Moving away from the hospitalized, medicated, intervention births that have come to define birth in our society and culture can mean a lot of things.  For some, it’s simply birthing naturally in a hospital with doctors and nurses around.  For others, it’s having a midwife and birthing in the comfort of one’s own home.  For yet another, it would be having a midwife in a birthing center.  And then there is a minority for whom this means birthing alone, without assistance at home, an “unassisted birth” if you will.

If you look at births historically or even in some cultures today, the unassisted birth does occur (though far less frequent that one would imagine).  It certainly occurs for most animals, who birth on their own, away from prying eyes.  The primary argument in favour of unassisted birth is that we humans are also animals who instinctually know what to do to give birth and need no assistance from others in doing so.  But for some, the thought of a woman birthing herself, without any help or back-up, is flat-out dangerous or irresponsible.

So what does the research say about unassisted birth?  At a population level, unassisted birth carries higher risks than other birthing scenarios

[1], despite the fact that some people might argue otherwise[2].  When I say “at a population level”, I refer to the fact that research has found unassisted birth to be less safe than birthing at home with trained assistance, or birthing in a birthing center or hospital.  There are greater risks for complications, death, and poor outcomes for both mother and child.  [Notably, when there is another individual there (even if not a trained individual, though a certain level of understanding of birth is necessary), the risks are still there but are smaller, and thus we must always distinguish between a true unassisted birth and one that is unattended by a trained birth attendant.]

Why might this be?  Well, one of the primary things we have to contend with is that although we are animals, we birth socially.  For human history, the norm has been to birth in the presence of another individual, but why?  In an amazing review of human evolution and birth, Dr. Wendy Trevathan[3][4][5] provides support for the argument that our social birth culture emerged with the advent of bipedalism.  Bipedalism changed  the way in which we birth physiologically (e.g., the birth canal was reoriented such that infants now need to rotate several times during the process, something that does not happen for nonbipedal primates), making the process inherently more dangerous when done alone than with assistance.

Furthermore, human evolution has meant that the birthing of our children is done earlier than other primates and mammals, with human infants born with only a quarter of the brain capacity of an adult (instead of the usual half).  Infants, therefore, are unable to care for themselves to a certain degree after the birthing process the way other mammalian or primate infants are.  This helplessness of infants, coupled with physiological difficulties for women birthing alone, meant that having an additional person there to guide or assist in the birthing process (when mom needs and requests it) allowed for our species to continue to thrive.  And arguably has allowed our brains to continue to grow and mature.  There are also social reasons that have been hypothesized for social birth.  Namely, that women and children are part of a social group and the group has a greater vested interest in the child if they assist with or are present for the birth.

Although we have arguably evolved to birth socially, this does not inherently mean that unassisted birth is dangerous for everyone.  That is, while it poses increased risk at a population level, what of the individual level?

I will immediately say that I do believe there are individuals for whom an unassisted birth is probably quite safe (and perhaps their safest bet).  Why?  Because of tantamount importance is the comfort level of the mother who is doing the birthing, and for some women, that may mean being on their own (or with a partner – though technically this would not be unassisted per se and would fit the evolutionary criteria for social birth and would decrease the risks, though still be slightly above those attended by an experienced individual).  But there are other considerations as well.

First, for a mother to safely birth unassisted, she must have the utmost confidence in her body and instincts, something that is sorely lacking in our society.  We have suppressed so many of our instincts that when we are placed in a situation where they come forward, we become fearful.  And if a woman is afraid of what her body is doing at any point in the birthing process, she is at higher risk of experiencing problems because she may begin fighting the process.  Second, a woman must be armed with a lot of knowledge about what will happen at each stage and how to care for a newborn who may encounter problems.  Humans have been passing on information about birth via the social structure for millions of years.  Traditionally, a midwife would simply be there in case – fulfilling the criteria for social birth but also reducing the risk.  However, if you wish to do one yourself, alone, you need to find a way to glean the information we’ve been passing between ourselves for generations.  If it holds that our bodies changed when we became bipedal then with that, our birthing changed.  This means we have some instinct about birth, but that may not be wholly complete given our dependence upon others in the birthing process.  If one is to birth safely alone, an understanding of birth more generally is needed, particularly why there was a higher risk for solitary birth leading to the change in how we birth, in order to prepare.

Some women prepare themselves and are fully equipped to handle most situations in an unassisted birth.  And in today’s world, where unassisted typically refers to the lack of experienced help (e.g., midwife, doctor; notably it is sad that experienced now has to refer to medicalized/trained in many places when historically, the midwife simply had her experience from attending births and trusting women to do what they need to do during the birthing process, intervening only when absolutely necessary), the presence of a partner makes this form of “unassisted birth” safer – as the other person can help guide the baby out, deal with respiratory issues if needed, call for help if needed, remove a cord from around the neck (quite common), etc. – but the risks always remain for more difficult and serious problems.  But these are the risks people take to birth in the manner that they feel comfortable.

The absolute risk of something serious going wrong is small when the pregnancy is normal, and every woman has to decide what her risk threshold is.  Once she’s decided that, if she truly feels that an unassisted birth is for her, then she should make sure she is well-informed and comfortable listening to her body.  But one thing we should not do is pretend that true, unassisted birth is what humans have evolved for, whether we’re talking socially or, arguably, physically.  When we started walking on two legs, we changed birthing from a solitary activity to a social one and social reasons may be key in social birth.  Trusting your body to know how to birth and birthing without interventions is evolutionarily normal (and when used sparingly and only when necessary, life saving measures like c-sections increase our chances of survival).  But birth is social.  Let’s not forget or diminish that.

[1] Sibley L, Sipe TA.  What can a meta-analysis tell us about tradition birth attendant training and pregnancy outcomes?  Midwifery 2004; 20: 51-60.

[2] Shanley LK.  Unassisted Childbirth: Second Edition.  Santa Barbara, CA: Praeger (2012).

[3] Trevathan WR.  The evolution of bipedalism and assisted birth.  Medical Anthropology Quarterly 1996; 10: 287-290.

[4] Rosenberg KR, Trevathan WR.  The evolution of human birth.  Scientific American 2001; 73-77.

[5] Rosenberg KR, Trevathan WR.  Birth, obstetrics, and human evolution.  BJOG 2002; 109: 1199-1206.