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Born free: Unassisted childbirth in North America

Dissertation
Author: Rixa Ann Spencer Freeze
Abstract:
Unassisted childbirth--giving birth at home without a midwife or physician present--emerged as a movement in mid-20th century North America. While only a small number of women choose to give birth unassisted, its significance extends far beyond its numbers. Unassisted birth illuminates trends in maternity care practices that drive, and sometimes force, women to choose unassisted birth. It also is part of a larger set of connected values and lifestyle choices, including home schooling, breastfeeding, co-sleeping, ecological awareness, cloth diapering, sustainable living, and alternative medicine. Finally, the emergence of UC as a conscious birth choice requires a re-examination of how we understand, frame, and interpret childbirth paradigms. There is very little written about unassisted birth in the academic world, although media reports on the practice have become increasingly prevalent since 2007. This dissertation begins the conversation for a scholarly inquiry into unassisted birth. My research is based primarily on interviews, essay-response surveys, and archives of internet discussion groups. After setting unassisted birth in historical context, I explain why women make this choice; the knowledge sources they privilege; how they understand the concepts of safety, risk, and responsibility, and their complex and sometimes contradictory relationship with midwifery. I also examine midwifery, and to a smaller degree, obstetrical, perspectives on unassisted birth, focusing on how birth attendants who are sympathetic to UC reconcile that with their training and experience attending births. Unassisted birth has changed the core questions we need to ask about birth. Instead of home or hospital?, natural or epidural? , or midwife or obstetrician? , questions asked by existing models of childbirth, unassisted birth poses a different set of core questions: Is birth disturbed or undisturbed? Is it social or intimate? managed or intuitive? attended or unattended?

iv TABLE OF CONTENTS

LIST OF TABLES vi

LIST OF FIGURES vii

LIST OF ABBREVIATIONS viii

CHAPTER 1: INTRODUCTION 1

Terminology 4 How Common Is Unassisted Birth? 7 My Background 12 Sources and Methods 17 Chapter Overviews 24

CHAPTER 2: THE EMERGENCE AND EVOLUTION OF UNASSISTED BIRTH 33

Natural Childbirth 36 Midwifery in the U.S. and Canada 39 Important Figures in Unassisted Birth 42 It’s Mental: Painless, Fearless Birth 44 Home Birth Advocates: UC as a Springboard to Home Birth Midwifery 52 Intimate Birthing 56 Freebirth: Every Mother Her Own Midwife 62 Failings of Midwifery 65 Other Authors 67 Organizing, Advocating, and Educating 69 Is UC a Movement? 73

CHAPTER 3: DISCOVERIES, JOURNEYS, AND TRANSFORMATIONS 92

The Discovery 95 Role of Previous Birth Experiences in Choosing UC 98 Birthrape: UC as the Final Safe Haven 104 Cornered Into UC 114 The Transformation 118 Prenatal Care 122 Women Who Leave UC 131 UC and the State 139 Core Values and Beliefs 144 The Internet as a Tool for Education, Awareness, and Support 149

CHAPTER 4: INTUITION AS AUTHORITATIVE KNOWLEDGE IN UNASSISTED BIRTH 155

v Authoritative Knowledge 157 Intuition in Childbirth 163 Intuition and Unassisted Birth 168 Varieties of Intuition 170 Embodied Knowledge 179 The Limits of Intuition 188 Conclusion 194

CHAPTER 5: SAFETY, RISK, & RESPONSIBILITY 196

Medicine as Progress 200 Midwifery as (Safe) Tradition 205 Using the “Language of the Aggressor” 211 Safety in Unassisted Birth 214 Selfish Mothers 235 Reframing Risk and Responsibility 238 Birthing Free of Monopoly and Compliance 256

CHAPTER 6: RECONCILING MIDWIFERY AND UNASSISTED BIRTH 261

Mythological Midwifery 263 Midwifery Perspectives on Unassisted Birth 274 Birth Attendant Profiles 280 Doing Less 292 Reconciling Midwifery with Unassisted Birth 299 Assisting UC Families 305 Conclusion 311

