No / In October 2002 the ex-RCIVI director of education and research Rosaline Steele wrote an editorial in the RCM Midwives Journal on problem-based learning (PBL), entitled 'the emperor's new clothes or a new way of seeing?' This is a response to that article.

A confident midwife has an impact on a pregnant woman’s clinical outcome and birth experience. Knowledge acquisition, competence, and confidence develops over a lifetime and is of great importance in developing and forming personal skills and allowing the personal traits to grow and mature. Previous international studies have shown that midwifery students do not feel confident in many areas in which they are supposed to practice independently. The aim of this thesis was to investigate confidence levels in basic midwifery skills in Swedish midwifery students in their final semester just before entering the midwifery profession. An additional aim was to describe clinical midwives’ reflections about learning and what factors that developes professional competence, and confidence. Study I was a cross-sectional survey with Swedish midwifery students (n=238). They assessed their own confidence in all competencies that a midwife should have and could practice independently. The results of study I confirmed that Swedish midwifery students feel confident in dealing with the most common procedures during normal pregnancy, childbirth, and postpartum and newborn care. However, they do not feel fully confident in cases in which there are deviations from the normal procedures and obstetric emergencies. When comparing groups of midwifery students, the younger group of midwifery students felt more confident in general compared to the older group. Students at a university with a medical faculty were also more confident than the students at a university without a medical faculty. In study II, focus group discussions were held with 14 midwives emphasizing the way in which midwives reflect on learning and the development of competence and confidence. Content analysis was used to analyze the focus group discussions. Four categories were identified as a result of study II: 1.) feelings of professional safety evolve over time; 2.) personal qualities affect professional development; 3.) methods for knowledge and competence expansion; and 4.) competence as developing and demanding. The conclusion of this thesis is that more practical and clinical training during education is desirable. Midwifery students need to have access and the opportunity to practice obstetrical emergencies within a team of obstetricians and pediatricians. Learning takes time, and one improvement is to extend midwifery education to include and increase in clinical training. This would strengthen the students theoretical, scientific, and clinical confidence. Clinical midwives claim that it takes time to feel confident and that there is a need to develop professionalism. / En trygg barnmorska har en positiv inverkan för förlossningsutfall samt förlossningsupplevelse. Kunskap, kompetens och trygghet är ett livslångt lärande och har stor betydelse för att utveckla och forma personliga färdigheter, att låta de personliga egenskaperna växa och mogna. Tidigare internationella studier har påvisat att barnmorskestudenter känner sig otrygga inom områden där förväntas vara självständiga. Syftet med denna avhandling var att undersöka graden av trygghet hos svenska barnmorskstudenter strax innan de var färdigutbildade. Ett annat syfte var att utforska hur kliniskt verksamma barnmorskor reflekterar över lärande och vilka faktorer som bidrar till att utveckla yrkesmässig kompetens och trygghet. Studie I var en tvärsnittsundersökning med svenska barnmorskestudenter (n = 238). De bedömde egen trygghet inom alla kompetenser som en barnmorska förväntas kunna samt utföra självständigt. Resultaten av studie I bekräftade att svenska barnmorskestudenter känner sig trygga att hantera de vanligaste rutinerna vid normal graviditet, förlossning, eftervård samt nyföddhets vård. De känner sig emellertid inte fullt så trygga när något avviker från det normala samt vid obstetriska nödsituationer. Vid jämförelse mellan yngre och äldre barnmorskestudenter samt grad av trygghet, var det den yngre gruppen av barnmorskestudenter som kände sig tryggare i allmänhet jämfört med den äldre gruppen. Studenter vid ett universitet med en medicinsk fakultet var också mer trygga än studenterna vid ett universitet utan en medicinsk fakultet. I studie II hölls fokusgrupper med 14 barnmorskor, de diskuterade och reflekterade över hur barnmorskor utvecklar kompetens. Metod för att analysera var innehållsanalys, i resultatet framkom fyra kategorier 1.) känslor av professionell trygghet utvecklas över tid ; 2.) Personliga kvaliteter påverkar yrkesutveckling. 3.) metoder för kunskap och kompetensutveckling; och 4.) Kompetens som utveckling och krävande. Slutsatsen av denna avhandling är att mer klinisk träning under utbildning är önskvärt. Barnmorskestudenter behöver tillgång och möjlighet att öva obstetriska nödsituationer tillsammans i team bestående av förlossningspersonal och barnläkare. Det tar tid att lära samt att känna trygghet, en möjlighet att underlätta för studenter vore att utöka samt förlänga barnmorskeutbildningen, att inkludera mer klinisk träning. Detta skulle innebära att stärka studenters möjligheter till en utökad klinisk trygghet. Kliniska barnmorskor hävdar att det tar tid att känna sig trygg och att det ett finns behov av att utveckla professionalism.

