked at outcomes for families who choose the option of unassisted birth. Shanley says that in her own extensive contact with scores of women who have had unassisted births, she knows of only one woman who has experienced serious complications.
"I know of one woman who had problems after her unassisted birth. She was five weeks overdue and ended up hemorraghing. She was transported to the hospital but everything turned out fine. Yet she is still an advocate for unassisted birth. All her previous births had been problematic also. She had hemorraghed after all of them, after giving birth in the hospital. Her unassisted birth was peaceful and empowering."
Shanley herself experienced what most people would consider a complication--a footling breech (feet first) presentation--with the birth of her second son. Although the great majority of birth attendants today would recommend a C-section in this situation, Shanley says that her own intuition led her to assume an upright position during the birth, which as it turns out is the safest way to deliver a footling breech baby.
" . . . (During labor), a foot appeared between my legs. I wasn't expecting a breech birth . . . I said belief suggestions that everything would be all right, and then patiently waited for Willie to be born. Little by little his foot got lower and soon his other foot popped out. When I felt the time was right, I gave one push, and gently pulled him out by the feet. Incidentally, twelve years later I read that Michel Odent, the well-known French obstetrician, says that for a breech delivery a woman should always be in a 'standing squat' or 'upright' position and an attendant should do absolutely nothing to interfere if at all possible," writes Shanley on her Web site.
Most couples who decide in favor of unassisted birth educate themselves extensively in how to recognize any symptoms in the birthing mother or baby which would require transport to a hospital. Many even decide to take on all of their own prenatal care, learning to listen for the baby's heartbeat, take the mother's blood pressure, and measure her growing uterus throughout pregnancy. Ultimately, however, advocates of UC say that not even a highly trained doctor can guarantee a particular outcome in birth, regardless of where or how a baby is born. Additionally, a strong part of the overall philosophy of unassisted birth is that the mother herself must accept full responsibility for her entire birth experience--whatever the result-- rather than, as one UC advocate describes it, "giving her power away." Some women's spiritual beliefs factor into their decision to turn over their concerns regarding their health and that of their baby to their personal higher power.
"No one, regardless of their 'expertise,' can guarantee that a baby will be born safely. Some babies die. It's simply nature's way," says Shanley in explaining her own views.
Maka is a pregnant thirty-year-old mother from Columbus, Indiana whose first child was born in a freestanding birth center, but who is planning an unassisted birth with her upcoming labor and delivery. Maka, who lost one baby in a hospital emergency room, says that she is not worried about potential complications that could arise without medical assistance on hand.
"No, I don't worry about any sort of emergency situation arising," she explains. "I will listen to my intuition and if I feel medical care is necessary, I will, of course, seek it. But I doubt that this will happen. I believe that birth is inherently safe. I don't have any sort of formal back up plan. If I feel a need for medical care, I will either drive to the hospital or call 911, depending on the circumstances."
Not surprisingly, in a culture like this one in which midwifery care is still considered radical, the idea of unassisted childbirth at home is extremely controversial. In fact, in some cases it is even against the law. Although homebirth itself is legal in every state, several states such as Nebraska and Colorado have made it explicitly illegal for an "unlicensed attendant" to "catch" a baby. Therefore, a father helping to deliver his child could be breaking the law. Many women planning an unassisted birth choose to keep their decision private so as not to risk interference from authorities. In some cases, this can make obtaining a birth certificate for a just-born baby a tricky business. Although each state has its own law regarding how to go about registering a child's birth, most require some confirmation of the birth by a doctor or midwife. According to Shanley, she has never heard of anyone actually denied a birth certificate after an unassisted homebirth, although she claims that some women have not been treated well by their local health-department officials.
Despite these obstacles, Laura Kaplan Shanley believes that as more women become dissatisfied with the increasing technical emphasis and medicalization of childbirth, unassisted birth will continue to grow in popularity.
"People are becoming more self-sufficient in all areas of their lives, and this is naturally translating into the area of childbirth," says Shanley.
Katie Allison Granju is a contributing editor to Minnesota Parent.
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