the fear response to unassisted birth (and the birth workers who attend them)
fear can keep us safe. fear is what keeps (most of) us from jumping off buildings or hugging brown bears. but not all fears are created equal and we should always evaluate what exactly it is we’re afraid of before we conclude whether the fear should be heeded. and in the case of unassisted birth, fear may have led us astray from the deepest calling of holding space and caring for birthing people.
before we get to the meat of this conversation let me say this…
i do not believe everyone should have an unassisted birth. if an unassisted birth or a freebirth doesn’t feel good to you, please don’t have one. you get to decide what is best for you and your journey.
nor do I believe that all licensed providers are part of the problem. in my community we have several beautiful providers. providers who trust birth and trust birthing folks. i don’t think that midwives are power hungry monsters. they desire to embody the definition of midwife — they want to be “with women.”
please, don’t hear what I am not saying. we can all be part of making birth better. if this conversation makes you feel uncomfortable, if it makes you feel attacked, or angry, please move through those feelings thoughtfully and and with self reflection. This is a big conversation and one that requires us (me included) to move through it with open hands.
so let’s talk about it. these are the three most common arguments i hear in mainstream home birth communities against unassisted birth and doulas attending them:
“what if something goes wrong?”
the fear in this question is more obvious than the rest, and at its core is a deep mistrust of birth and its physiological processes, and of birthing people. the perspective that a birthing person can (or should) be allowed to make the choices that are most true and feel the safest for them often makes us feel uneasy.
in her blog entitled, what makes birth “safe”?, maryn green of indie birth says this, “Birth is just as safe as it always has been, and will continue to be, if we allow women to lead.”
if we take our hands and egos out of birth, birth is as safe as it’s always been and when i make a choice out of fear that that something might go wrong if i don’t do something, i am making birth less safe.
if we operate with the mindset that the birthing person should have full autonomy over their care, and that they are the final authority over their birth we allow birth to function as it always has.
the indie birth podcast also has an episode entitled, “Is Homebirth Safe?” and Other Stupid Questions We Should Stop Asking. it is so powerful and may give you that squirmy feeling again. Remember to sit in the discomfort and move through it thoughtfully.
“doulas who attend unassisted birth open themselves up to liability or litigation if there are any negative outcomes.”
please hear me with all the love and kindness i have in my heart. no certification or regulation or licensure will protect you from litigation if there are negative outcomes, and if someone wants to hold you liable for them.
within the system of maternity care as it currently stands, there is a deep mistrust of women and people with uteruses. it is deeply engrained within us. over the last several years we have seen both midwives and doulas, working within their certification and regulation, face litigation in multiple states.
we’ve seen obstetrical providers, and even family members call for the prosecution of anyone who was present at an out of hospital birth that had a negative outcome. whether or not there was fault. whether or not the parents believe the midwife did anything wrong. when birthing people say, “i don’t want what you, obstetrician or hospital, have to offer me and i can make a different choice,” there is so much pushback from the established obstetrical model.
when we choose to attend births, as doulas or midwives, we accept the possibility that at some point someone might decide we didn’t do enough, or we did too much.
the fear of litigation has never made this profession any less threatening to the establishment, nor has it made anyone a better provider.
“doulas who attend unassisted births are practicing midwifery without a license.”
this is something we hear anytime the conversation of someone attending an unassisted birth trends, but what we know is that it’s almost always factually wrong. the vast majority of doulas or birth keepers who attend unassisted birth don’t do anything that even comes close to practicing midwifery.
we’re providing our regular childbirth education throughout pregnancies.
we’re offering book recommendations.
we’re giving them evidence based information about their options.
and come birthing time, we’re squeezing hips and brushing hair and we’re holding space as usual.
doulas and birth keepers who attend unassisted births aren’t checking cervixes, or checking heart tones, or performing urine analysis — though the parents may choose to engage in those practices themselves — they are providing the same comfort and education and advocacy that they would if there was a licensed medical provider present.
of course there are outliers in this conversation.
there are folks who are led by their ego and misrepresenting themselves to birthing folks.
i’m also not talking about the wise ones who are in states that won’t license out of hospital providers or who are ‘independent’ or ‘underground’ or ‘traditional’ midwives moving outside of the colonial model.
people who are choosing to birth without a medical provider present, want to take ownership of their pregnancies and births and aren’t looking for someone to make choices for them. They aren’t seeking a cheaper option for someone to tell them what to do. They are most often seeking someone who believes that they have it within them to find the answers they need within themselves or through education.
which leads me to what i think is a more subtle fear that we have to acknowledge. the fear that we, as birth professionals are not vital to the process.
if birthing people can choose to educate themselves outside of the medical model, and give birth outside of the model of care that says the provider is the most knowledgable and is the final authority in the room, what does that mean for my role in this community, in this vocation?
we’ve been fighting to prove the validity of midwifery for the last eighty years. since a very well implemented smear campaign undermined the role of midwifery and homebirth we trying to prove that midwives are just as capable, and even more experienced in physiological birth than some obstetricians. advocates for out of hospital birth have been fighting for even the smallest bit of power in this community, and when there is scarcity mindset, there is fear of losing that power.
but in order to truly serve birthing people, we need to release power. i don’t mean we should share the power of the birth space between midwives and doulas or birth keepers. i am saying that we should release all of the power that we hold, both midwife and doula alike, and allow the birthing person to take up all the power in the birth space so that we can sit and learn from them.
obstetricians took birth away from the home and from the care of community midwives and we are only just bringing out of hospital back to the mainstream conversation. but before there were community midwives, there were wise ones who sat with birthing people and those birthing people had always known their ability to birth because they had watched many many people birth before them.
as we consider our role in birth, not only should we check in with our ego, we also need to check in with our fears. what do we as birth professionals bring into the birth space with us? how are we serving the people who come to us? and how are we navigating a space where birthing people come to us for support, but they hold all the power and authority within their autonomy?
grace and peace