CHAPTER 7: BEYOND THE MEDICAL/MIDWIFERY MODELS OF BIRTH 317

APPENDIX A. UNASSISTED BIRTH SURVEY 333

APPENDIX B. SURVEY ABOUT UC FOR BIRTH ATTENDANTS 335

APPENDIX C. BIRTHRAPE SURVEY 337

BIBLIOGRAPHY 339

vi LIST OF TABLES

Table 1 Survey Participants’ Highest Completed Educational Levels 19 Table 2 Percent of Births Occurring in Hospitals in the U.S. 34 Table 3 English Language Media Reports About Planned Unassisted Birth 74 Table 4 Books Mentioning Unassisted Birth 83 Table 5 Most Common Reasons for Choosing UC 94 Table 6 Planned Location of First Baby’s Birth 99 Table 7 Books and Journal Articles That Mention Birthrape 107 Table 8 Unassisted Prenatal Care Activities 126 Table 9 Important Parenting and Lifestyle Practices 146 Table 10 Outcomes of Planned Unassisted Births 219 Table 11 Technocratic, Humanistic, and Holistic Models 324 Table 12 UC Model of Birth 329

vii LIST OF FIGURES

Figure 1 Unassisted Birth Circle 3 Figure 2 The Birth Pyramid 327

viii LIST OF ABBREVIATIONS

AAFP American Association of Family Physicians AAMI Ancient Arts Midwifery Institute ACNM American College of NurseMidwives ACOG American College of Obstetricians and Gynecologists AIMS Association for Improvements in the Maternity Services AMA American Medical Association AP Attachment Parenting CNM Certified NurseMidwife CPM Certified Professional Midwife CPS Child Protective Services DEM Directentry (nonnurse) midwife EDD Estimated date of delivery/estimated due date FHT Fetal heart tones (fetal heart rate) FSBC Freestanding birth center HBAC Home birth after cesarean IUGR Intrauterine growth restriction JBLI Joyous Birth League International L&D Labor & Delivery LDRP Labor/Delivery/Recovery/Postpartum LDS LatterDay Saint (Church of Jesus Christ of LatterDay Saints) LLL La Leche League LM Licensed Midwife MDC motheringdotcommune forums

ix NAPSAC InterNational Association of Parents & Professionals for Safe Alternatives in Childbirth NARM North American Registry of Midwives NICU Neonatal Intensive Care Unit NN/NNII The New Nativity/The New Nativity II RANZCOG Royal Australian and New Zealand College of Obstetricians and Gynaecologists RCM Royal College of Midwives (UK) RGOG Royal College of Obstetricians and Gynaecologists (UK) RIF Reinvented family SOGC Society of Obstetricians and Gynaecologists of Canada TOL Trial of labor (i.e., laboring after a previous cesarean) UBAC Unassisted birth after cesarean UC Unassisted childbirth/unassisted birth UHB Unassisted home birth VBAC Vaginal birth after cesarean

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CHAPTER 1 INTRODUCTION

Home birth in North America is a relatively uncommon phenomenon—around 1% of all births—and home birth intended to occur without midwives or doctors present is even rarer. Unassisted childbirth, as it is most commonly called, is supported by a small but vocal grassroots movement that began about a half century ago. Unassisted birth arises out of a deep trust in the inherent safety of the birth process and a belief in women’s innate ability to give birth. It is also a reaction to the increasing medicalization of pregnancy and birth. A simple definition of unassisted birth (often abbreviated as UC for “unassisted childbirth”) is childbirth without a midwife or doctor in attendance. However, that definition alone is both too wide and too narrow. Unassisted childbirth is as much a process as it is a discrete physical act. It usually does not refer to births in taxicabs or cars on the way to the hospital, or hospital births where the baby emerges when the doctor is out of the room. Nor does it refer to most unplanned UCs at home, where the midwife does not arrive in time; these are usually qualified as “unplanned unassisted births.” Within the UC community, there is disagreement about what births qualify as unassisted. For example, if a woman hires a doula for her UC, some might argue that it’s not unassisted because doulas are paid birth professionals. Doulas do not perform clinical tasks such as checking cervical dilation or monitoring fetal heart tones. Instead, they are hired to provide nonmedical services such as emotional support, information, physical comfort measures, and companionship during the prenatal, birth, and postpartum periods. During an online discussion about what constitutes a UC, Marguerite commented: When you pay someone it is hard for everyone to get out of the “patient/professional” or even just “customer/provider” mode. The provider always

