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Posts Tagged ‘Unassisted birth’

One of the women featured in the channel 5 documentary about unassisted birth, Clio, is discussing her choice in The Mail’s “Freebirthing: Is it madness or the ideal way to give birth?”, the article has so far elicited 60 comments, the majority of which are against the idea of a woman giving birth without trained support. Obviously, as a midwife I am going to counsel against an unassisted birth, I would also advise against an unsupported pregnancy, meaning no antenatal care. I know, and have seen too much to take the attitude that Sue (one of the commentators) does ‘ If you listen to your body and you are healthy there should be no reason why you can’t have an unassisted birth, We need to go back to the old days, pregnancy and birth are not illnesses.’ She is right, pregnancy and birth are not illnesses’, but that does not exclude circumstances which are capable of changing an everyday ‘natural’ event into a life threatening emergency. I remember that fact EVERY time I am called to a homebirth and EVERY time I conduct a routine antenatal examination. Sue wants us to go back to the old days. What ‘old days’ would those be? The days when women died from eclampsia; haemorrhage; puerperal fever, ruptured uterus when babies died or were damaged by obstructed labour, cord prolapse, undiagnosed twins, locked twins? 

  

So, I’ve let my feelings known, now I’m going to present an example of unassisted childbirth that happened recently. The woman is at term, uncomplicated second pregnancy, apart from her requiring much debriefing about her last labour and birth and a meeting with the anaesthetist to attempt to discover why her last epidural hadn’t worked and an assurance that she would be offered an epidural as soon as she goes into hospital this time. On the day of the birth she as a ‘show’ in the morning and is experiencing slight lower, back pain. Early afternoon saw her having painful tightenings, she sent her husband off to buy a few groceries, he was gone half an hour. He returned to find her on all-fours, telling him that the baby was coming. He insisted they get into the car to go to the hospital, she describes being on the pavement, on her hands and knees, unable to move. He somehow got her into the car, and off they went on a 10 mile drive. A mile from the hospital, stopped at traffic lights in the town centre, she told him the baby was coming, her waters broke and baby’s head started to come. He pulled over, leapt out of the car, asked a group of teenagers to call an ambulance, pulled off his wife’s trousers and baby was born into her underwear. After a struggle with baby and it’s cord, which was tangled in her undies, he gave the baby to his wife. She describes how terrified she was, as initially the baby was ‘floppy’ and didn’t cry, but then she hugged it hard and he cried. They cancelled the ambulance and drove the mile to the maternity unit where Mum had a couple of stitches to a small tear, cord blood was taken, as she was rhesus negative, and they then got back into the car and drove home. When I saw them the next day they were both ‘on a high’. Basically they, especially her, view the experience as being, eventually, better than the birth of their first baby but terrifying at the time. I asked if they would deliberately have an unassisted birth. NO! Would they have a midwife attended homebirth? Not too sure as those seconds, where they thought that the baby was not breathing, made them realise how unpredictable events could be. 

Not freebirthing, in fact very much the opposite as Mylene Klass is someone who had private antenatal and birth care. Now though she is outraged at the lack of care she received after the birth of her baby . I have a few thoughts about this, many contradictory. My overall thoughts are that I can’t defend the lack of care she received from the NHS but…..why did she choose to rely on the NHS for her postnatal care having gone privately during her pregnancy and birth? Was it because her private hospital does not provide a domiciliary service, however much you pay and she would have had to go to a clinic for her and baby to be seen?

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“Following the Channel 5 programme broadcast 9 July 2008 (Extraordinary People – Outlaw Birth) featuring three women in the UK and the USA who opted to give birth unassisted at home, the NMC would like to clarify the following points.
Legal position
In the UK it is legal to give birth at home without any professional or medical help.

However, it is illegal for an unqualified, unregistered person to perform the role of a doctor or midwife during the birth.

Standards and resources
As part of their training, all midwives are taught that they must

  • Work in partnership with women to facilitate a birth environment that supports their needs.
  • Provide care that is delivered in a warm, sensitive and compassionate way.

The Midwives rules and standards states that a midwife

  • Should respect the woman’s right to refuse any advice given

The Code states that

  • You must listen to the people in your care and respond to their concerns and preferences

In addition, a recent report from the Royal College of Obstetricians and Gynaecologists (RCOG) states that

  • Women who choose a home delivery as their birth option should be supported in that choice, appropriate to the level of clinical risk.

Responsibility
In a free birth situation, the mother-to-be takes full responsibility for the birth of her baby.

The mother may choose to have any friend, partner or relative present at the birth.

They may support the mother emotionally but it is not legal for them to assist her in the birth or take any kind of responsibility for the successful outcome of the birth.

Midwives must respect a woman’s decision to have a free or unassisted birth.

The Code and NMC Midwives rules and standards require midwives to be supportive and not be judgemental or critical of this choice.

If midwives have any concerns at all about the woman’s decision, they must address them to their Supervisor of Midwives.”