Thesis ( Ph.D. ( Nursing)) -- University of Limpopo, 2016 / The purpose of this study was to develop an evidence-based model for enhancing optimal midwifery practice environment in maternity units of public hospitals, Limpopo Province. A mixed method sequential explanatory design was adopted. The study was conducted in four phases, namely: quantitative, qualitative, model development and validation of the model. Self-developed 4-point Likert scale questionnaires consisting of 81 item questions for learner midwives and 89 item questions for midwifery practitioners were administered. The questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of midwifery practioners was 174 and that of the learner midwives was 163. Data collected from respondents were analyzed quantitatively using descriptive and inferential statistics. Tables, pie and bar graphs were drawn to present the results. The results from the quantitative phase were utilized to formulate the interview guides that were used to explore the experiences of midwifery practitioners, experiences of learner midwives and perceptions of puerperal mothers. Phenomenological semi-structured individual interviews were conducted for midwifery practitioners (n=20), 3 Focus group discussions of learner midwives (n=18) and 3 focus group discussions of puerperal mothers (n=18) were held until data reached saturation. Data were analyzed qualitatively using Tesch’s open-coding method. Themes and sub-themes were coded manually. Results that emerged from the corroboration, comparison and integration of quantitative and qualitative results revealed the existence a sub-optimal midwifery practice environment, sub-optimal midwifery experiential learning environment and provision of sub-optimal midwifery interventions in the public hospitals of Limpopo province. Development of an evidence-based model emanated from the findings of numeric quantitative data and qualitative narratives. The evidence-based information from the existing situation as seen from the world of participants brought about a gap of optimal midwifery practice environment. The ideal situation was designed in a way of addressing the gaps identified. Experts were given the validation tool to assess whether the model was clear, simple, understood and that it can be utilized by any discipline in future.

Research has shown that there is a problem in the delivery of quality care in maternal and child health services in Zambia. The 1996 Zambia demographic and health survey estimated maternal mortality rate as high as 649 per 100,000 live birth, with this reason among others, human resource constraints and low number of supervised antenatal clinics, deliveries and postnatal clinics by skilled personnel as some of the reasons for the high maternal mortality. Selected studies identify the role of a clinical nurse specialist in advanced midwifery and neonatology who has acquired the knowledge and practical skills to bring about the desired impact of quality care in safe mother hood in order to bring down the high maternal mortality rates. In order to achieve this, the government needs to integrate the advanced midwifery and neonatology clinical nurse specialist in the health system. It was the purpose of the study to inquire into the feasibility of integration of the advanced midwifery and neonatology clinical nurse specialist in the Ndola District Health system .

United Kingdom (UK) health policy over the past thirty years has been predicated on a partnership model focusing on empowering service users to be fully involved in their care. Within maternity care partnership relationships have been conceptualised as empowering women to have continuity, choice and control (Department of Health (DoH), 1993), within a relationship of personal autonomy between the woman and her carers. In this study I sought to identify the extent to which the Government agenda for partnership working and choice is realised or desired by women during pregnancy and childbirth. In addition, I wanted to examine the level of alignment between the views of midwives with that of women accessing the maternity services. This study took a qualitative approach, drawing on the principles of grounded theory. In the first phase of the study a purposive sample of sixteen pregnant women were recruited and invited to complete a diary and to take part in two interviews. Women maintained diary entries following appointments with the midwife during pregnancy and childbirth. Semi–structured interviews were undertaken at 36 weeks of pregnancy and four weeks after the birth, based on the diary entries. In the second phase, four focus groups were undertaken with two groups of community midwives and birth centre midwives from two National Health Service (NHS) Trusts. Quotes from the diary-interviews from phase one were utilised to develop three vignettes which acted as a prompt during the focus group interviews. Following a thematic analysis of the