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feels the need to “provide” and the customer feels the need to find something for the provider to provide. Even if you think it’s not going to matter, the structure of the relationship will have a subconscious effect on what is going on. 1

Others have argued that because doulas are not clinically or medically trained, their presence does not disqualify a birth from being a UC. Another area of contention is whether a home birth with a handsoff midwife can be a UC. If the midwife stays in another room the whole time and does nothing to manage or direct the birth, is that a UC? What if the midwife stays in the driveway? On call at a local café? An overarching theme in these debates about how to define unassisted birth is that of freedom: freedom from institutional procedures, freedom from guidance or management by medical professionals, freedom from rules. Valarie Nordstrom, editor of the unassisted birth newsletter The New Nativity II, commented: “In UC, it’s all about deciding to step outside of the conventional framework and totally do your own thing.” Another UC mom, Suzie, added: “the biggest thing is that WE the birthing moms are in control and there are NO medical trained persons there telling us what to do.” 2

Rather than adhere to a strict set of rules about what does or does not qualify as a UC, I have created the following model (see Figure 1). The births in the inner circle are indisputably unassisted births: ones with no paid attendants present, in which the mother directs the course of her own birth. Births with friends or doulas present are also generally considered as unassisted births. At the outside of the circle is a grey area where other kinds of birth experiences may overlap at times: unattended home births where the husband or partner acts in the role of a birth attendant (checking dilation, assessing fetal heart tones, or

1 Marguerite, “yay!! I found...,” cbirth, July 7, 2005. Cbirth is located at http://groups.yahoo.com/group/c birth . 2 Valarie Nordstrom, “New Intro Description and Hi Dina...,” cbirth, January 13, 2005. Suzie, “UC theory,” c birth, December 28, 2004.

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Figure 1: Unassisted Birth Circle

instructing the woman when and how to push), some quasiaccidental unassisted births (where the woman purposely or subconsciously doesn’t call the midwife in time), or home births with a handsoff midwife in another room or on call nearby. It isn’t my desire to draw a clear line anywhere in this model; rather, it will illustrate that there are a variety of experiences, some of which are clearly UCs and others which include elements of UC. My dissertation focuses mainly on those births in the central part of the circle—births planned to have no midwife or physician present. The only births that I deliberately excluded (from

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those who filled out the survey on UC, for example) were accidental UCs and home births with midwives. Terminology Although I examine the key figures in UC thought in chapter two, I want to briefly touch upon the terminology they used and note how it has changed and evolved. In her 1956 book Come Gently, Sweet Lucina, Patricia Carter used several different phrases to describe the way she gave birth. She began by discussing natural, normal, undisturbed birth—a birth with no deterrent to “functional efficiency.” She argued that a truly undisturbed birth should have no labor (as in hard, arduous work) and very little pain. In fact, she also called her preferred way of birthing fearless, happy, painless childbirth and invented a synonym for that idea: euthagenesis. Elsewhere in her book she advocated pro-instinct birth and a brainless, will-less birth. Despite all of these descriptions, Carter never settled on a single, concise term. Marion Sousa’s 1976 book Childbirth At Home favored the phrase “home childbirth,” but that term encompassed both attended and unattended home births. She also used the terms “unattended home birth,” “unassisted home birth,” and “doityourself childbirth” once or twice each in her book. Marilyn Moran’s focus on birth as an essential part of a marriage relationship shows in her terminology. Moran preferred husband-wife childbirth, although genital love gift and DIY birth came in a close second in her 1981 and 1997 books. 3 Jeannine Parvati Baker coined the term freebirth, using it as both a verb and a noun. I have not been able to pinpoint exactly when she first started using that word, although it was some time after the

3 Marilyn Moran, Birth and the Dialogue of Love (Leawood, KS: New Nativity Press, 1981), Pleasurable Husband-Wife Childbirth: The True Consummation of Married Love (Leawood, KS: New Nativity Press, 1997), and her edited collection of birth stories Happy Birth Days: Personal Accounts of Birth at Home the Intimate, Husband/Wife Way (Leawood, KS: New Nativity Press, 1986).

