Evaluating the Risks
As chief of maternal-fetal medicine for Virtua Health in Voorhees, New Jersey, Dr. Ronald Librizzi, sees women whose pregnancies have been deemed high risk. These are women who might not even know they or their babies are at risk if they go the route that some women who choose unassisted birth advocate—a route that excludes prenatal care. He notes that even in a population that appears to be glowingly healthy, in about 20 percent of all pregnancies something will go seriously wrong and require medical intervention. Only a trained professional, he says, can recognize those at high risk.
As for the effect of stress on pregnancy, Dr. Librizzi notes that there is no credible evidence that a hospital birth is any more stressful than that of a woman trying to act as her own OB-GYN, or the worries she might have with an untrained partner delivering her baby. Unassisted birth may be perceived as Mother Nature's way, but, as Dr. Librizzi points out, nature can be cruel.
"I encourage people to go out and look at the [unassisted birth] websites and come back to me with their questions so I can answer them," Dr. Librizzi says. "The work we do in the obstetrics field is based upon solid research, not anecdotal evidence. I advocate for people to be able to make choices, but you have to make logical and informed choices. Don't confuse a soliloquy with solid data."
Current Birthing Options
Mairi Breen Rothman, a certified nurse-midwife and a consultant with the American College of Nurse Midwives (ACNM), understands why some women would opt for unassisted birth in a system she calls "so restrictive that people are choosing to opt out." This restriction includes the fact that in many areas of America women can't even choose a midwife over a doctor. It's a hospital birth with a physician in attendance or nothing.
"I think this trend has more to do with the current system we have in this country rather than the attractiveness of staying at home," Rothman says. "If women felt safe and listened to in a hospital or at home with an attendant this wouldn't be necessary at all. There's an accurate understanding [among women] that if they go to the hospital they will be interfered with, and at home with an attendant they may be interfered with."Still, she worries about women who choose unassisted birth, likening it to swimming in the ocean without a lifeguard.
You don't have to pay any attention to the lifeguard while you're swimming, but it's nice to have someone on the beach watching for dorsal fins. "My feeling is that it's really nice when the mom can be the mom and not have to be her own midwife and the dad can just be the dad," Rothman says.
Rothman does agree that the stress of a negative birth experience can impact labor, but she also thinks building a relationship with a birthing professional through the term of pregnancy can alleviate much of that stress. If every woman had a choice of a midwife-attended birth, had access to a midwife and was able to build that relationship over nine months, she could choose a birth with as little intervention as she wanted. Contrary to the belief that midwives are required to perform invasive procedures on laboring women, Rothman notes that "a midwife who is adhering to the midwifery standard of care will not do anything unless the woman agrees to it."
"I've had two children at home, but I would never consider being my own midwife," Rothman says. "If you give birth in the natural, normal way and Mom is completely relaxed she'll go to a place I like to call the 'birth planet' where you're just being your animal self and you shouldn't be thinking about things like tying off the cord, or maybe wondering if you should call 911. Even coyotes have a midwife in the pack that stands outside the hole to keep the other animals away. Bringing in a professional is something that's perfectly natural in our birthing history."