Wednesday, May 16, 2007

DIY delivery


From Tuesday's Globe and Mail

BURNABY, B.C. — When Nicole Becker felt the pangs of late labour in January, she lit candles in the bathroom of her two-bedroom flat in Burnaby, B.C., and filled the tub. Only her husband and the couple's four-year-old son looked on as baby George slid into the water. "It was my dream birth," Ms. Becker says.

Ms. Becker planned throughout her pregnancy to give birth without a midwife, doctor or other birth attendant. After using a doula for her first child's home birth, Ms. Becker decided that the job of a good midwife is to "let the process happen," she says. So with George she decided to go solo.

Choosing to deliver without skilled help remains a controversial and uncommon choice. But now, spurred by the Internet, unassisted childbirth is reaching a broader range of women than ever before.

On sites such as Birthjunkie.com, Mothering.com and Trustbirth.com, women trade tips on such topics as how to measure the uterus to calculate the due date and how to figure out if the baby is breech. One of the most popular sites, Unassistedchildbirth.com, now has 30,000 to 40,000 visitors each month.

Many women join one of nearly 100 Yahoo groups that list unassisted childbirth in their subject lines, including UCbirthnews, an online newsletter with over 1,110 members. They also browse online for books, videos and do-it-yourself resources such as Unhindered Childbirth - The Online Childbirth Class (at Unhinderedliving.com) as well as inflatable birthing pools.

"People who wouldn't have considered this years ago are considering it now," says Laura Shanley of Boulder, Colo., who wrote the influential book Unassisted Childbirth in 1994 and runs the website Unassistedchildbirth.com.

Until recently, "I was hearing more from hippie types, people more on the fringe," says Ms. Shanley, who gave birth to five children without medical attention - including one breech presentation. "I do think it's getting more into the mainstream."

But most doctors and registered midwives strongly oppose the practice. Skilled attendants play a crucial role in identifying problems such as hemorrhages and fetal distress before they become emergencies, they say.

In a few cases, child welfare authorities in Canada and the United States have investigated parents who planned unassisted births.

Although there are no large or recent studies on the outcomes of planned unassisted childbirth, the evidence stacked against the practice is "overwhelming," according to Vyta Senikas, associate executive vice-president for the Society of Obstetricians and Gynecologists of Canada.

Dr. Senikas questions the rationale for choosing unassisted childbirth. "By all means, choose the home," she says, "but have a skilled attendant there."

Childbirth is a natural process, she adds, "but you can die and you can end up having problems."

Advocates of unassisted birth say that any medical interference, no matter how well-meaning, can disrupt the instinctive and hormonal processes of labour, triggering a stress response that halts the birth's progress. They believe that widespread use of interventions that slow labour can contribute to higher rates of C-section.

Adherents base their beliefs on the writings of authors such as French obstetrician Michel Odent, who wrote Birth Reborn in 1984. Although he does not specifically advocate unassisted childbirth, Dr. Odent says that in his practice, women who weren't observed in their labour had faster and easier births.

There is no way of knowing for sure how many Canadians are choosing to give birth unattended, since neither the federal nor provincial governments collect statistics on planned unassisted childbirth. But the rate is probably much lower than home births attended by registered midwives, which accounted for just 1.5 per cent of all deliveries in British Columbia and Ontario in 2005 and 2006.

Jodie Boychuk of Dunnville, Ont., says she chose an unassisted birth for her second child because of the difficult recovery following the cesarean delivery of her first daughter. In September, 2005, her second daughter was born at home into the hands of her husband, Richard. The labour was smooth and the 8½-pound baby was healthy, Ms. Boychuk says.

But the practice remains controversial enough to impel some midwives and authorities to intervene. When Ms. Boychuk declined the services of a registered midwife during her second pregnancy, the midwife - who questioned the safety of even an attended home birth after a cesarean - promptly called the Children's Aid Society.

A two-week investigation ensued, but it was dropped because unassisted childbirth is not illegal.

Even the staunchest advocates of the practice acknowledge that it's not for everyone.

Sarah Buckley, an Australian physician trained in obstetrics and author of the book Gentle Birth, Gentle Mothering, says a woman must be healthy and educated about birth to deliver unassisted.

As well, she says, the woman should be relaxed enough to avoid triggering the fight-or-flight response that can delay the birth, and should have a backup plan such as transferring to a hospital.

Registered midwives agree that too much medical intervention can impede labour - but they "cannot support the concept of unassisted, unattended births" due to the risks, says Elana Johnson, president of the board of directors of the Association of Ontario Midwives.

For Ms. Becker of Burnaby, the birth of her baby in January is still fresh in her mind. It was a joyful occasion to share with her husband and her son Max, she explains, and most of all, "it was just us."

1 comments on "DIY delivery"

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