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unassisted births of her last two babies in 1984 and 1986. 4

After Laura Shanley published Unassisted Childbirth in 1993, the term “unassisted” stuck. She commented: “When I first submitted my book to my publisher I had never heard the term ‘unassisted childbirth.’ My editor titled the book and I said “OK” for lack of anything better!” 5 Shanley was not entirely satisfied with those terms, but has not found a better alternative. In some limited midwifery contexts, the term “unassisted birth” can mean a birth with a midwife present, in which the mother catches her own baby, so at times it might lead to confusion. 6 Lynn Griesemer (Unassisted Homebirth, 1998), Hygeia Halfmoon (Primal Mothering In a Modern World, 1998), and Laurie Morgan (The Power of Pleasurable Childbirth, 2003) all adopted unassisted birth or unassisted homebirth in their books. The only new term to arise since Shanley’s book is midwife Zuki Abbott’s “parent assisted birth” in This Sacred Life (2007), but I have not seen it used much outside of her own book and website. 7

Some other less common words currently in circulation include DIY birth, unattended home birth, and pure birth. 8 DIY birth seems to have fallen out of use within the UC community, probably due to its connotations with home renovating. Instinctive birth, raw birth,

4 In a tribute to Parvati after her death, Mothering’s website noted that “after the water births of her last two babies, Jeannine’s work became focused on freebirth birth unassisted by a paid professional.” “News Bulletin,” Mothering, December 2005, http://www.mothering.com/sections/news_bulletins/december2005.html#jpb

(accessed August 15, 2008). 5 Larua Shanley, “‘Freebirth’ or ‘Unassisted’?” motheringdotcommune forums (MDC), April 28, 2005, http://www.mothering.com/discussions/showthread.php?t=279140 . 6 Jan Tritten, editor of Midwifery Today, noted an alternate use of the term in Europe: “In Germany I spent time with Cornelia Enning, a brilliant midwife who has been doing homebirths for more than 25 years....She has been doing ‘unassisted births’ for her whole practice. In Europe ‘unassisted’ doesn’t refer to ‘no’ midwife present at the birth as it does here, but really ‘mother assisted.’ In other words, the mother ‘delivers’ or ‘catches’ her own baby.” Jan Tritten, “Editorial: Birth Odyssey,” Midwifery Today, no. 58 (Summer 2001): 1. Also see discussions about UC terminology on the Yahoo group “doula” (http://health.groups.yahoo.com/group/doula/ ) in late February 2007. 7 Zuki Abbott, “This Sacred Life,” http://www.thissacredlife.com (accessed August 1, 2008); This Sacred Life: Transforming Our World Through Birth (Wisdom’s Birth Keepers, 2007). 8 The term often used by Australian UCers.

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or undisturbed birth (a favorite of Dr. Sarah Buckley’s in her 2005 book Gentle Birth, Gentle Mothering) are terms that capture the spirit of UC, but they could also apply to some attended births. In fact, the journal Midwifery Today recently dedicated an entire issue to instinctive birth, featuring both midwifeassisted and unassisted births. 9 One of my personal favorites, although not one I use in the dissertation, is autonomous birth, first used as a chapter title in Laura Shanley’s book. Linda Hessel, a twotime UCer, is currently writing a book with that same title. On her Autonomous Birth blog, she described her choice of terminology: The dictionary definition runs something like this: “selfdirected; not subject to control from outside; existing and functioning as an independent organism.” And to my delight, “produced by internal forces or causes; spontaneous,” and in that sense related to the word “autonomic,” which is used in biology to refer to bodily systems that are not under conscious control. 10

This term also shifts the boundaries beyond strict UCs, as it can encompass some births where attendants are present. I use the terms unassisted birth, unassisted childbirth and UC/UCer, unless I am citing a direct quote, because they are the most widely used today. I decided to use the most common term mainly for practical reasons. The concept of birthing without midwives or physicians present is radical enough that adopting a lesserused term would be too distracting or confusing to my audience. I do have some issues with the term unassisted, though. My predominant concern is that unassisted birth is a negative term, referring to what it is not—birth without medical professionals—rather than what it is. It also reinforces assisted birth as the normative experience, as the way birth is. (Of course, both numerically and historically, assisted birth is the norm.) One woman on a UC board commented: “I can’t

9 Midwifery Today, no. 68 (Winter 2003). 10 Linda Hessel, “Terminology,” Autonomous Birth blog, September 7, 2006, http://autonomousbirth.blogsome.com (accessed October 1, 2007). Hessel has temporarily taken down content on this blog.