Further information
Free birth advice sheet [PDF]
The Code
RCOG Standards for Maternity Care
[PDF] (external website)

Well, that’s made it all very plain. I think! Support her choice, be non-judgemental, contact my Supervisor of Midwives if have any concerns about her choice. Ummm, if I’m supporting her and being non-judgemental then going to my Supervisor could be perceived by a woman as obstructive and judgemental. Oh well. All I can say is, as I said here, if you thinking about it then please don’t just read the legal stuff and DIY sites on the web, there are a lot of sites out there with enthusiastic people who mean well but can be somewhat blinkered when it comes to the nitty-gritty. Talk to your midwife, see if a compromise can be reached, most of us don’t want to be ‘in control’, we would just like to try and help you, and your baby, have a positive, safe birth.

 

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So, there I was reading Homebirth Debate and I started trying to find the UC site that Dr Amy refers to. I must be particularly unobservant as I can’t discover the name, or a link, which would allow me to read the forums. Whilst searching I stumbled across this midwifery today forum, which contained the following:-

Hi my name is Lisa, I am 28weeks and I am moving to South Carolina (Spartanburg County) in the next few weeks. I have been researching UCand I absolutley want to do this. I attend breastfeeding meetings once a week and I always ask a lot of questions (questions concerning pregnancy, usually). But there are some that can’t be answered because they are not into what I believe in (as to do it the natural way). Here are some questions that I can’t seem to get answered and hope someone can help.

1. What “exactly” do I need to do to get a birth certificate? Do they need the weight and length of the baby, too?

2. Is it illegal in the state of South Carolina to do UC?
3. I want to have the birth in the tub. So when the head comes out do I need to stand up, not to drown the baby?

4. *I would like to know of a herbologist or whom ever knows about such things, in this area, so that if something happens that I may have
tintures to use (instead of drugs) for hemmoraging etc., or say soothing smells in the home.*
5. I am Rh- I do not want the shot, which my doctor wants to give me next week at my visit, (to his surprise I am not taking that or the blood test for diabetees – I feel great!). What are your feelings on this matter?
6. Where can I go to find out about positions for delivery, in case my baby is breeched?7. Should I go to Lamaze class?

8. Do I need to get out of the tub once I delivery the baby, so my body can deliver the placenta?

9. If it is a boy, I would like him to be circumsized. How long do I wait? Where do I go? and does he realy need a vitamin K shot? (I would prefer the oral vitamin K.)

10. Last but not least if something goes wrong I will go to the hospital, but will they respect my wishes as to no Hepititus B, Ointment in the eyes, PKU test, etc.? I do have a Birth Plan.

I’m sorry that it is so lengthy, but
I am almost prepared in having this baby! Thanks so much!

Where do I start? I’m going to begin my saying that my first thought when I read this was ‘ This has to be a wind-up. Someone who is so clearly uninformed can not be considering UC’. Then I mused again and thought that at least she is trying to find out about the process. Logic stepped in ‘ She has access to the internet, she must have done a search.’ That was my next step and immediately I found this guide to unassisted childbirth. and these extracts from video’s . Lisa must have found these as well, why the naive questions?What has caused me so much angst? I’ll start by discussing he points that I’ve highlighted in green. I attend breastfeeding meetings once a week (crikey, is she studying for a diploma?) Why not ‘birthing classes’. If I was thinking of giving birth wihout any professional assistance I would be going to any groups, meetings I could track down which may give me a few ideas about the whole birthing experience.I want to have the birth in the tub. So when the head comes out do I need to stand up, not to drown the baby? Now I’m worried. She has an idea in her head but really knows nothing about it. This is phrased as if she believes that it would be easy to stand up as the baby’s head is being born. Does she really appreciate the effort that is involved in giving birth, the overwhelming sensations that a woman experiences? I’m not even going to touch on the dangers of a pool/tub birth if she has not done a great deal of reading/research around the subject.tintures to use (instead of drugs) for hemmoraging etc., or say soothing smells in the home Haemorrhaging. Yes, lets use a few ‘tinctures’, that should stop a haemorrhage. Let’s put this in context, we are not talking about a trickle of blood here, we are talking flood,It is estimated that as much as 600 ml of blood flows through the placenta each minute in a full-term pregnancy, that’s over a pint a minute. Okay, so Lisa could try Arnica or Bellis , but that’s assuming that the bleeding is caused by her uterus not contracting down, supposing she has sustained a huge tear which has severed a blood vessel, making her womb contract, is not going to be of much use. PPH (postpartum haemorrhage is the leading cause of maternal death worldwide. If it is a boy, I would like him to be circumsized  Why? Come on Lisa, you don’t want any medicalisation to do with his birth so why have a part of him removed following his birth? It may be a religious demand, but otherwise??????I am almost prepared in having this baby No. She is no where near being prepared, and the fact that she believes that is what is so frightening.I don’t believe that all births should happen in hospital, but I do believe that having someone present who is equipped and trained to deal with any problems is desirable. There will always be times when babies are born before assistance arrives. However, in the main these births occur quickly and this generally means that all is well with the relationship between the Mum’s pelvis,the size of the baby and the ability of the uterus to contract efficiently. These are not long labours which can cause the uterus to tire and not contract down well following baby being born, births with the Mum lounging about in the bath and not knowing what to do, or births where there is a problem with the baby being too large and getting its shoulders stuck.

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