Has anyone on here had an unassisted birth or know anyone that has? Was it by choice or necessity? Would you do it again? What are your opinions on the matter? I’d love to hear your stories! It is something I have become inceasingly interested in since I began my doula and lay midwife training.
I have not but do have friends who have done it. I live in an area where there are many mw’s who are able and willing to be there with you at home or in the hospital. I at one time though UC birth might be for me until I had my third. My first two were born in the hospital and my third at home. But he got stuck. Seriouslt stuck. I had zero risk factors (upright during labor and pushing, etc) but he still got stuck. Thank goodness I hadnot only a MW extreamly skilled in handing shoulder distocia and her assistant there too, but they had everything needed to handle him afterwards and he is 6 and healthy with no issues. My foyrth was born at home with a mw and this baby unless there is a reason to transfer will be to. For me, whois a big believer in births being “hands off” (when mom and baby are fine of course) UC just is nothing I have any desire to do. I know my friends who in my “crunchy birth world” wear their UC births like a badge of courage or something, but, to me, at the risk of sounding judgemental, its putting bot you and your baby at risk. Sure reading on UC birth stories for 9 months and taking your own blood pressure and peeing on the pee strips may seem like preperation to some, but imho, its not, no matter how much you belueve your body will grown and birth the baby fine there is always that unknown. The baby with the heart defect, the twins with twin to twin transfusion, the refusal of rhogham after the first UC birth causing the death of the seconds child concieved, GBS positive nottreated, placenta issue…all of these and more. [name]Trust[/name] me, I consider myself hands off, but I like blood tests, ultrasounds, my rhogham, mw tracking me and knowing that she has had years of experience handling births where as I have given birth yes, but would never consider myself able to handle the things that she can and does.
Thats my 2 cents of course. I do see the appeal of HB which is why I choose to have them, 5 minutes from the hospital, with my MW here.
I have a few friends that went this route, but I had the total opposite experience (in a hospital, epi, dr, ect).
Now I wonder how the hell my hippie friends did it!
I have a friend who was in labor for a few days & finally gave birth just her & her boyfriend on a renovated school bus in the woods somewhere! Her other son she had in a house with other friends around who had had kids…so a home birth but no midwife. Another friend had two kids at home, one just among family & friends, one with the help of an “illegal” midwife…they can’t practice in ny state at least not at that time.
No horror stories, no after-care at a hospital, no traditional prenatal care…
Not my thing at all, but I don’t judge it. [name]Just[/name] a very different lifestyle than mine! If I were to really think about it there are aspects of it I admire & respect & aspects I find totally insane & careless!
These friends of mine were very lucky though. I am not suggesting anyone else try this!!
Never. I had my first daughter as a c-section (emergency) and my next is going to be c-section as well. I’m definitely NOT cutting myself open.
[name]Ivy[/name]
I had a friend that didn’t make it in time for her midwife to arrive and ended up delivering with just her husband and doula. She was very lucky and everything went smoothly.
If I would have had an unassisted birth I likely would have died, and maybe my son too. He had his cord wrapped around his neck, but not too tightly so he was fine, but it could have been much worse. I had a massive postpartum hemorrhage minuted after birth. If it weren’t for rapid intervention to stop the blood loss and replace it I wouldn’t have made it.
I know people like to think that those things would never happen to them, or that it was somehow caused by my own fault for having interventions, but it wasn’t. It just happened, it was unexpected and scary. I’m very glad I gave birth somewhere that had the capabilities to save my life. I’m sure my son is too.
I suspect my perspective will probably be heavily discounted due to being a doctor, but I’ll add my 2 cents.
A. the argument against biological essentialism
simply possessing a body part does not make one an expert in its physiology, pathophysiology, or function. I have a colon and poop daily, but it doesn’t make me a gastroenterologist. Likewise, I have a uterus and have successfully gestated and given birth to a child, but that in no way qualifies me to understand obstetric or medical complications of pregnancy, or fetal well-being. The notion that a woman could provide her own prenatal care or, more importantly, manage her own childbirth in the face of any-- even the most humdrum-- complication simply by ‘intution’ or ‘women’s knowledge’ is just a silly as pretending to be a cardiologist because you possess a heart and know it beats correctly.