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help but feel like calling it ‘unassisted’ birth is like calling an intact penis “‘uncircumcised.’” Another added: “it’s a little like someone who is gay being described in terms of non heterosexuality, or someone of colour being described as nonwhite.” 11

While I was writing this dissertation, freebirth experienced a renaissance in media articles and now rivals unassisted birth in frequency of use. Freebirth captures the nebulous, borderless spirit of unassisted birth, although its vagueness is a significant weakness. Does free mean unpaid? Free from what or whom? It also has, in the words of one UCer, “crunchy granola hippie” overtones. 12 The term remained largely out of circulation until a May 2007 examination of the “growing trend of freebirth” in The Guardian, 13 a national daily newspaper in the UK. Since then, the media in the British Commonwealth (UK, Australia, New Zealand, and Canada) have been using freebirth with increasing frequency, while the American media has generally stuck with unassisted birth. UC and unassisted birth are still the terms of choice among women on internet boards and discussion groups. How Common Is Unassisted Birth? The short answer is that we do not know, and probably never will with any degree of certainty. This is an extraordinarily difficult question to answer because of the nature of UC. There are no institutions, professionals, or organizations that collect reliable numbers on unassisted births. Birth certificate data can only give a rough and highly inaccurate picture of the frequency of unassisted birth. Although it is the only comprehensive source for estimating how many UCs occur annually, birth certificate data can be unreliable. Some of the “unattended” births could be precipitous births that occurred before the woman could

11 Poppy (Arwyn) and Carrie (JanetF), “‘Freebirth’ or ‘Unassisted’?” MDC, April 27 & 28, 2005. 12 Justina (MamaTaraX), “‘Freebirth’ or ‘Unassisted’?” April 27, 2005. 13 Viv Groskop, “Going It Alone,” The Guardian, May 9, 2007.

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leave for the hospital or while her midwife was in transit. In states where home birth midwifery is prohibited, midwives often do not sign birth certificates, which artificially inflates the number of unattended home births that appear on birth certificate data. 14 On the other hand, some UCers obtain assistance with their birth certificates from friendly midwives or doctors, which could skew the data in the other direction. Finally, a small number of UCers decide not to complete birth certificates at all, preferring that the state remain completely out of their children’s lives. We know that approximately 12% of the U.S. and Canadian population births at home. 15 The number of UCs is certainly not in the tens of thousands. 16 The maximum possible number of UCs per year in the United States is around 8,000, but it is likely lower than that. In 2005, the National Center for Health Statistics reported that 24,468 babies were born at home, based on birth certificate data; 14,677 of those births had a midwife in attendance, 7,233 home births had attendants listed as “other,” and an additional 790 attendants were recorded as “unspecified.” 17 Laura Shanley has noted that in Colorado, Wyoming, and Arizona, approximately onethird of all home births have no professional attendant listed on the birth certificate. Based on this information, Shanley has estimated that there are 5,000 UCs per year in the United States. My guess is that those two numbers

14 In Iowa, where midwifery is currently deemed the practice of medicine without a license, most of the states’ directentry midwives agreed not to sign birth certificates. The father usually signs as the attendant. I learned this through attending Iowa Midwives Association meetings and apprenticing with a directentry midwife in Iowa. 15 The rate of home birth is about 1.6% in Ontario, where home birth midwifery is currently legal and regulated. Joanna Zuk, Senior Communications Officer for the Association of Ontario Midwives, email message to author, October 9, 2008. 16 About 4 million births occur each year in the U.S, so 1% of that number is 40,000. This might be a low estimate, as I have seen the number of home births estimated between 1 and 2 percent. On the other hand, 2005 U.S. data show a number of less than 1%. See J.A. Martin, et al., “Births: Final Data for 2005,” National Vital Statistics Reports 56 no. 6 (Hyattsville, MD: National Center for Health Statistics, 2007). 17 Martin, et al., 70.

