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Choosing Between Unassisted and Midwife Assisted Homebirth

by Becky Jackson

Ever since my last hospital birth 5 years ago, I've known that if I ever did it again, it would be at home. The things I wanted from a homebirth would include freedom (from being strapped down with monitoring equipment and hospital rules), comfort (in the form of familiar surroundings), control (in choosing labor and birth positions), and a cozy, intimate setting with my husband and baby.

Once we decided to try for another baby, the question now was, what kind of homebirth did we want? Enlist the assistance of a midwife or take on pregnancy and birth entirely on our own? Either choice sounded like a reasonable way to reach my goal of a natural, instinctive, empowering birth experience.

I remembered a cousin who had 3 unassisted, or perhaps more correctly "husband assisted" homebirths and I thought that sounded wonderful. My husband had been with me at other deliveries and was confident that he could handle the job.

I checked out the homebirth forum at http://www.mothering.com/ and found several women discussing their experiences with unassisted childbirth, or as it's commonly nicknamed, "UC". My reading there led me to http://www.lauriemorgan.com/ for some great, affirming articles and practical answers. I also checked out Laura Shanley's articles at http://unassistedchildbirth.com/ and bought Lynn Greisemer's book, Unassisted Homebirth: An Act of Love.

Through my research, I became aware of a crucial point in the argument for the safety of homebirth: the many surprising and unknown ways that hospital routines and doctors' intervention can cause many of the very problems that they are there to fix. I began to trust that by birthing in a more natural setting where intuition plays a major role, many common problems do not arise.

I realized I had experienced intervention-induced difficulty first hand in my hospital births. For example, at the end of my first delivery, my daughter's head remained high even though I was fully dilated and having the urge to push. The doctor couldn't understand why and resorted to forceps, vacuum extractor, and eventually, two nurses pushing down hard on my belly. These maneuvers finally forced my baby down, fracturing her collarbone in the process. I made it through the ordeal with a badly torn perineum and a somewhat damaged bladder.

When I was giving birth for the third time, I was beginning to have the same problem once again. My son was remaining high though I was starting to have the urge to push. This time though, I had a doctor (a D.O.) who was trained in natural childbirth methods. He'd already clued me in on the benefits of perineal massage and an upright birthing position. He speculated that my bladder was too full for the baby to properly descend. He instructed me to empty my bladder, and my son came down and out right afterward. After that, I figured out the problem and related it to my first birth. Each time I was in labor in the hospital and needed to use the bathroom, the nurses told me it was too much trouble to unhook me and I would have to use a bedpan. "Never mind, I'll hold it," I said, which I did for 8 hours the first time and 4 hours the third birth. Toward the end of labor, I could no longer feel the sensation of a full bladder and, even though I wasn't allowed to drink water, I was being filled with fluid through the standard IV.

In a home setting, I would be able to walk to my own private bathroom without permission or fuss. I would do whatever comes naturally for my body.

Almost halfway toward my planned unassisted childbirth, I suffered a miscarriage (see Emotions and Choices in Miscarriage). When we conceived another baby a few months later, I was feeling much more vulnerable this time. I felt like I couldn't bear the responsibility for my baby's well-being alone. I still respected unassisted birth and admired its advantages. But whether driven by fear or by divine leading, I wanted someone to help me make decisions, to provide quick and relevant medical help if needed, and simply to check the baby's heartbeat with a doppler if I was feeling worried. I read many positive and inspiring stories of midwife-assisted births at http://pub11.ezboard.com/bgentlechristia... and some encouraging articles at http://www.quolkids.com/birthing/. I also read Birthing in Paradise, an e-book by Helen Laing (see http://www.quolkids.com/birthing/bip3.ht... for more info.).

I called the only midwife within 100 miles of where I live. I was still unsure how involved I wanted her to be and whether I would continue seeing her. I was apprehensive about how much control I would be expected to hand over to her.

But when we visited for the first time, I was very relieved. The midwife just chatted with me, my husband, and kids for quite awhile. She told us how proud she was that I stayed home and that we homeschool (which she did herself for many years). She and I were on the same page on issues of unnecessary prenatal testing and birthing positions. But what really won my favor was when she asked Mike if he would like to catch the baby. I never dreamed I could have both, an experience birth attendant in case a problem arose AND the opportunity to for my husband and I to do things ourselves.

My goal is that the midwife will do very little unless there is some rare, unforeseen problem. But she will be available with her 20+ years of experience and her neonatal resussitation training should we need her. That is..unless things feel so right and natural when I go into labor that we decide not to call her afterall....We'll be making that final decision in a few more weeks.

Here are some points to consider for anyone else who is choosing which kind of homebirth to have:

Unassisted homebirth may be right for you if:

*You want things very private, no one there other than very close husband/friend
*You want complete control without any interference or instruction of any kind
*Your previous births have been basically free from complications
*You are confident and willing to shoulder the responsibility
*You have researched and are prepared to deal with complications such as shoulder distocia, cord around the neck, etc.

Midwife-assisted homebirth may be right for you if:

*You want help with prenatal care and making decisions
*You want someone else to be prepared for complications
*You want your spouse or yourself to be able to just enjoy the experience, without bearing the sole responsibility
*You feel more confident and relaxed knowing a professional attendant will be on hand
*You want someone who can set up a smooth hospital/doctor transfer if needed

This article was first published on Suite101.com and is reprinted with permission from the author.
Copyright 2002 by Becky Jackson


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