B. The argument for experience
Reading books and googling is no substitute for real education and hands-on training. Whether you’re an MD or a lay midwife with no formal schooling, simply attending births, managing labors and deliveries, and seeing what can and does happen and how one handles it is absolutely invaluable. Reading your driver’s ed manual is a great start to learning to drive a car, but it is no substitute for your dad taking you to the school parking lot and letting you muck around. For obstetricians and nurse-midwives, there is a very rigid credentialing process. After passing multiple examinations testing theoretical knowledge, an OB or CNM must have managed X number of normal labors, obstructed labors, precipitious births, obstetric/medical emergencies, performed X number of Csections, etc before they are even permitted to sit for the final board exam and go out into practice. When you entrust your care in the hands of someone with training, you know you’re getting a certain level of competence and confidence that a lay person could absolutely never replicate.
Not actually being a layperson is no protection. Even if you’re the chair of Ob/gyn at Famous Medical School, you’re fairly powerless to intervene in your own labor. How will you perform a vigorous bimanual uterine massage for a PPH-- the most common postpartum complication, affecting 10% of all vaginal births- if you’ve fainted from blood loss? It’s easy to say ‘McRoberts Maneuver!’ on a test when discussing nonoperative management of shoulder dystocia, but how on earth can you perform that on yourself?
C. The argument for an honest acceptance of increased risk
this is incontrovertible. Even the most ardent UC advocate accepts that not all pregnancies are healthy and not all births are uncomplicated. There are emergencies that occur that can be successfully managed with a neonatal resuscitation team, IV medications, fluids and blood products, and obstetric surgeons; without such interventions and professionals, death or longterm disability can arise. These emergencies can happen in perfectly low-risk women with uneventful pregnancies. Even if you think you’ve done everything you can to minimize the risk of something happening to you, even if you happily accept this risk and are willing to play the odds, you must accept that such things exist. Therefore it follows that some bad things, for mother and baby, can/will happen at home with untrained attendants, that could have been prevented or successfully managed in a hospital setting. Perhaps you are willing to accept these risks for the perceived benefits of UC or HB. But an informed decision to have a UC must involve an honest acknowledgement to yourself that it is an unnecessary risk, however miniscule you think that added risk is, and that the risk is potentially going to affect your baby, who cannot consent to such a risk himself.
D. The argument against Divine Protection or Naturalism
Whether or not you believe in God and are having a religiously-motivated UC, or are a naturalist who believes “we wouldn’t be here if we couldn’t give birth without interventions,” you are misinformed. Bad things happen to very good people (or will you argue that each loss mom actually deserved it, and you’re a more favored person to whom God would never cause any pain?) On more solid ground, evolution doesn’t give two shits if an individual baby-- or even an individual mother-- dies. If you give birth to ten babies and four of them survive, evolution is very happy. You’ve doubled the species, and perhaps the four stronger, fitter children survived. 3 billion people live without access to rudimentary medical care and give birth in low-resource, intervention-free settings, often without even traditional birth attendants. Population growth is still on the upswing in most of these places, but you do not want their birth/neonatal outcomes!
E. The argument discrediting the supposed safety net
this is the most important thing I want to say, because it’s not often thought about. If you throw out all of the above as Evil Doctor Wanting to Control Womens’ Bodies above, please think strongly about this.
“5 minutes to a hospital” is NOT ENOUGH TIME.
By the time you-- in the middle of the pain and physical exhaustion of birth-- have successfully diagnosed a problem and think you need to transfer to a hospital, it’s too late.