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are both a bit high, since these “other” and “unspecified” birth certificate categories include unplanned unassisted home births and “under the table” midwifeattended births. On the other hand, I would estimate that it is higher than a few hundred, based on the volume of birth announcements I have seen while immersed in UC culture and online communities. When other researchers or journalists have pressed me for a numerical estimate, I have put the number at up to a few thousand in the U.S. I cannot provide hard numbers either way, however. Statistical uncertainty is inherent in the nature of unassisted birth. I anticipate some objections to my project because of this uncertainty; if I cannot even give a reasonably accurate estimate of the frequency of UCs, then what worth is the project? As frustrating as this elusiveness is for me, and probably for many in the academic community, it is a core characteristic of unassisted birth. Unassisted birth is truly off the grid in many ways: it lies outside of social control, governmental surveillance, and medical or professional supervision. It challenges canonical knowledge about birth, moving outside the boundaries of both obstetrical and midwifery texts and practice. Another related question is whether or not UC is becoming more common. Without accurate numbers, we cannot answer with any degree of certainty. Recent news articles and television reports about UC have claimed that it is a growing movement, which I discuss more in chapter two. I find this interesting, as the reporters have access to the same information I do. Do they report that it’s growing because more people are talking about it in the media? Because certain key figures within the UC community told them that it is growing? Because it makes for a better story? I would probably agree that UC is growing in number, as well as in familiarity. But that conclusion is an intuitive guess based on years of immersion in the topic rather than on concrete data. If unassisted birth is so rare—less than onethird of one percent of all births—why

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bother studying it? After all, women who give birth without medical or midwifery assistance are “the fringe on the fringe,” as one unassisted birther so aptly put it. My first justification is that the unassisted birth movement has an influence that extends far beyond its small numbers. It has inspired some midwives and doctors to radically change their philosophical approach to birth, which then significantly affects the way they practice. There is something noticeably different even between midwifeassisted and unassisted home births, enough that childbearing women and care providers have remarked upon it. Reviewing a documentary about unassisted birth, A Clear Road to Birth, 18 Canadian midwife Gloria Lemay commented: I came away from it with questions about how my presence at a birth affects the behavior of all the participants. The women on this film are not asking, “How much longer will it be?” They are not saying, “I can’t do it anymore.” There is no illusion or possibility of some other woman “saving” them. They are going to do it themselves, and they seem to have an inner core of resolve about it….This is unlike births where there is an “expert” present, and the waiting and watching seem to go on forever. 19

As I discuss in chapter six, exposure to unassisted birth leads sympathetic midwives and doctors to do less during births, to question routine procedures (including seemingly innocuous things like putting hats on newborns or suggesting positions to the laboring mother), and to trust that the birthing mother knows what to do and how to do it. Second, the current birth climate in North America is leading, and sometimes forcing, more women to consider unassisted birth. The policies and routines common in many hospitals—such as electronic fetal monitoring, IVs, denial of food or drink during labor, pressure to induce or accelerate labor, confinement to bed, pushing while lying down, or separation of mother and baby—drive some women away. Alternatives such as home

18 The documentary produced by Judy Seaman (Keyframe, 2000) is a collection of unassisted birth videos (mostly home videos) and interviews with UC moms and key figures in the UC movement, including Jeannine Parvati Baker and Laura Shanley. 19 Gloria Lemay, “Interventions,” Midwifery Today, no. 63 (Autumn 2002): 9.

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birth midwifery or freestanding birth centers are becoming more common in both Canada and the U.S., but many states and provinces still restrict one or both. Some women who would prefer but cannot obtain a midwifeattended home birth or a freestanding birth center choose unassisted birth rather than use a hospital’s services. UC is also an increasingly common choice for women with prior cesarean sections, as VBACs (vaginal births after cesarean) are not allowed in many U.S. hospitals. 20 In places where, on top of a VBAC ban in hospitals, home birth midwives are not legal, not available, or not allowed to attend VBACs, a woman’s only other option besides a mandatory repeat cesarean section is to birth without professional assistance. Unassisted birth also serves as a safe haven, sometimes the only one, for women who have experienced abuse, manipulation, or harassment in previous births. Third, the choice to birth unassisted does not arise in a vacuum. It is strongly correlated with other behaviors and lifestyle choices, including breastfeeding, stayathome parenting, home schooling, ecological consciousness, and alternative medicine. These behaviors signal a profound disillusionment with conventional social and medical norms that extends beyond birth practices themselves. Instead, UC is part of a larger critique of modern institutions, including medicine, government, education, and consumerism. A final reason to study UC—and the overarching thesis of this dissertation—is that unassisted birth presents a radically new worldview or paradigm of birth. Currently accepted conceptual models of birth refer to a spectrum of beliefs ranging from medical/technocratic to midwifery/holistic approaches. First articulated by Barbara Katz Rothman and fleshed

