12/16/2025
I want to talk about something near and dear to my heart. This morning I had a lovely prenatal visit with a new client where the topic of unassisted birth came up and as I've gone about my day, my thoughts keep coming back to all of the women over the years that I have supported in one way or another as they planned to birth their babies unassisted. I also recently spoke to a woman who lost a baby during an unassisted birth, and her grief and words are fresh in my mind.
Some people know this about me, I had our first 3 babies at home, their births I would call "unassisted with a safety net" (the twins were home births also, but monitored and caught by the midwife)... with my first 3 I wasn't monitored, the midwife was mostly in the other room, and I pushed out and caught my own babies without interference.
I felt like I would know intuitively if something was off and I needed help for my baby or me... somewhat recently I had a lovely message conversation with one of my favorite OBs and she said the term "radical ownership" of one's outcome in regards to unassisted birth, or something similar (I would have to go look at those messages and confirm her verbiage, but that is what I took it as). Those words stuck with me, what a beautiful term for it.
As a birthing woman myself, I felt that, if something happened I wasn't going to blame someone else, I knew I was risking it... even though I felt intuitively like I just knew everything would be ok. This is the beauty of autonomy right? Being able to choose what is right for you and your family.
Back to unassisted birth....
As a midwife I have seen many times where my presence and intervention prevented hospital transfer, prevented excessive blood loss, helped a baby breath who may or may not have been able to have been resuscitated by parents, and supported many many women when they felt like it was too hard and they couldn't go on. And as a midwife, I still hope at every single birth that we are completely unnecessary, unneeded, and get to be a non intrusive presence that only offers moments of reassurance to the birthing mama. I have seen first hand many times where unassisted birth could have been disastrous, and other times where it wouldn't have changed a thing. Thankfully, I’ve seen even more births where us midwives weren’t needed at all.
When I think about the women who have planned unassisted births, who I've told "you've got my number, don't hesitate to call if you need some guidance" and who have called me dealing with issues (normally bleeding too much or the placenta not coming out) I have loved it when just a few suggestions and words a reassurance have allowed them to get the bleeding stopped or the placenta out, and they haven’t needed anything further and that allowed them to stick to their plans and stay home. I also have ended up at an unassisted birth turned life-threatening emergency because they happened to be close enough to me, and I figured medics may not quite be able to do everything possible to keep them home or alive (we transferred in to the hospital anyway, my hands holding her uterus to prevent further blood loss en route).
I know in my being that birth is life, it’s not without risk…. Sometimes we walk the bridge of death.
Even birthing in the hospital, you are not risk free... life is, life.
Over the years I’ve had this conversation with many midwives, most have vehemently hateful feelings about unassisted birth. Although, I certainly don’t have feelings like that, I do want to give anyone considering it some food for thought.
First question to consider- if your husband is your only birth attendee, truly, how does he feel about being that if birth were to turn more difficult or emergent? Most don't, and some husbands are very equipped to handle if they do, but it's worth it to ask yourselves. I have had probably more than a dozen husbands call me stressed out while their wife was birthing, so I could reassure them that it all sounded ok, and they could take a breath and just be with her and love and support her the best you possibly can.
Second, there are many “birth keepers” - they normally don’t have medical experience and play the role of doula more (there are all variations- some are traditional experienced midwives that choose to be unlicensed). If you invite a birth “keeper” to your birth - are you still taking radical ownership over your birth, body, outcome? Or are you seeking to still have someone hold that space for you and be there in emergencies if needed? This is big, and only you can decide what you need to support you.
I’ve talked to a few moms after they lost babies during birth with “birth keepers” and their expectation of hiring that person was that they would have that safety net to avoid staying too long if birth became riskier. You truly need to know what the person you invite knows, and offers. A skilled midwife will monitor baby and hear when heart tones tell us it’s wise to get a baby out quicker, or wise to transfer to the hospital for more care. The same question I encourage for people choosing a midwife to hire, do they monitor non-intrusively but sufficiently to really have a good idea how baby and your health is (if you are ok with those things- there is still benefit to a midwife even if you don't allow monitoring).
Third, and arguably in my mind, one of the most important if you are considering unassisted birth, do you feel like you can truly let go of the medical concerns, be fully present and internalized enough to allow labor to progress if you don't have a fellow experienced woman to hold those concerns for you? Stress and worry prolong labor, being relaxed and feeling safe allows birth to happen. A good support will remind you that you are made to birth this baby and can relax fully because you are supported.
You are very welcome to comment opinions on this, or privately message me about this.
Source of this painting Amanda Greavette