It is an incontrovertible fact, not open to interpretation or bias, that a baby will experience some degree of permanent neurological damage within 7 minutes of hypoxia. You have 7 minutes from the time of detection of fetal distress until you get the baby safely out. Pretend you’re at your UC. Perhaps you’re intermittently checking your fetal heart tones with a stethoscope every, say, 15 min. You think it’s slowed or stopped. You grunt through a couple more contractions and listen again. Yup, 80s. Got to transfer! The clock is ticking!!
You call 911. The ambulance arrives in 5 minutes, very fast. They load you up on the gurney, get you into the rig. 5 more minutes if you’re ready to go. They drive to the hospital-- 3 minutes, very fast! You arrive and they unload you. You are seen immediately by triage and rushed back, where EFMs are placed-- 5 minutes. An IV is started. The diagnosis is confirmed by the ER doctor, who immediately pages obstetrics (let’s pretend you’re lucky and it’s a big hospital with an OB in house 24/7, as opposed to a smaller community place where they have to drive in). OB get to the ED in 5 minutes-- very fast. She agrees-- fetal demise imminent, need a stat section: 2 min. The procedure is explained and consent is obtained (2 min). You are registered with the hospital and rudimentary labs are drawn, including the mandatory Type & Screen in case you need a transfusion (ultra-fast nurses: 2min). You are rushed to the obstetric operating room and make it in record time-- 2 min. You are intubated by the anesthesiologist (epidural placement takes 15min, no way, this is under general anesthesia), your abdomen is prepped and draped (5 min). The obstetrician is in the uterus in 30s. Baby is out.
How long was that-- this magical situation with no delays? 36:30.
Just keep that number in mind, please, whenever you feel reassured that you’re “5 min from a hospital” or “10 min away if you need to transfer.” Obviously not everything represents life-threatening ischemia, but the range of complications you’ll be able to diagnose in a timely fashion while UC’ing is basically nil.
F. Some thought experiments
As a doula student, have you attended many births yet? Have you seen anything go wrong?
The umbilical cord can be anywhere at the end of pregnancy with a healthy, vigorous baby. It could well be nuchal, bunched above Baby’s head, anywhere. You have your hand-held little doppler in your bedroom, you’re picking up ominous long decels-- what could you possibly do to move the cord that’s still inside your uterus out of the way of the baby who is also inside your uterus? Without fetal monitoring, how will you know there’s a problem at all?
What if you have early placental detachment, or you’re postdates and your placenta has somewhat calcified? Baby’s oxygen supply is being cut off. Can you hold your placenta in place? Can you force it to re-implant back into your uterine wall to give your baby oxygen until he is born?
You have a breech baby (3% fullterm babies are breech). You’re philosophically committed to the notion of homebirth and UC and decide to take your chances. Your chances turn out to be against you-- you, a primigravida with an unproven pelvis, have delivered the smaller body of your baby but can’t deliver the fetal head. Head is entrapped. What do you do?
Your baby comes out at the end of a long labor and isn’t breathing. The cord has stopped pulsing. Baby is blue and still, but you feel a heartbeat. What do you do?
You’re GBS positive, like 25% of women, but didn’t know it because you didn’t seek prenatal care with anyone capable of diagnosing it or prescribing medications for it. You give birth to your healthy baby vaginally and cuddle with him for a few hours. Within a few hours your baby has increasing difficulty breathing and cannot breastfeed. He has a fever of 100. He begins to seize from hypoxia. What do you do?
You’re a primigravida and since you’re UC’ing, you don’t have anyone assisting you with even gently slowing the baby’s descent. You sustain third-degree vaginal tears through musculature (relatively common) as a result. How would you diagnose them? How would you repair them to prevent long-term disability, infection and anogenital malformation?
Your placenta is a bit difficult to separate at the end of birth. Finally you deliver it with gentle cord traction and notice immediately that it’s jagged in appearance, and some fragments have surely been retained. In short order you begin to hemorrhage while holding your baby. What do you do?
