Reviewed By Charlotte Grayson
Laura Shanley not only had her four children at home, but she birthed them without a doctor or midwife. Hunkered over a plastic tub, she even tugged out a breech baby by herself while her husband was away. This was decades ago, before home births, much less unassisted births, gained popularity.
Shanley, author of Unassisted Childbirth, is not alone, although she is still in a distinct minority, probably because of the significant risks perceived to be associated with this decision.
"Doctors think I am crazy," laughs Shanley. "But I believe childbirth is not inherently painful or dangerous unless there is interference from within or from outside."
"She sounds like one of those women who have an easy time," deadpans Marion McCartney, a certified nurse-midwife and director of professional services of the American College of Nurse-Midwives in Washington. "Most of us are somewhere in the middle, between easy and hard."
Shanley says she had not even planned on having children until she met her husband-to-be, who was exploring various issues of consciousness and turned her on to a book called Childbirth Without Fear by Grantley Dick-Read. That must have been quite a first date! "That book told me about the fight-flight response [changing muscle behavior in response to fear] and approached it all so logically," she recalls. "It made sense to me."
"People often contact me and say they are high risk," Shanley comments. "I don't tell them what to do: All I say is what I did." Shanley does argue, however, that a lot of problems that define high risk are the result of the overmedicalization of pregnancy and delivery. She mentions the confining belt monitors and sensors that are attached to the scalp of the emerging child. "Those can pick up variations that probably aren't dangerous at all," she claims. "If you become afraid, blood stops flowing to your uterus and labor is impeded. If I had had my breech baby in the hospital, they probably would have cut me open."
Most doctors and midwives would disagree.
Predictably, Shanley also had no prenatal care during her four pregnancies. "We call it 'prenatal scare,'" Shanley says.
The prenatal visits, McCartney points out, are when you learn how to stay healthy and have a healthy baby. The doctor or midwife will decide whether you are facing unusual risks. "It's hard to assess ahead of time what sorts of risks you face. The idea is to take away as many of the risks as you can take away."
Medical research and clinical experience demonstrate the profound benefits of prenatal care, and careful guidance during delivery, to both mother and baby. Medical practitioners, including physicians and midwives, have been emphasizing the importance of letting the pregnant woman guide her delivery -- including underwater births and the use of birthing rooms that are like a bedroom in a home. These advances have reduced the frequency of medical complications, while helping women have the childbirth they envision.
"I truly think women are treated like morons," counters Shanley. "You don't have to understand every aspect of pregnancy to relax and trust yourself. You don't understand every step of digestion, do you? You just trust that your food is being digested. The same 'intelligence' that caused the baby to grow so miraculously also will help the baby emerge. There is a force there that will shoot the baby out." Unfortunately, for many women childbirth is not that simple.
Affirmations -- and More
During childbirth, relaxation and guidance are key. Some contractions are painful, Shanley says. She started early in her pregnancies saying daily affirmations: "I believe I am not afraid. I trust myself. My body knows what to do."
Trying to encourage relaxation is a reason unassisted-birth believers don't want a doctor or midwife present.
Traditional medicine holds that a midwife or doctor can help with physical and emotional relaxation during childbirth. Prenatal classes that teach methods of breathing and relaxation are embraced and encouraged by most midwives and doctors.
But, Shanley counters, "Just as most couples would find it difficult to have sex with others in the room, many of them feel the same way about birth." Speaking of sex, during one of her labors, she and her husband had intercourse. "It just happened," she says, smiling. "Why not take advantage of your own natural resources?"
The American College of Obstetricians and Gynecologists (ACOG) has taken an official position on this -- that labor and delivery present potential hazards to mother and fetus before and after birth. "Those hazards," according to ACOG's Web site, "require standards of safety that are provided in the hospital setting and cannot be matched in the home setting."
Shanley says that many supporters of unassisted childbirth are reluctant to admit it.
Preventing Childbirth Hazards
One woman who does talk about unassisted childbirth, and remains an advocate, has had terrible experiences with it and describes herself sitting naked in a pool of blood surrounded by firemen responding to a hasty 911 summons.
One reason for the silence of other supporters is that unassisted childbirth is illegal in at least one state, Nebraska. "Yes, there is a law that says a father cannot catch a baby except in an emergency," Shanley confirms.
"We strongly recommend that a home birth be attended by someone who can assess a woman's needs and get her the level of care she needs as the birth progresses," says midwife McCartney. "There are risks in a hospital birth and risks in a home birth. The mother must decide what her comfort level is."
Given a caring doctor or midwife, these days a mother has many options that offer flexibility and the ability to have the childbirth of her dreams while protecting her health and the health of her baby.
Originally published April 15, 2002.
Medically updated February 2005.
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