Are 'Free Birth' And 'Unhindered Birth' A Thing?

By Jamie Wells, M.D. — Jan 23, 2019
For some expectant mothers, there's a strong desire to have less "medicalization" of labor and delivery. It manifests itself in home births and water births for those adamantly opposed to a hospital setting. Now, “unassisted birth” goes a step further excluding a trained professional from the delivery. It's time to clarify the risks.
Credit: Pixabay

The New York Post just published a piece entitled Mom gives birth in outdoor bathtub without medical help: ‘It felt right to me.’ In it, a new, first-time mother explains what this means and why she wanted one, "An unassisted birth is one without medical intervention. You give birth unhindered and without medical interference." She maintains she received prenatal care throughout her pregnancy via a midwife and would have rethought things if an issue arose,

“I had a healthy pregnancy and I visited a midwife all along. I had prenatal care...There was no sign that anything was wrong, and if there had been I would have had to think about changing my plan...Depending on the severity I would have had to consider a hospital birth in that case. But I really made sure I had done a lot of research.”

The desire to have less "medicalization" of labor and delivery is a strong one today, manifesting in home births and water births for those most adamant about avoiding the hospital. Now, this “unassisted birth” goes a step further to exclude a trained midwife from the actual experience of delivery. Thankfully, this story has a good outcome for mother and infant.

It is great news that most births go well for those at low risk and with otherwise healthy pregnancies. But, there is a reason the medical field and modern advances in infection control measures to surgical intervention like C-sections drastically improved abysmal maternal-fetal mortality rates in our history. And no amount of research prior to birth can adapt in real time to the dynamic nature of the process.

In those instances when things go badly, they do so quickly and the difference between a healthy mother and healthy baby is directly impacted by speed of identification of the problem, access to vital equipment, and avoidable delays in appropriate, often aggressive intervention by well-trained, knowledgeable staff. Consider the need for giving oxygen to a newborn and clearing to stabilizing the airway. Time lost for proper oxygen administration could have drastic adverse neurological effects in the short- and long-term. Hampering resolution of maternal bleeding or infection management can have serious consequences.

Then, tack on the added risk factor of water births which have no proven clinical benefits for the infant. There are known infant cases of: delay of aid for fetal distress, snapped umbilical cords leading to blood loss and possible shock (requiring transfusion), Grade 2 & 3 Hypoxic Ischemic Encephalopathy (HIE) and perinatal asphyxia (aka the type of brain damage when an infant’s brain does not receive adequate oxygen and blood), radiologic findings of fresh water drowning with pulmonary edema, respiratory distress, seizures as a result of very low sodium (aka hyponatremia) secondary to water intoxication, Group B Strep (GBS) meningitis and death. Risks for mom include: loss of control of blood loss, decreased fetal monitoring, limited alternative analgesia, ineffective contractions, higher risk of infection especially with membrane rupture.

To read more comprehensive pieces on water birth, review these articles:

Hospital delivery is not always perfect, but these days women have more options. Practice groups now include midwives. They have the ability to monitor lower risk deliveries in a hospital setting that has a less encumbered birthing center only feet away from an operating room and obstetrician should their assistance become necessary. Sub-specialists, medications and neonatal critical care services are readily available to prevent more common, minor issues that would otherwise occur in their absence from evolving.

Famously, comedian and late-night television host Jimmy Kimmel told the terrifying tale of the post-delivery discovery and treatment of his newborn son's unexpected congenital heart defect. Due to the presence of medical personnel and an astute nurse, his baby, within hours of birth, was given the best chance for a good outcome (review the case here). The reality is childbirth is not a series of static events. Unpredictable and unanticipated moments arise in a process that has high stakes - the health and well-being of a mother and her child.

Fortunately, many, many deliveries occur without event and healthy moms and babies abound. For those times when help is needed, we are lucky we have options to intervene successfully. Being fully informed by your doctor who knows your thorough history and clinical status is an ideal first step in determining what is right for you and your family. In so doing, you will best understand the immediate and future risks and benefits of your decisions.