My friend gave birth in her car en route, but it was an EXTREMELY rare case where a first time mother went into labor and had her baby 1 1/2 hours later. I personally would be very uncomfortable with and unwilling to take on the risks of an unassisted birth. I have no problem with a low-risk woman choosing to birth her baby at home, but I don’t see the benefit of not having a midwife attend.
Not for me. I can totally understand doing an HB with an attending MW and crew, due to a pretty crappy hospital experience with my first (damn those grabby nurses!). However, all of the things that blade mentioned can and [name]DO[/name] happen to women all.the.time. With a UC, you don’t even have an MW to assess baby’s level of distress and get you to the hospital right away (and obviously there is the “5 minutes away” not-so-perfect scenario mentioned above. I just don’t get the point of not having someone who is truly experienced attending your birth. [name]Even[/name] indigenous people usually have midwives or some equivalent.
That said, it certainly can’t hurt to read up as much as possible on UC in case you find yourself in an emergency “baby hanging out” type situation! Personally, I was 6+ cm when I moseyed into L&D with DD and had NO IDEA I WAS IN LABOR (I chalk it up to having intense and incessant BH from about 25 weeks on). I was only there because I hadn’t felt her move much that morning and was getting concerned. I have a feeling DH will be wanting to work from home from 36 weeks on with me next time around, for fear I’ll be having my own unintentional UC 
I agree, it’s not a bad idea to know as much as possible. There was a woman in my area recently that had her baby at a bus stop and a grad student with her toddler in tow had to help. I don’t know if she was taking the bus to the hospital or had no idea she was even having the baby–the article didn’t specify. While it’s an unlikely situation, it does happen from time to time.
Thanks for the thorough reply, although I do find your “evil doctor” remark a little condescending. I wasn’t really wondering about the risks since I am ready fully aware of them. I was wondering more about the experiences of people who have had a UC. I’m trying to decide if I would be willing to attend one or not. I already know tht I am not willing to attend a birth if the mother has received no formal prenatal care seeing as that is completely irresponsible and quite frankly, insane [name]IMO[/name]. I have a question, have you ever heard an incidence of a woman having a UC within the walls of a hospital or birth center? By that I mean 0 interventions and self delivery with a nurse in attendance in case things head south and interventions are absolutely necessary. This would be a good option for me to offer clients who are interested in UC.
I have not had an unassisted childbirth and I hope not to! [name]Both[/name] of my kids were born at freestanding birth centers attended by midwives. We have since moved to another state and there are no birth centers nearby, so I have chosen to have a homebirth this last time around, and am hoping that my midwife will arrive in time. I certainly can’t plan on making it to the hospital with how fast my last birth went, so I figured it is better to plan for home birth. My second child was born in only a little over an hour from start to finish. (I had 15 minutes of discomfort, 30 minutes of hard labor, my water broke and my body immediately started pushing (while I was walking out to the car) and then I had a 20 minute drive to the birth center in which I tried not to push, and DS was born 8 minutes after walking in. It would have been even shorter if I didn’t have that 20 minute drive.) Thankfully DH was already home when labor started (it was evening). And FTR, that birth hurt like hell. My first labor was so pleasant and manageable in comparison, at 7.5 hours total. The second was like a freight train and it was miserable. Understandably, because that was a lot of dilation in very little time.
I am actually afraid that I will end up birthing alone this time. I’ve talked about this with my midwife and she said that most of the time, if labor happens that fast, it’s because everything is going the way it should be regarding positioning and cords and such, and so it shouldn’t be something I should worry about much if it goes fast again. (Not that I can slow it down!)
I actually agree with the vast majority of what [name]Blade[/name] posted. I think the question of risks is important. For me, the risks of UC do not outweigh the risks of birthing in a hospital. But the risks of having a qualified midwife and a home birth or birth center birth do outweigh the risks of birthing in a hospital for me and my specific situation. [name]Blade[/name] stated that the baby cannot consent to the risks that a UC (or HB) present. The only small quibble I have is that the baby cannot consent to the risks that a hospital birth presents either. There are risks on both sides - risks of increased interventions (which result in way more common but perhaps not as serious problems) vs. risks of not enough interventions (which result in much less common but perhaps more serious problems).