20 This is due to a 1999 ACOG recommendation that the woman’s physician and anesthesiologist be “immediately available” throughout the entire labor for VBACS. Although the recommendation had no scientific justification, many hospitals adopted it. In practice, only large tertiary hospitals could meet the requirement for roundtheclock inhouse anesthesia. American College of Obstetricians and Gynecologists, “Vaginal Birth After Previous Cesarean Delivery,” ACOG Practice Bulletin no. 5 (Washington, DC, July 1999): 8 p.

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out by Robbie DavisFloyd, 21 this model makes sense of the various approaches to childbirth held by both care providers and parents. Unassisted birth, however, falls outside that conceptual model. As the endpoints of the spectrum shift to accommodate unassisted birth belief systems, so also do the basic ways in which we understand and interpret birth. My Background During my first year as a PhD student at the University of Iowa, a graduate student colleague introduced me to the world of midwifery and home birth. I was immediately fascinated. I began reading anything I could get my hands on: midwifery textbooks, scholarly articles, medical studies, and birth stories. I started teaching a unit themed around childbirth as part of my freshman rhetoric course. In the fall of 2003, I trained to become a doula through DONA International. I attended my first hospital birth as a doula that winter and my first home birth a few months later. In the spring of 2004, I started an apprenticeship with a directentry “underground” midwife that lasted until I moved a year later. I attended state midwifery association meetings, observed peer review sessions, and acquired handson skills such as neonatal resuscitation. I also assisted a home birth certified nursemidwife (CNM) in Illinois. The culmination of this handson “apprenticeship” to birth came when I gave birth to my daughter at home, unassisted, in the fall of 2006. While doing my graduate student coursework I focused on childbirth at every opportunity. I wrote about the architecture of birth spaces, communication styles of home birth midwives, freestanding birth centers, midwifery history and legislation, and the predominance of biomedical interpretations of childbirth. One of my two fields of study for

Full document contains 370 pages
Abstract: Unassisted childbirth--giving birth at home without a midwife or physician present--emerged as a movement in mid-20th century North America. While only a small number of women choose to give birth unassisted, its significance extends far beyond its numbers. Unassisted birth illuminates trends in maternity care practices that drive, and sometimes force, women to choose unassisted birth. It also is part of a larger set of connected values and lifestyle choices, including home schooling, breastfeeding, co-sleeping, ecological awareness, cloth diapering, sustainable living, and alternative medicine. Finally, the emergence of UC as a conscious birth choice requires a re-examination of how we understand, frame, and interpret childbirth paradigms. There is very little written about unassisted birth in the academic world, although media reports on the practice have become increasingly prevalent since 2007. This dissertation begins the conversation for a scholarly inquiry into unassisted birth. My research is based primarily on interviews, essay-response surveys, and archives of internet discussion groups. After setting unassisted birth in historical context, I explain why women make this choice; the knowledge sources they privilege; how they understand the concepts of safety, risk, and responsibility, and their complex and sometimes contradictory relationship with midwifery. I also examine midwifery, and to a smaller degree, obstetrical, perspectives on unassisted birth, focusing on how birth attendants who are sympathetic to UC reconcile that with their training and experience attending births. Unassisted birth has changed the core questions we need to ask about birth. Instead of home or hospital?, natural or epidural? , or midwife or obstetrician? , questions asked by existing models of childbirth, unassisted birth poses a different set of core questions: Is birth disturbed or undisturbed? Is it social or intimate? managed or intuitive? attended or unattended?