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By now, you’ve probably discovered there are a number of ways to birth your baby. Some people deliver in hospitals or at birth centers. Others choose to do it at home with a midwife attending. And some may end up delivering surprise-style in cars, at home, or elsewhere.

Unassisted childbirth is yet another option some people are choosing. While it may look similar to the surprise scenarios, it’s actually quite planned out and intentional.

Here’s what you need to know about unassisted birth, why some people choose it, what the risks are, and whether or not it’s legal in the United States.

Unassisted childbirth (UC) also goes by the names freebirth or DIY birth. In its most basic definition, UC is intentionally birthing at home without a doctor, midwife, or other trained health professional in attendance.

In 2017, 1 out of every 62 births in the United States happened outside of a hospital — amounting to 1.61 percent of births. Those included births in birthing centers, at home (both planned and unplanned), and a few in “other” or unreported locations.

While there aren’t exact numbers for how many of those deliveries were purposefully unassisted births, data indicates that back in 2007, up to 33 percent of all home births in the United States were unassisted. That was 8,708 births not attended by a physician or a midwife.

Birth without medical assistance does happen in surprise or emergency scenarios, of course. But some two-thirds of these unassisted births were reported as “planned.”

According to The American College of Obstetrics and Gynecology (ACOG), approximately 35,000 births occur at home each year, and of those, approximately one-fourth are unplanned or unattended.

Reasons pregnant people may choose an unassisted birth are deeply personal. Some have roots in bad previous experiences with doctors or hospitals or concerns about the safety of birthing parents.

Others may be out of a desire to eliminate interventions, like induction or cesarean section. Some people are interested in freebirth because of the high cost of care during pregnancy and birth. And some simply want to take the clinical aspect out of the birth experience.

Those who choose UC may or may not choose to get regular prenatal care during pregnancy. Again, whether they seek medical advice, testing, or information is often related to their personal reasons for choosing unassisted birth.

Whatever the case may be, the end goal of an unassisted birth is the same: For the pregnant person to guide the birthing and delivery processes themselves, however they see fit.

It’s important to understand that most doctors do not recommend freebirth. Dr. Vyta Senikas, the past vice president of the Society of Obstetricians and Gynaecologists of Canada, said that “unassisted childbirth is unsafe — period.”

ACOG shares their guidance that there are certain situations where any type of home birth, including UC, is particularly unsafe. They include fetal malpresentation (breech, for example), multiple gestation (twins, triplets), or a previous cesarean delivery.

ACOG acknowledges that each individual has a right to make an informed decision about delivery, but stress the importance of understanding who is a good candidate and ensuring the availability of certified providers in case of emergency.

What about doulas?

You may also be wondering how birth doulas fit into the equation. If you’re unfamiliar, doulas are knowledgeable birth support people.

Some expectant parents choose to employ a doula to help them physically and emotionally through the rigors of labor and birth. Doulas do not perform any clinical or medical procedures.

Doula certification organization DONA International does not prohibit its members from attending freebirths.

Instead, DONA International notes, it’s up to each doula to make the decision on whether or not to participate. They encourage their members to consider the legal and medical issues that can arise as a result of an unassisted birth.

Be clear with your intentions when looking into a doula so they know your birth plan. For some, attending a freebirth may void their liability insurance coverage.

A doula is in no way a replacement for a midwife or other health professional. Be sure to ask your doula to explain their scope of practice to you.

If you are looking for any medical support, consider finding a midwife or doctor.

Laura Shanley, birth consultant and author of the book “Unassisted Childbirth,” contends that birth is emotional, spiritual, and even sexual in nature.

“The very act of observing [birth] changes it,” she says. For this reason, many giving birth may see the main benefit of UC as freedom from rules, judgement, fear, and other aspects of the birth experience.

Possible benefits of UC:

  • Provides privacy for the person giving birth. While the trend in hospitals and in other birth environments seems to favor including lots of people, often strangers, some people prefer a more intimate and personal setting during childbirth. Some even opt for a solo birth, laboring and delivering completely alone.
  • Allows control over visitors. On the other hand, some wish for birth to be a broader celebration. There are often limits on who can be in the room during and after delivery. Unassisted births can include absolutely anyone the family chooses at any stage of the process.
  • Empowers the person giving birth. Without a doctor or midwife, the person in labor decides how they approach birth. They are able to decide when and how to push, what position to assume, and where to do it all. Shanley explains that those she’s interviewed describe freebirth as the “most fulfilling experience of their lives.”
  • Addresses previous birth trauma and fears regarding care. A 2017 study uncovered an underlying theme of fear expressed by those who choose UC. This fear surrounds both bad outcomes and conflicts over birth plans. Birthing outside the hospital setting and without medical personnel may alleviate those fears.
  • Permits unconventional augmentation/pain relief methods Shanley explains that some couples choose to engage in sex during labor as a way to stimulate contractions. Sexual stimulation floods the body with oxytocin, which is the primary hormone of labor. Oxytocin stimulates uterine contractions. Its synthetic form, Pitocin, is often used to induce or augment labor contractions in the hospital setting. Studies show that oxytocin may also provide pain relief.
  • Costs nothing. Recent reports show that hospital births may cost over $4,500 — even with medical insurance. Aside from a few inexpensive supplies, unassisted childbirth is essentially free.

