Unassisted Childbirth - Controversy

Controversy

Controversy over the practice of UC has largely centered over whether it is, as claimed by proponents, a safe method of childbirth. Critics of UC, such as the Society of Obstetricians and Gynaecologists of Canada (SOGC), claim that unassisted childbirth is quite unsafe, and that those who engage in it are "courting danger". A spokesperson for the American College of Obstetricians and Gynecologists issued a one-word assessment of freebirth: "dangerous". The SOGC notes that more than 500,000 women worldwide die annually from complications during childbirth, and that even in developed countries, in which expectant mothers generally receive complete prenatal care, as many as 15% of all births involve potentially fatal complications. In poor countries in which there are conditions of malnutrition and taboos surrounding childbirth or there is a lack of qualified birth attendants, rates of maternal and infant mortality and complications such as fistula are much higher, with disparities in death rates from childbirth between developed and developing countries approaching two orders of magnitude. Critics also point out the high rates of complication and death arising from childbirth that existed before the development of modern medicine: between 1,000 and 1,500 deaths per 100,000 births.

UC proponents have responded to these criticisms by emphasizing that childbirth is not a disease, but rather a natural, physiological process requiring proper nutrition, hygiene, prenatal self-care, and psychological preparation. They claim that both throughout history and in the impoverished regions of today's world it has not been the lack of medical assistance, but rather conditions of poverty and nutritional ignorance which cause maternal mortality to be a major health issue. Rickets, for example, is prevalent in daughters of malnourished women, resulting in deformation of the pelvis and an increased chance of hemorrhage in scenarios of anemia. Proponents assert that the women who plan unassisted childbirth today (many of whom are giving birth to their second or third child, with a 'proven' pelvis), do so with a wealth of information and self-care, and are better prepared than most women who depend on care providers to deliver their child.

Proponents also claim that modern maternal mortality rates in American hospitals are often obscured by being statistically tracked under 'anesthesiology'. However, evidence suggests that if this is in fact the case, the practice is unlikely to account for more than a small fraction of maternal deaths: one study of maternal mortality records lists the 'total' share of maternal mortality deaths recorded as stemming from anesthesia-related complications as just 5.2%.

Other aspects of this response have also been called into question by scientific research. First, an analysis of historical data from Europe and the United States concluded that in developed countries, the main determinant of maternal mortality before 1937, and its decline since the 1930s, was not levels of poverty and associated malnutrition, but rather the overall standard of maternal care provided by birth attendants.

Second, with respect to UC proponents' claim that unassisted childbirth is a natural process, researchers in the field of paleoanthropology have asserted that assisted childbirth is, in fact, a central evolutionary aspect of humanity, and may date back as far as five million years to when humanity's ancestors first began walking upright.

On 27 March, 2009, Janet Fraser, a leading advocate of UC and national convener of the highly popular Joyous Birth website, lost her child during a birth assisted only by her partner and a female friend. In an interview five days earlier with The Sunday Age, Fraser, in the early stages of labor at the time, stated that she had at no point during her pregnancy consulted with a health professional, and that she intended to deliver the baby at her home without an attending midwife. The cause of death was reported to be cardiac arrest. A police investigation and coronial inquest were undertaken, the results of which were published in 2012. The coroner found that Roisin Fraser's death was almost certainly preventable if the birth had proceeded in a maternity unit and probably preventable if the birth at home had been attended by a registered midwife. He also found that Fraser's claim of "birthrape" during her first birth followed a planned homebirth attended by a midwife, where Fraser herself requested transfer to hospital for epidural anaesthesia, and then subsequently requested caesarean birth without medical indications and against medical advice.