I am all for home birth, but I don’t see how choosing unattended childbirth can possibly win in the assessment of risks.
As I think about UC more, I have a few more thoughts. Even if everything with birth goes perfectly (which it basically has for me), I am so physically exhausted, in a different state mentally because of dealing with the pain, etc., that I can’t imagine having to actually take care of myself and the baby alone in a UC. Even just the clean up afterward, or making sure I don’t faint the first time I stand up, or any of the extremely simple things would not be in my capacity to accomplish immediately after birth. And if there was any little complication at all - no way. Both times in order to get the placenta out, I’ve had to stand up and let gravity help. I couldn’t even do that by myself without the midwives to help me. I’ve read that women who UC claim they have some sort of extra energy, extra awareness, extra whatever, precisely because they are not attended during birth. But why would you want to rely on that? Again, I really, really hope my midwife and my husband make it on time!!
I’m not blade, but I’m having a hard time imagining how that scenario would actually work out - UC in a birthing facility? So contradictory! Wouldn’t a hospital or birth center have too much liability in this situation if something went wrong, even if they agreed to not intervene and let the woman deliver herself? I mean, how would they come to a mutual agreement that something was wrong and intervention was needed? Only if the woman asked? And why would a woman who wants to UC seek out a situation like that (or your services?) unless she changed her mind at the very end of her pregnancy and then no longer actually wanted to UC. Maybe I’m being naive, but could you explain a bit more about when this kind of thing might happen?
What I’m thinking is more of a modified UC than a traditional one. Also it is not uncommon for women to seek out a doula to attend their UC since a doula is non-medical by definition. I think a woman who wants a UC would be more open to the idea of delivering in a birth center or hospital knowing that she would still be able to catch the baby herself. Certainly this would not be a good alternative for everyone. It would depen on their motives for wanting a UC. I am not a lawyer or a doctor so I don’t know the legalities of it or if it would ever be possible which is why I asked someone who might. I couldn’t find anything about it in a google search. I just think of it is at all possible that it would make a much safer alternative for me to offer these women than a traditional UC at home. It’s always good to have a safety net [name]IMO[/name], but I am all for women wanting to deliver their babies the way nature intended. Within reason of course.
I didn’t mean to be condescending, quite the opposite. I was hoping to have a fruitful discussion and that is exactly what occurred.
In answer to your question-- absolutely not. No patient can be admitted to a hospital without being under the official, formal care of a licensed and credentialed practitioner (physicians, nurse-practitioners including CNMs, and in some states, PAs). That practitioner must provide care or will be held liable. Even if there are no adverse outcomes, they could be disciplined and lose their license for patient abandonment.
Birth centers are not considered health facilities in the eyes of the law; instead they are private businesses and are not regulated or licensed any more than a Hallmark franchise (there are no inspections, licenses or permits required to open one), so they can set their own policies. Perhaps a birth center and a non-credentialed midwife who does not have prescribing powers, does not operate under the license of a physician, and is not formally trained (i.e. a “Certified Professional Midwife,” or a “Licensed Midwife,” or neither) would be willing to provide a ‘UC room,’ but honestly it goes completely counter to the entire philosophy of UC. I would imagine an ardent UC’er would argue that the presence of help in a nearby room would undercut her sense of autonomy and confidence and would produce worse outcomes, or some such thing.
In my non-objective, non-official and quite personal opinion, I think Unassisted Childbrith is nothing more than Russian roulette with only bragging rights as a prize. That’s why women who have UC’d wear those births on their sleeves like merit badges and talk about them in the same way other people describe drinking 20 tequila shots, tandem skydiving, or climbing Everest, like you’re supposed to be really impressed that they’re such a badass. While I disagree with homebirth too as a philosophy, at least when I hear women justifying their choice to HB I feel they’re being logical and genuine. When I hear women attempt to justify UC, I just hear narcissism.
