No, I don't think that Unassisted Childbirth is a safe birthing option

Let me preface this by saying that I will always support a woman's right to chose her place of birth, whether it be hospital, birth center, or home. I would support a woman making an informed decision about having an induction, having a planned c-section, or having an epidural for her hospital birth if she is aware of the chances that she is taking. I support a woman's choice in going to a birth center for an out of hospital birth experience if she is aware of the chances that she is taking. I support a woman giving birth at home with her choice of midwife, direct entry or certified nurse midwife if she is aware of the chances that she is taking. I even support a woman who chooses to have an unassisted birth, or UC, or freebirth, if she is aware of the chances that she is taking.

However, being supportive of her ability to make the decision to freebirth as an adult and being tolerant of her choices are different than believing that it is a safe choice. Planned c-sections come with their own risks, and many in the natural childbirth world are quick to tout statistics about that, but are often quiet about the risks associated with an out of hospital birth (even with a midwife attending there are risks as we are not surgeons and do not have a nicu at home) and even going so far as to promote unassisted birth as a better option than a planned surgical delivery. I often see a lack of balance in both the medical world and the natural childbirth world. Both downplay the risks and upgrade the safety of birth within their realms (medical professionals will often not tell mothers about increased risks of hemorrhage and death in a c-section and the impact it can have on her future fertility). Truthfully, birth is not something that can be controlled in any setting. It is wild, it is fierce, it can be gentle, it can be orgasmic, and it is unpredictable. It is also the most amazing and beautiful thing that I have the privilege to be a part of. 

I'm a direct entry midwife, I practice pretty much hands off unless the mama and her baby need me to be otherwise. And the majority of the time at homebirths, and births in general, moms and babies do just fine. They may need emotional support, physical support, mental bolstering, but really they do all the work and do just fine on their own. But the minority of the time, either mama or baby need a little help. That's why midwives and doctors spend years training and learning and never stop learning their craft. We midwives are not accessories to birth, we are an integral part of the process and are there to watch out for times when intervention or transport to a medical facility is necessary. 

When a mama is in labor, she is in "labor land". She's focused solely on the task at hand, she is bringing forth new life, and she is working the hardest that she ever will on the most fulfilling event she will ever experience. This is how it should be, all the focus is on her and her baby's well being. She is vulnerable, she is raw, she is fierce and she is magnificent. 

But while she is in labor, she also should not be expected to be fully aware of how her baby is doing. She can't be aware of any large changes in her own blood pressure. She can't be aware of how her baby's heartbeat is speeding up or slowing down  or staying steady as she labors. She is usually unaware of whether or not she will need assistance getting her baby's shoulders to deliver when she pushes. Those are the things that her midwife or her doctor is to be monitoring. I believe in mother's intuition, but even that has it's limits. Mothers haven't been schooled in all the nuances of pregnancy, birth, and delivery. Their provider should be encouraging them to learn as much as they can and be providing her and her partner with information along every step of the way and not glossing over possible complications and yet not using scare tactics to get their way. Balance is key and the mother is always in charge. Her choices must be respected and if the provider disagrees, they can call EMS or another professional to take over for them if they don't feel that the situation is safe for them to continue on in her care.

There is a difference between scare tactics and true reporting. We don't have great numbers on unassisted birth and mortality rates. The only study is one from many years ago, focusing on a religious community in Indiana.  http://www.cdc.gov/mmwr/preview/mmwrhtml/00000345.htm The rates of death are high, more than twice what was reported in the state during the same years. In that case, the women not only had no one to attend them during their births, but also no prenatal care. Prenatal care is important, Providers can find out through testing when something is wrong in most cases. Not in all cases, sometimes testing does not reveal when something is wrong, but you have absolutely no way of knowing about certain defects without blood work and ultrasounds. 

You have no way of knowing if you may possibly have GBS without a vaginal culture at the end of pregnancy. GBS does not always result in problems of course, but it can cause a respiratory infection that spreads quickly.

And if you are having an unassisted birth, you do not have someone there who knows how to handle somewhat common occurances like shoulder dystocia, neonatal resuscitation, and hemorrhage. You likely don't know what constitutes normal bleeding and what is abnormal during labor. You likely don't know what is an acceptable amount of time to wait for a placenta to birth, or how to check to see if all of it is there. You also may not know how much is an appropriate amount of traction to place on a cord to get the placenta to slip out of the birth canal and how much resistance means it hasn't detached and it's better to wait. You may not know what to do in the rare instance of the dreaded prolapsed cord in order to save the baby's life. You may not know what a well contracted uterus after birth feels like versus a boggy uterus.

I have attended over a hundred fifty births in the capacity of traditional homebirth midwife. I've attended another forty plus as a doula and a few dozen more as either an apprentice or assistant midwife. Most births go smoothly and without a hitch. But sometimes, even when the mama has had a low risk, uneventful pregnancy with nothing showing up in her ultrasounds or blood work as being off, shit happens. I have been at births where the mama was up and walking around, beautiful calm music playing, eating and drinking as she pleased, no internal exams or very few, her every wish being supported and nothing seeming to be off, and then suddenly the baby's heart rate drops and we have to transport asap, or she is pushing and the baby gets stuck and needs a lot of assistance to be born, or the baby doesn't start breathing right away, or the mama starts bleeding like a faucet. 

I may be accused of fear mongering by saying that, but it's true. My job, my calling, for the most part is highly rewarding and does not include intense situations, it's mostly hard beautiful work. But occasionally, it's scary, it's intense, and I have to call upon my training to try and save lives. An unassisted birth does not have that sort of safety net in place. Most unassisted birthers have educated themselves as much as possible about the practice, but they do not have years of experience in dealing with emergencies in their background. They also can't make and should not want to be in a position to make heart wrenching decisions about their spouse or baby's well-being, becoming responsible for all of their actions or inactions during that time period. In those instances having a lesser emotional attachment and a more professional outlook can help. I believe that unassisted birthing is irresponsible on the part of parents. Wanting to have a peaceful homebirth is one thing, taking chances with your child's life and the life of the woman is entirely another.

I have given prenatal care to a few families who were planning an unassisted birth. I don't have a problem with this. Often these families eschew any prenatal care at all or are scared of all health professionals. I feel it is the right thing to do to help them during their pregnancy, with the understanding that if I find anything that is a problem or could be a problem that they must get further care from a medical professional. If they are ok with this, and so far no one has had a problem with that, then we can have a few prenatal appointments and I will go out to see them after they have had their baby for a checkup on both mom and baby. 

Most unassisted birthers are very well educated about their choice and understand the risks, or at least they report that they do. I have however have one client who was obviously oblivious to any risk and even after she had fired me as her midwife, opting for an unassisted birth, tried to pump me for answers on some very basic questions that she should have known if she was seriously considering this option. I felt she was taking a big risk and since she was involved in a state run program for her insurance where the insurance company would call me to check in on her periodically, I called them and told them that she was no longer receiving care from me and that she was planning an unassisted birth and that I wanted to be on record that I had nothing to do with her or her birth plans. She had not informed them of this and had in fact called them after she had fired me and had told them she was still receiving care from me.

There are times of course, that a woman has precipitous labors and has no choice. A woman can't help that. Sometimes a baby comes before I make it there, it happens and usually all is fine. That's not the kind of Unasssisted childbirth that I am talking about.

I say all of this out of love, because I want mamas and babies to come into this world safely, peacefully, and with lots of love and joy surrounding them. As with anything, do your research, and don't drink the kool aid without checking out the ingredients.