data, I analysed women’s views on partnership working and choice. Most women in this study did not feel that they developed a partnership relationship with the midwife. This was associated with a lack of continuity of care and insufficient time to engage in meaningful discussion in an environment which was not conducive to shared decision making. Women described wide variations on the midwives role in supporting decision making. This ranged from decisions being dictated to midwives guiding choices and for some women, being facilitated to make informed choices. Many women described input of family and friends and widespread use of the internet as an information source. Women depicted their antenatal midwifery care as medicalised and felt that whilst their bio-medical needs were met their psycho-social and emotional needs were not. Women described the visits frequently as ‘in and out’ or ‘ticking the boxes’ to describe this approach to care. A small number of women (n=5) did experience a partnership relationship. Three of these women knew the midwife from a previous pregnancy; the remaining two women attended a midwifery led unit for all of their care. In relation to the choice agenda, most of the women who participated in this study were not aware that they had a choice about who provided their care or where they would have their care. The midwife focus groups concurred with the women’s findings and suggested that a lack of time was a significant factor hindering the formation of a partnership relationship. Midwives felt that this was exacerbated by the paperwork they were required to complete in order to audit care and meet the ‘payment by results’ agenda (DoH, 2003b). During the focus groups midwives identified strategies which could be implemented to enhance midwifery led care, including offering antenatal care to small groups of women and undertaking an antenatal home visit towards the end of pregnancy, to provide women with the time to discuss any issues that they wanted to explore in more depth. The findings from this study contribute to the current body of knowledge on midwifery led care particularly in providing the women’s perspective on partnership working. Women want to experience midwifery care that meets their psycho-social needs as well as bio-medical needs through a model of care that provides continuity. In contrast to previous research findings, the women in this study described community based care as mechanistic, clinically focused and time bound, more in line with an obstetric model of care than a midwifery model. However, midwifery led care offered within a birth centre was perceived by women as providing a more holistic, social model of care. Whilst continuity of care is not a new concept, what this study contributes is that despite successive administrations supporting partnership working and informed choice over the past twenty years, most of the women in this study did not experience this level of care. The findings from this study resulted in the development of a midwifery partnership model as a theoretical framework that could be utilised in future research studies to evaluate the extent to which a partnership relationship exists within a range of midwifery care settings.

Introdução: No parto normal, muitas mulheres têm lacerações perineais espontâneas, mas a prevalência, as características e os fatores relacionados a estas são pouco estudados. Objetivos: 1. Caracterizar as lacerações perineais espontâneas no parto normal; 2. Analisar as lacerações perineais espontâneas no parto normal, conforme as condições sociodemográficas maternas, as condições clínicas e obstétricas na gestação e no parto e as condições do recém-nascido; 3. Avaliar as morbidades perineais relacionadas às lacerações espontâneas até 48 horas após o parto. Método: Estudo transversal, realizado no Amparo Maternal, São Paulo (SP), entre outubro de 2011 e janeiro de 2012. Foram incluídas 100 mulheres com idade 18 anos; gestação a termo; feto único, em apresentação cefálica; parto normal com laceração espontânea. Os desfechos primários foram tipo, localização, grau, forma e tamanho da laceração espontânea, avaliados com a Peri-Rule. As análises descritiva e inferencial foram realizadas por meio dos testes Qui-quadrado, t-Student, ANOVA e correlação de Pearson, com p-valor <0,05 apontado como estatisticamente significante. Resultados: 51% das mulheres tiveram laceração única, 49% lacerações múltiplas; 58% tiveram laceração na região anterior do períneo, 80% na região posterior e 23% na parede vaginal; 77,5% tiveram laceração de 1º grau, 20% de 2º grau e 2,5% de 3º grau (sem rotura completa do esfíncter anal); 62,5% das lacerações eram de forma linear, 35% em forma de U e 2,5% ramificadas; na região anterior, a média da extensão das lacerações foi 28,6mm (±12,9); na região posterior, a média da extensão da mucosa foi 26,1mm (±10,5), a média da extensão da pele foi 24,3mm (±10,4) e a média da profundidade