The Original Birth Attendants

I’ve often heard midwives say that midwives were the original birth attendants or that midwifery is the world’s oldest profession (or second oldest profession, as the case may be). Some also claim that we know midwifery is “natural” because even animals have “midwives.” And while I certainly give midwives credit for helping women give birth - both now and in the past - none of the above statements are true. The original birth attendants were friends or family members of the woman giving birth.

Judith Goldsmith writes in her book Childbirth Wisdom from the World’s Oldest Societies that, “Many students of childbirth, however, speak of the midwife as woman's first helper. In reality, though, even the midwife is a relative newcomer on the scene. In those tribal communities where birth is aided, the assistant is most commonly the woman's own mother.....A casual reading of anthropology does not always make these close family ties apparent, because often the European writer, seeing things in the light of his own background, referred to the person assisting the mother as the ‘midwife’ whether or not she was called this or considered as such by her own society. Further examination, however, reveals that the so-called midwife was very often a close relative of the mother, with no more special knowledge of birth than any other mother in the tribe. This underlines an important point: in a large part of the world, except in difficult cases, a birth required no more specialized help than the members of a woman’s own family could provide."

Michel Odent, M.D. echoes these sentiments in his recently released book The Functions of the Orgasms: “The concept of a birth attendant is more recent than is commonly believed, although a mother or mother figure was probably around when a woman was giving birth in primitive societies. This was mostly to protect the privacy of the birth woman against the presence of wandering men or animals. No doubt this is how midwifery began.”

Odent also claims that “Everywhere in the world there has been a tendency to dramatically alter the original role of the birth attendant, to deny the birthing woman’s need for privacy and to socialize childbirth. More often than not, the midwife has become an agent of the cultural milieu, transmitting its specific beliefs and rituals.”

Veronika Sophia Robinson, publisher of the UK magazine The Mother, expresses similar views in her book The Birthkeepers: Reclaiming an Ancient Tradition: “We’ve been led to believe that midwifery is the oldest profession, but this is a romanticized notion, and not a fact. It is perpetuated by practitioners of midwifery and childbirth. When assisted and observed birth did start becoming common place in our history, the attendant was not a specialist in birth, but most usually the mother of the woman in labour.”

As far as animals, some do give birth in the presence of other animals (although most seek seclusion). But these animals cannot be considered “midwives” in any sense of the word. As with tribal cultures, the animals “attending” are simply other members of the pack or herd. You can be sure that none of these “attendants” are sticking their paws inside the mother animal’s vagina, or telling her when and when not to push.

So why does this matter? It matters because as unassisted childbirth grows in popularity, I and other unassisted birth advocates are hearing from more and more midwives and midwife supporters who claim that we’re infringing on their territory or that unassisted birth isn’t “natural.” Some even write that (in the case of an unassisted birth gone wrong) we’re “giving homebirth a bad name.” But the truth is, not only is unassisted childbirth natural, it’s also safe, provided a woman doesn’t live in poverty, and the birth isn’t interfered with either physically or psychologically. Throughout history, healthy tribal women have successfully given birth without medical assistance.

I recognize that many women find the presence of a midwife helpful in birth, and I hope that midwives will continue to be available - to those who want them. But birth doesn’t “belong” to midwives. Nor does it belong to doctors, the AMA or the state. Birth belongs to mothers and babies – and ideally to fathers should they choose to be involved, and it’s time this truth was recognized.

Two new articles about unassisted childbirth

For the past month or so I’ve been hearing about a UC article that was published in the UK magazine Junior Pregnancy and Baby. Yesterday someone finally sent me a copy, which I scanned in.

In addition to some nice quotes from me, there were several wonderful quotes from the lovely and talented Veronika Robinson, editor of The Mother magazine, and many excellent comments from our dear Dr. Michel Odent. “For decades, women have been told that they need a guide to tell them what to do and when,” says Odent. “But the basic mammalian need is for privacy. To give birth, women must release the key hormone oxytocin, and it is a shy hormone – if there are people around it doesn’t appear. These women are teaching us what is most important.” Wow! Thanks, Michel! British mum, Julia Wilson spoke beautifully about UC, once again. Julia is one of the women that appeared with me on the Richard and Judy Show last summer.