Edit: since you asked about nurses attending births-- an RN with no further education and training (not a CNM) cannot attend patients. It is completely outside the scope of training and licensure. Not that a good nurse isn’t very savvy and worth their weight in gold (L&D nurses in particular are the primary labor support person for most and have seen everything), but they’d lose their license immediately.
I definitely know why you mean about the bragging rights and merrit badges. In all honesty, I find it increadibly obnoxious. But that is why I don’t think I would be willing to attend a birth if I thought the choices the mother was making were for the wrong reasons. I do think that catching your own baby and forgoing interventions is a natural and beautiful thing that any women should be entitled to if she wants it. Again, that goes within reason.
For me personally, I don’t believe that having help nearby in case I needed it would undercut my sense of autonomy or produce worse results. On the contrary, I believe it would reduce stress and my feelings of “what if”. I just don’t see how a reasonable person could fear having help nearby could produce a worse outcome. But then ardent UC’ers are not known for being the most reasonable people.
Quick question: do hospitals ever allow the mother to catch her own baby? I have heard of this happening with the father, but never the mother.
[name]Ah[/name], thanks for the explanation. If you as a doula (not as a midwife) choose to attend a UC birth, because you’re not a medical professional you’re not liable, right? But once you’re done with your midwifery training, how would you separate those two parts of yourself professionally? It seems that could come back and bite you - to attend a UC birth as a doula but actually be a midwife and if something went wrong you’d be on the hook anyway even if they hadn’t hired you as a midwife.
If you were attending as a midwife, it wouldn’t be a UC anymore, not even a “modified UC”. I think that women who choose to UC do so largely because of other reasons, not just because they want to catch the baby. Sometimes it’s because of money - they don’t have insurance and don’t have the cash to pay for an attendant. Sometimes they were treated terribly during a previous birth and can’t bring themselves to have an attendant. And sometimes it’s for some of the reasons [name]Blade[/name] outlined in her first post. I think that whether you could or should consider helping out in a UC situation would depend a lot on their reason for wanting to UC, and those reasons are quite varied. And it sounds tricky to figure out how to make it a “modified” UC given that you also need to protect yourself in all this.
For the reasons for wanting to UC you’re describing, I think that it is very easy to have a hands-off birth and catch the baby yourself with a midwife attending. I’m not sure about OB’s, but I’ve read plenty of stories of women catching their own babies with midwives in attendance. During labor itself, my midwives were not very invasive at all. They checked the heartbeat with a doppler intermittently (during the pushing stage between every contraction). They checked my cervix once when I was feeling pushy, and I didn’t feel pressured to consent to that one check. They suggested positions to push in when I asked, suggested that I try going to the bathroom, etc. But mostly they were quiet and preparing and watching and charting. The second delivery they just suggested that I not push but instead ease the baby out. They monitored blood loss afterward. They made sure breastfeeding looked like it was starting off right, etc. I have a hard time figuring out why someone would choose to UC only because they want no interventions and to catch the baby themselves when they could have such good but still relatively hands-off care with a midwife. I think there’s usually more to their decision than that.
This is an interesting discussion, though, and I wish you luck in your studies and in figuring out if there is anywhere you can fit professionally in this UC realm!
Yes - I hear stories all the time of nurses telling patients not to push until the doctor gets there because they’ll get in trouble if they’re the ones who catch.
Well, that’s kind of a trope circulated around natural childbirth circles. It’s usually cited as an example of how childbrith has become ridiculously over-medicalized and doctors are just looking to protect their turf.