foi 18,1(±8,6). Na parede vaginal, a média da extensão foi 19,8mm (±6,5). Para o cálculo da média do tamanho das lacerações, foi considerado o maior valor para cada mulher. Houve diferença estatisticamente significante em relação às seguintes variáveis: localização (região anterior e posterior do períneo e parede vaginal) e idade materna; grau (primeiro, segundo e terceiro) e realização de exercícios perineais na gestação, edema perineal no parto, tipo de puxo, variedade de posição no desprendimento cefálico e tamanho da circunferência cefálica; forma (linear, U ou ramificada) e exercício perineal na gestação, uso de misoprostol, tipo de puxo, variedade de posição no desprendimento cefálico e circunferência cefálica; tamanho das lacerações na região posterior do períneo (extensão na pele) e edema perineal, altura do períneo e uso de ocitocina; tamanho das lacerações na região anterior do períneo (extensão da mucosa) e idade materna, uso de misosprostol e peso do recém-nascido; extensão parede vaginal e edema perineal. Não houve diferença estatisticamente significante em relação ao tipo de laceração (única ou múltipla). As principais morbidades perineais no pós-parto foram ardência, edema, hematoma, equimose e dor. Conclusão: A região posterior do períneo foi a mais afetada e as médias do tamanho das lacerações variaram de acordo com o local atingido. A ocorrência de lacerações de terceiro grau e a frequência de lacerações na parede vaginal indicam a importância da avaliação criteriosa do esfíncter anal, assim como do canal de parto, mesmo quando não há solução de continuidade aparente na região perineal. / Introduction: Most vaginal delivery are accompanied by spontaneous perineal lacerations. However there is a lack of knowledge related to prevalence, characteristics and risk factors of these lacerations in the literature. Aims: 1. To characterize the spontaneous lacerations in normal birth; 2. To analyze the spontaneous perineal lacerations in normal birth, according to socio-demographic, clinical and obstetric conditions during pregnancy and childbirth and the conditions of the newborn; 3. To evaluate morbidities related to spontaneous perineal lacerations until 48 hours after delivery. Methods: A cross-sectional study was carried out in Amparo Maternal maternity unit, São Paulo, BR. The data was collected from October, 2011 to January, 2012. There were included 100 women aged 18 years; fullterm pregnancy; single live fetus and vertex presentation; normal birth with spontaneous laceration. The primary outcomes were type, area, degree, shape and size of spontaneous lacerations, using the Peri-Rule. Descriptive and inferential analyzes were appraised using the chi- square test, Student\'s t-test, ANOVA and Pearsons correlation, with p-value<0.05 indicated as statistically significant. Results: 51% of women had single laceration and 49% multiple ones; 58% had anterior perineum lacerations, 80% in the posterior area and 23% in the vaginal wall; 77.5% had 1st degree, 20% 2nd degree and 2.5% 3rd degree lacerations (without complete rupture of the anal sphincter); 62.5% of lacerations were linear, 35% were \"U\" shape and 2.5% star shape. The average length of lacerations was 28.6 mm (sd ± 12.9) in the anterior area; the average length of the mucosa in the posterior area was 26.1 mm (sd ± 10.5), the length of skin was 24.3 mm (sd ± 10 4) and the depth was 18.1 (± 8.6); the average length of the vaginal wall was 19.8 mm (sd ± 6.5). In order to calculate the average size of lacerations, the highest value for each woman was considered. There were significant differences for the following variables: area (anterior and posterior perineum area and vaginal wall) and maternal age; degree (first, second and third) and perineal exercises during pregnancy, presence of perineal edema during labor, type of pushing, fetal position variety and size of head circumference; shape (linear, \"U\" or star) and perineal exercise during pregnancy, use of misoprostol, type of pushing, head delivery position and head circumference; size of lacerations in the posterior perineum area (skin length) and perineal edema, perineum height and use of oxytocin; size of lacerations in the anterior perineum area (mucosa length) and maternal age, use of misoprostol and weight of the newborn; length of the laceration on vaginal wall and perineal edema. There was no statistically significant difference in the type of laceration (single or multiple). Major postpartum perineal morbidities were blazing, edema, hematoma, ecchymosis and pain. Conclusion: The posterior perineum area was the most affected and the average size of lacerations varied according to the affected area. The occurrence of third degree lacerations and the frequency of lacerations in the vaginal wall indicate the importance of careful evaluation of the anal sphincter, as well as the birth canal, even if when the is no apparent solution of continuity in the perineum.

