Why I would never be present at a planned unassisted birth

​There has been and still are a lot of debate among doulas about what a doula should do if she was at a birth and her clients turned around to her and told her that they were not planning to call a midwife but instead give birth unassisted.  Or whether doulas should or shouldn't support a couple that plan from the start to give birth without medical support; free birthing as it is also known.

For me, it is quite clear cut and if I was at a birth and the parents surprised me by saying that they weren't going to call a midwife, I would say that I would be unable to stay and I would leave.  If they told me in one of the antenatal meetings that they were planning to free birth, I would tell them that I was not the right doula for them and I could not be at their baby’s birth.  My reasons for seeing this so black and white are as follows:

• In my view, an unassisted birth is just that, unassisted, which to me means that no one else is there, apart from the birthing woman and perhaps her partner in the back-ground.  If a woman really and truly wants to birth on her own, that means having no one there.  When a woman chooses to have a doula there, it suggests that she is not committed to free birthing and she is opting for something in between by having her birth supported by a professional and to me, that is not an unassisted birth.

• If a woman told me she was free birthing, I would try to encourage her to make contact with the Supervisor of Midwives at the local health trust to create a personal care-plan for her.  I would actively try and mend the bridges between the woman and the health professionals so that she could still have the birth she wanted but with the backup of medical care, should she need it.  If the couple decides to keep from me the fact that they were planning to give birth unassisted I would interpret this as a massive breakdown in trust.  I could not stay and support them as I would not be able to trust them.  

• As doulas, we provide information not advice, however, if something was to go wrong when a doula is supporting at an unassisted birth and the parents decide that some of the information the doula gave was incorrect or caused things to ‘go wrong’, the doula could find herself is some very hot waters.  If she was found to be liable for providing information that directly led to the cause of something going wrong, the doula would be held accountable.  This could happen at any birth a doula supports but if she is the only person there who is not part of the family, it might be more likely that the parents want to blame her if something went wrong.

• By supporting at an unassisted birth, I could also potentially jeopardise my own reputation and that of all doulas in the UK.  Giving birth is generally very safe but sometimes things go wrong and I know that having a midwife at a birth could save the life of the baby and of the mother.  I would not want to find myself in a situation where I am helpless and clueless that ends with damage to the baby or mother or even worse, the loss of life.  The impact such a tragedy would have on the parents is unimaginable and the impact on the doula and all doulas would be devastating.

• I value the relationship I have with the midwives I work with.  I see doulas as supporters of midwives and together, we work as a great team.  I've heard stories of doulas keeping midwives out of the room where the woman in birthing and only letting the midwife in if there is a problem.  I think this is wrong and also deeply unfair.  Either you birth without a midwife OR with a midwife.  Keeping the midwife outside until there is an emergency or on stand-by ‘just in case’ prevents her from carrying out her job and also puts the midwife in a very difficult position.  It most likely doesn't do much for the relationship between the doula and the midwife either...

• Fundamentally, I trust that all women are capable of making informed choices and if a woman wants to give birth unassisted, then I respect her choice, however, I am not willing to put myself in a situation where I am out of my depth by being present at the birth.  I've found myself alone at a BBA (Born Before Arrival) when a baby was born into my hands on the bathroom floor five minutes after I walked through the front door.  I managed to get the husband to call for an ambulance before the baby arrived and everything went very well. If the baby had not been breathing or the woman had haemorrhaged, at least I knew that medical support was on the way.  

So, these are the reasons why I personally would not be present with a woman or couple who were planning to free birth.  I encourage all doulas to seriously consider the possible consequences of their own choices and to bear in mind that birth is unpredictable - anything could happen.