In reality, there is usually one in-house attending obstetrician at a time. In very large hospitals or teaching hospitals, there might be a general obstetrician and a perinatologist, as well as a team of residents. But in a smaller place, it’s perfectly conceivable that two patients deliver near-simultaneously (or that one patient is having difficulties whereas the other is uncomplicated) and the RN is the only person in the room for the delivery. That’s perfectly fine and reasonable. It would be exceedingly rare because members of a health care team really do work as a team and respect each other’s roles and skill sets, but if there was any kind of deception involved on the part of the RN such that the MD/CNM wasn’t notified of imminent delivery, yes, there would be trouble.
Many people don’t know that there are two types of midwives. Certified Nurse Midwives (CNMs) have a rigorous training and credentialing process; they have prescribing powers and they are professionally monitored and licensed. They (in most states) are required to work under the license of a physician but are independent practitioners. As such they can be professionally disciplined and carry liability insurance. They usually work in harmonious conjunction with obstetricians, as they take care of lower-risk women and manage uncomplicated pregnancies and labors, either in a hospital or in a hospital-attached and obstetrician-attended birth center. This is considered by many to be the ‘golden mean’ or ‘happy medium,’ with the safety and resources of a hospital, but the personalized attention midwives provide.
On the other hand, the midwives who provide homebirths and freestanding birth center births are not professionally educated nor formally credentialed. They do not ever carry malpractice insurance and they are generally paid in cash themselves. They are called Certified Professional Midwives, and they have set up their own board in a few states offering their own credential, the “Licensed Midwife.” To be clear, this license is not granted by a state medical board and there is no set education, training or apprenticeship required to earn this title. They are very, very much a mixed bag; some might be very good with a great deal of experience and savvy, but others can be really awful. You don’t really know what you’re going to get, and one of the more frustrating aspects to this part of the birth universe is that the bad apples cannot be forced out of practice. Any other substandard or renegade professional could be formally disciplined, could be sued in civil court and held liable for malpractice, and could have their licensed stripped and be barred from hurting more people. Bad lay midwives can keep practicing with impunity since again they have no license to strip, do not carry liability insurance, and have no formal professional body to be held accountable to. The only alternative has been prosecution in criminal court for criminal negligence in the case of gross malpractice.
[name]Long[/name] story short, a LM/CPM can absolutely attend a birth as a doula with no consequences whatsoever.
I know I’m posting lots!
Last thing, I promise: I know you read these sorts of stories on internet forums, but the logistics of being able to genuinely deliver your own child are pretty tough. I’ve delivered about 40 babies myself (and only 3 in the last few years-- when a general surgeon is delivering babies, you know there is some serious badness going on in the form of major trauma and perimortem C-sections; mine involved a woman stabbed 30+ times in the abdomen in an attempt to kill her and the baby, as well as a woman run over by a city bus) so obviously I’m not an expert, but here’s my thoughts on the mechanics of delivery.
The baby, if everything is going well, will naturally make a series of position changes and movements as it exits the birth canal. The neck is hyperextended to get underneath the pubic bone. The baby will then make a quarter-degree turn as the head truly enters the vagina and exits the pelvis, so as to assume the minimal transverse dimension and get out. At that point the birth attendant, whoever it is, needs to inform the mother to stop pushing so as to check for a nuchal cord and reduce it if possible. Slowing down the speed with which the head travels through the vagina, as well as providing some perineal pressure really really is necessary to reduce the chance of serious lacerations to the cervix, vagina and perineum. The baby is unbelievably slippery-- it’s coated in vernix and slick amniotic fluid in order to squeeze out-- and needs to really and truly be caught and cradled. I suppose if you’re delivering on a flat surface the baby could just sort of flop out and land on the bed or whatever, but that’s not the nicest way to make an entrance into the world.
That’s obviously in the scenario of a a 100% normal, clockwork delivery. Where the real skill comes in is handling fetal malpresentation, shoulder dystocias, and other extremely common problems in normal vaginal childbirth. I know women who UC have delicious visions of squatting in a bathtub and delivering their baby straight into their own outstretched arms, but it really doesn’t work well.