Background: Historically, the focus of the UK and international research exploring planned home birth decision making has been largely focused on understanding the experiences of women who decide to birth at home. As a result of high-profile research that suggests that non-OU birth locations are safe for low risk women, there has been a recent shift in focus resulting in research studies that aim to increase the rates of planned home birth, or more often the rates of all non-obstetric unit birth within the UK. However, despite this increased level of attention, the rate of home birth remains stubbornly low. Whilst there is some research to indicate why this might be the case, research that sheds a new light on the issue, and that develops an evidence base for new interventions is required. This thesis illuminates the factors that need to be considered in order to increase women’s abilities to make an informed decision about planned birth. Methodology: A pragmatic approach, using mixed methods, was used to explore the current way that we offer planned home birth to maternity service users, and to ultimately make suggestions about how this could be improved. The following studies have been undertaken: Study 1: Initial exploratory study: The case notes of one hundred and sixty nine women, from one health board and who had planned to birth at home, were audited. Non-participant observation of birth planning meetings at thirty-six weeks gestation were undertaken with seven community midwife and low-risk women dyads. These were followed by individual semi-structured interviews with the participants. Study 2: Scoping review: Qualitative and quantitative research, and non-research based literature, were analysed to produce a qualitative review of planned home birth decision making. Study 3: Active offer of planned home birth concept analysis The findings of the initial exploratory study and the scoping review, in addition to active offer literature that is predominantly applied to support the provision of services within minority official languages, were used to create an active offer of planned home birth. Study 4: Workshop study testing the findings of the concept analysis Narrative based exercises were used to explore the concept analysis findings with twenty previous service users who had birthed at home, nine previous service users who had chosen an institutional birth, and fourteen community midwives. Findings: Women will either take a ‘passive’ or ‘active’ approach to the offer of planned home birth, with a passive approach likely where no motivation for an active approach has been provided. Where a woman takes a passive approach, her ability to make an informed decision about planned home birth will depend on an active offer being made by her midwife. This will be most effective when it is supported by a midwife’s employing organisation. The findings of this thesis suggest that a two stage active offer of planned home birth (AOPHB) process, consisting of ‘Creating the conditions’ and ‘Positive reinforcement’ stages, can be used to underpin the offer of planned home birth. Discussion: There has previously been minimal understanding of how to facilitate the home birth decision making process, and a passive offer is routinely provided to women in the UK. The proposed two-stage AOPHB process provides a structured way for midwives to underpin their offer to women, in order that an increased percentage of women are able to make an informed decision about home birth and/or decide to birth at home. Where midwives apply the AOPHB, women who may take a passive approach could be ‘activated’ to engage in home birth decision making. A pilot intervention has been drafted to implement the AOPHB within clinical practice. The intervention provides support for the implementation of the two-stage AOPHB process through the use of individual components focused on midwives and their employing organisation; student midwives; and women, and their significant others. Implications: This thesis has contributed to the developing knowledge base about planned home birth decision making. The application of active offer theory to the offer of planned home birth has been undertaken for the first time, and this has generated a new and useful perspective on this area of midwifery practice. The resultant two-stage AOPHB process has the potential for developing midwifery practice in terms of supporting midwives to understand and facilitate women’s decision making around home birth, providing a flexible tool that can be used in clinical practice. This is the first approach that has been developed with the aim of increasing the ability of women to make an informed decision about whether they wish to birth at home. Additionally, the pilot AOPHB intervention has implications around the understanding of how employing organisations can best support midwives in this aspect of their role, and developing how student midwives are educated about offering home birth to women.

Healthy Start is the United Kingdom government’s food voucher programme for low-income, pregnant women and young children. Eligible women receive vouchers worth £3.10 per week, which can be exchanged for fruit and vegetables, plain cow’s milk or infant formula. There has been no robust evaluation of the impact of Healthy Start on nutritional outcomes since its introduction in 2006. Therefore, this study aimed to explore potential outcomes of the programme (including intended and unintended outcomes) and develop explanations for how and why these outcomes might occur. A realist review was conducted in two iterative and overlapping stages: 1) developing theories or hypotheses about how the Healthy Start programme works, for who, in what circumstances and why; 2) testing those theories using relevant evidence from existing studies of Healthy Start and a similar food voucher programme in the United States. The review findings comprised three ‘evidence-informed programme theories’ about how low-income pregnant women use Healthy Start vouchers and why. A qualitative study was undertaken to further refine and consolidate the programme theories derived from the realist review, and to develop new and emerging programme theories. Semi-structured interviews were conducted with 11 low-income women from North West England, who received Healthy Start vouchers during pregnancy. An innovative combination of realist interview techniques and vignettes was used to communicate and exchange theories with low-income women. A realist logic of analysis was applied to generate clear and transparent linkages between outcomes and explanations. Five ‘evidence-based programme theories’ were developed to explain why low-income pregnant women may experience one or more of the following outcomes from the Healthy Start programme: dietary improvements, shared benefits, financial assistance, stockpiling formula, misuse of vouchers. These programme theories were integrated with existing behaviour change theories and an overarching theoretical model for Healthy Start was developed. This model illustrates the combination of context and resources needed to generate the intended outcome of dietary improvements for low-income pregnant women, and the mechanisms by which this outcome may be generated.

