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Should Unassisted Childbirth Be Outlawed?

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Last Friday, Massachusetts’ Supreme Judicial Court threw out the conviction of Alissa Pugh, a Milford woman who delivered her baby own stillborn, breech baby over a toilet in her home , and then hid the infant’s remains in her trash. She'd been convicted of involuntary manslaughter and sentenced to two and a half years in prison. The court has also ruled that, along with the overturning of Pugh’s conviction, women who choose to deliver their babies without a midwife’s or doctor’s assistance will not be criminalized. As Justice Barbara Lenk wrote, in explanation of the court’s decision, “Existing criminal laws proscribing murder, most late-term abortions, and the neglect and abuse of children appropriately protect the State’s interests in safeguarding viable fetuses and living children without the need to subject all women undergoing unassisted childbirth to possible criminal liability.’’

Pugh, who didn’t inform family and friends of her pregnancy, and who didn’t realize her baby was breach until she was in labor (after mistaking her water breaking for a miscarriage), clearly isn’t big on planning, but she’s not alone in attempting an unassisted childbirth; many families actually choose, and plan, to deliver their children this way. The unassisted birth stories in this collection  run the gamut from midwives not arriving on time to women having sexual experiences in labor (wow), and reflect a range of reasons behind unassisted births, from the unplanned to the faith-based. These stories also echo, to a degree, the notes of self-empowerment, family involvement and, yes, ‘natural’ inclinations that commonly characterize natural (without medical interventions) and home-birth (birth at home with midwives) stories, but – and maybe unassisted birth advocates will disagree with me here – the leap from a midwife-assisted birth to an Unassisted birth seems pretty enormous to me.

Many people, of course, can’t even wrap their heads around births taking place outside of a hospital setting, even in the capable hands of a midwife. When the New York Times published its recent story on the trailblazing American midwife Ina May Gaskin, comments poured in , many referencing the birth practices of prehistoric people (yeah…), maternal death rates before the dawn of modern medicine, and, above (and most relatable of) all, the looming possibility of unforeseen medical emergency. Home-birth proponents were quick to jump in with information on midwives’ capabilities in most birth-related emergencies (which in Gaskin’s case are extensive), statistics from countries where the majority of births take place with midwives at home (those stats kick America’s butt in terms of maternal and infant death rates, medical interventions, etc.), stories of hospital births gone awry, and reminders that childbirth involves an element of risk no matter where it goes down. Whether or not you’re in favor of midwife-assisted home birth, it’s clearly not the same thing as either prehistoric or pre-modern-medicine birth. But when it comes to unassisted birth, some of the more extreme commentary that doesn’t actually apply to most home births begins to sound a bit less extreme.

In terms of Massachussetts’ decision to protect unassisted birth’s legality, Lenk also wrote, “Imposing a broad and ill-defined duty on all women to summon medical intervention during childbirth would trench on their ‘protected liberty interest in refusing unwanted medical treatment.” Technically, she’s right. But what about the rights of those women’s babies? If they die after they’ve been born, real criminal charges can come into play, but not before? In Pugh’s case, her baby’s death couldn’t be proven to have resulted from her method of delivery, but… Delivering a breech baby over a toilet? For serious? I’m no expert, but I’d place a hefty bet on a very different outcome in that whole scenario had a midwife been present (most midwives consider breech babies to be hospital birth territory, too, so there’s a good chance that baby would be alive right now had Pugh consulted with a childbirth professional of any stripe in the weeks or days leading up to delivery).

The whole Pugh thing is horrible, of course, but the unassisted birth stories you’ll find online have insistently happy endings… And honestly, as much as I personally feel that there’s no way I’d attempt unassisted childbirth myself – for the sake of my own, and my child’s, well-being – I’m not necessarily opposed to the ruling in Massachusetts. I feel imposing laws on women’s bodies is a slippery slope (like, keep your laws off mine), and the judge is right that there are already ample laws in place to protect late-term fetuses, babies and children. I’d also be really against a law requiring that all births take place in hospitals, since our hospital systems don’t necessarily serve moms and babies best; homebirth rates are up  in large part because of discrepensies in standards of hospital care, and hospitals are beginning to learn a lot from natural birth advocates . Still, because of cases like Pugh’s and because it seems, to me, like a dangerously misguided choice, unassisted birth leaves me uncomfortably undecided in considering whether any laws should apply.

What do you think? Is unassisted childbirth the ultimate ‘natural’ birth? Is it irresponsible? Should it be illegal? I look forward to hearing your opinions and experiences! (Friendly reminder to keep it civil out there in comments-land…) Okay, Go!

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