Another nice UC article was just posted on the iparenting web site. I enjoyed talking to writer Kelly Burgess, and felt she accurately stated my views on the subject. But of course there were the usual quotes from a doctor and midwife (as there were in the British article). It’s too bad they don’t have a place for comments, as I would have liked to comment on this one.

Dr. Ronald Librizzi, chief of maternal-fetal medicine for Virtua Health says that “even in a population that appears to be glowingly healthy, in about 20 percent of all pregnancies something will go seriously wrong and require medical intervention. Only a trained professional, he says, can recognize those at high risk.” Of course I question this statistic. It was also cited in the New York Times article on UC in 2002. Jack Travis, M.D. disputed this figure in a letter he wrote to the Times which was never published. I did, however, post it on my site.

Mairi Breen Rothman, a certified nurse-midwife and a consultant with the American College of Nurse Midwives was more understanding of women who choose unassisted birth, but likens it (says the writer of the article) to “swimming in the ocean without a lifeguard. You don't have to pay any attention to the lifeguard while you're swimming, but it's nice to have someone on the beach watching for dorsal fins.” I like Mairi, and corresponded with her briefly after we co-hosted a discussion on the Washington Post web site last July.

But the “lifeguard” analogy doesn’t sit right with me. Swimming is generally a social activity. Most swimmers are comfortable having other people around, and an occasional glance from a lifeguard isn’t an intrusion. But birth is an intimate, private act. How comfortable would most of us feel having sex in front of a lifeguard? Chances are a couple that wanted to have sex on the beach would find a secluded location.

I agree with Mairi when she says "If you give birth in the natural, normal way and Mom is completely relaxed she'll go to a place I like to call the 'birth planet' where you're just being your animal self” but she loses me when she goes on to say, “and you shouldn't be thinking about things like tying off the cord, or maybe wondering if you should call 911. Even coyotes have a midwife in the pack that stands outside the hole to keep the other animals away. Bringing in a professional is something that's perfectly natural in our birthing history."

When I was in labor I never thought about tying off the cord. What’s to think about? It's a very simple procedure that can be performed by anyone with a pair of scissors and a string. I did think briefly about calling 911 when my second baby was coming out feet first, but decided against it. I relaxed, didn't interfere physically or psychologically, and everything turned out beautifully.

However, had a midwife been there I certainly would have been transported to the hospital, as midwives in Colorado aren’t allowed to do breech births. Of course, a midwife might have detected the baby’s position prior to the birth and either tried to turn him (which I wouldn’t have wanted) or told me I needed to give birth in a hospital. As far as coyotes having midwives, another member of the pack may indeed keep other animals away, but how does this apply to women giving birth today in the safety of their homes?

Besides, midwives generally don't stand "outside the hole." In Colorado, not only aren't they allowed to leave the mother's side, they must do vaginal exams in labor (which puts them literally in "the hole"), take the mother's temperature and blood pressure on a regular basis, and check the baby's heart tones every 5 to 10 minutes during the second stage of labor (among other things). Many women find it difficult to go to the "birth planet" (i.e. relax into an altered state of consciousness) when they're continually checked and monitored.

Regarding Mairi's comment that bringing in a professional is something that's perfectly natural in our birthing history, this simply isn't true. Judith Goldsmith writes in her extensively researched book Childbirth Wisdom From the World's Oldest Societies that midwives are actually a recent phenomenon. "Many students of childbirth, however, speak of the midwife as woman's first helper. In reality, though, even the midwife is a relative newcomer on the scene. In those tribal communities where birth is aided, the assistant is most commonly the woman's own mother.....A casual reading of anthropology does not always make these close family ties apparent, because often the European writer, seeing things in the light of his own background, referred to the person assisting the mother as the ‘midwife’ whether or not she was called this or considered as such by her own society. Further examination, however, reveals that the so-called midwife was very often a close relative of the mother, with no more special knowledge of birth than any other mother in the tribe. This underlines an important point: in a large part of the world, except in difficult cases, a birth required no more specialized help than the members of a woman’s own family could provide."

I'm not anti-midwife, and I understand that most midwives genuinely have a woman's best interest in mind. But when midwives claim women in labor need "lifeguards" or use phrases “keeping other animals away” they perpetuate the idea that birth is dangerous and women need protection.