Li Siu-yan Susan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 156-168). / Abstracts in English and Chinese. / Abstract (English version) --- p.i / Abstract (Chinese version) --- p.iii / Acknowledgements --- p.v / Table of Contents --- p.vi / List of figures --- p.ix / Chapter I. --- INTRODUCTION --- p.1 / Background of the study --- p.1 / Chapter II. --- LITERATURE REVIEW --- p.5 / Maternal role attainment --- p.6 / Transitional theory --- p.16 / Feminist approaches to transition to motherhood --- p.23 / Local research on transition to motherhood --- p.26 / The rationale of the study --- p.30 / Chapter III. --- METHODS --- p.34 / Design --- p.34 / Setting --- p.39 / Sample --- p.39 / Ethical issues --- p.41 / Data collection --- p.42 / Data analysis --- p.46 / Trustworthiness of the study --- p.53 / Summary --- p.57 / Chapter IV. --- FINDINGS AND DISCUSSION --- p.59 / Conceptual categories --- p.61 / Keeping harmony --- p.62 / Giving of self --- p.63 / Discontinuity of self --- p.64 / Caring for (m)other --- p.75 / Replenishing --- p.91 / Daydreaming --- p.92 / Fortifying support --- p.98 / Developing self --- p.117 / Rewards of mothering --- p.118 / Achieving maternal competency --- p.121 / Renegotiating relationships --- p.127 / With mother-in-law --- p.130 / With husband --- p.135 / With work --- p.137 / The storyline --- p.139 / Chapter V. --- CONCLUSIONS AND RECOMMENDATIONS --- p.141 / Summary of the study --- p.141 / Implications for midwifery practice --- p.146 / Limitations and recommendations for further study --- p.152 / Personal reflections on study --- p.153 / References --- p.156 / Appendix / Chapter A. --- Letters of approval - The Chinese University of Hong Kong --- p.169 / Chapter B. --- Letters of approval - general hospital --- p.170 / Chapter C. --- Subject information sheet for the participants (English and Chinese version) --- p.171 / Chapter D. --- Consent form from the participant (English and Chinese version) --- p.173 / Chapter E. --- Transcripts in Chinese language --- p.175 / Chapter F. --- Translation of transcripts in English --- p.195 / Chapter G. --- Demographic summary of interview participants --- p.214

Unassisted childbirth--giving birth at home without a midwife or physician present--emerged as a movement in mid-20th century North America. While only a small number of women choose to give birth unassisted, its significance extends far beyond its numbers. Unassisted birth illuminates trends in maternity care practices that drive, and sometimes force, women to choose unassisted birth. It also is part of a larger set of connected values and lifestyle choices, including home schooling, breastfeeding, co-sleeping, ecological awareness, cloth diapering, sustainable living, and alternative medicine. Finally, the emergence of UC as a conscious birth choice requires a re-examination of how we understand, frame, and interpret childbirth paradigms. There is very little written about unassisted birth in the academic world, although media reports on the practice have become increasingly prevalent since 2007. This dissertation begins the conversation for a scholarly inquiry into unassisted birth. My research is based primarily on interviews, essay-response surveys, and archives of internet discussion groups. After setting unassisted birth in historical context, I explain why women make this choice; the knowledge sources they privilege; how they understand the concepts of safety, risk, and responsibility, and their complex and sometimes contradictory relationship with midwifery. I also examine midwifery, and to a smaller degree, obstetrical, perspectives on unassisted birth, focusing on how birth attendants who are sympathetic to UC reconcile that with their training and experience attending births. Unassisted birth has changed the core questions we need to ask about birth. Instead of home or hospital?, natural or epidural?, or midwife or obstetrician?, questions asked by existing models of childbirth, unassisted birth poses a different set of core questions: Is birth disturbed or undisturbed? Is it social or intimate? managed or intuitive? attended or unattended?