It’s worth acknowledging that there’s another option that can offer most of these same benefits. Midwife-attended home births offer people an empowering, low intervention birth experience in a familiar environment.

Okay, so people probably don’t want to have sex in front of their midwives, and it’s generally not free, but otherwise it offers the same benefits as an unattended birth.

Plus, you get the added benefit of having on hand a trained medical professional who has the skills and equipment necessary to deal with many medical complications that might arise.

The biggest risk of an unassisted birth is death of the baby, the mother, or both. Though estimates vary, 10 to 40 percent of home births require transfer to a hospital due to complications.

And not all complications come with warning signs that are evident to the untrained eye.

One way to decrease your risk of experiencing complications that might result in a negative outcome is to have a birth attended by a midwife or other medical professional.

That way if there is an emergency scenario you’ll have a medically knowledgeable person on site with the training and tools to respond.

Otherwise, it’s a good idea to be in communication with an OB-GYN and have an emergency plan in place should the need arise.

Who’s not a good candidate for home birth?

While this isn’t an exhaustive list, the American College of Nurse-Midwives notes that you are not a good candidate for a home birth if:

  • You’ve previously experienced a stillbirth, a C-section, a shoulder dystocia resulting in injury, or a severe postpartum hemorrhage.
  • You have an active herpes infection, preeclampsia, or gestational diabetes that requires medication.
  • You’re experiencing preterm labor.
  • You’re expecting multiples.
  • Your baby is breech or transverse.
  • There is evidence of fetal anomalies that require immediate assessment.

There aren’t laws specifically outlawing unassisted birth in the United States, although there are some states that have laws regulating home births and home birth midwives.

Different states may have different requirements. For example, some states require that the baby is taken to a doctor or midwife after birth to get a birth certificate.

The legality of it is a bit murky, too, when you consider that some unassisted child births may have been an accident or emergency, or reported as such whether intentionally planned or not.

Regardless, it’s a good idea to look up the rules for birthing outside a hospital or at home in your state.

Remember: Most doctors, midwives, and obstetric associations do not recommend freebirth — especially in certain situations, like if you’ve had a previous C-section or are expecting multiples.

Take your personal health and unique circumstances into consideration before you come up with your plan.

Basics

Prenatal care can identify and address any health concerns that may impact the safety of a home birth.

If cost is a concern, you may be able to find low cost or free services through community health centers or groups like Planned Parenthood. Pregnancy may also qualify you for low cost insurance through your state.

Working with a midwife may be an option to consider if you want to minimize clinical visits and birth interventions.

Many midwives offer visits in your home and will work with you as partners with the goal of a healthy birth at home with minimal intervention.

Emergencies

Preparing to birth at home means understanding when you may need to call for medical help in an emergency. Even if your desire is for an unassisted birth, an emergency plan is important.

You want to have this type of plan in place well before you’re in labor so you aren’t scrambling in the midst of a health crisis.

Your plan might include things like:

  • When to call emergency help. (Ask yourself at what point or due to what type of complication would you consider your situation an emergency.)
  • What hospital is nearest to you or — alternatively — what hospital would you prefer to use if necessary.
  • Contact information for your doctor or midwife (provided you’ve had routine care throughout your pregnancy).
  • What transportation you plan to use (if your complication is non-emergent).
  • Any instructions if you need to arrange care for other children in your home if you are transported to a hospital.

While hospitals and birth centers are often considered the safest places to give birth, you do have the right to choose how and where you bring your baby into this world. Freedom of choice is important, especially if you have had bad experiences in a medical setting.

That said, take time to consider your health, your pregnancy history, and other unique situations as they apply to your desire for an unassisted birth.

Consider writing out the pros and cons as they apply to you and your situation. Researching alternatives may help you feel more empowered regardless of the setting and provider you ultimately choose.