Often criticised as being unsafe, negligent or just plain selfish, I have spoken with a group of intelligent and fiercely passionate women who made the decision to birth their babies, free of any intervention, about freebirth and what it’s really all about.
The birth of my second child was a planned homebirth that, due to negligent midwives, became what is known as a BBA, or Birth Before Arrival (of a midwife). With a waiting time of over an hour and a half from making the call to their estimated arrival, I gave birth instead into the hands of a terrified, alarmingly undertrained, paramedic. I felt immediately euphoric and empowered, amazed that my body had taken over in ways that I have yet to understand. As if on autopilot, I made a series of decisions immediately prior to her birth that I don’t remember and that led to the safe and easy delivery of an almost 10lb baby. Not even a tear. Since then, I have been exploring the topic of unassisted birth with great interest.
Why do women choose freebirth?
Though unassisted births as a result of BBAs are alarmingly common, freebirths are the result of a planned decision to birth alone. The reasons for choosing freebirth are many and varied.
Speaking candidly, mother of 6 Vicki explained that her decision to birth without assistance was the result of a traumatic birth with her third child, after two positive birth centre experiences. Her third child was delivered via caesarean section after a series of interventions that Vicki believes were unnecessary and the result of a flawed system; “It was the result of a cascade of intervention and a system that did not believe in me or my body’s ability to birth. It was completely unnecessary, totally preventable. I feel very angry about so many things that happened, and about the way I was treated. I knew it was wrong, but the more I tried to resist the worse the pressure was. It was a completely impossible situation. I am generally assertive and forthright, but I was completely unable to stand up to the system, to the point where physical force was used to make me comply.”
After her experience, Vicki got in touch with Laura Shanley, author of Unassisted Childbirth, and decided to birth her fourth child, her way. The result was a happy, empowering and healing birth and it wasn’t to be her last. However, Vicki went on to suffer 3 miscarriages, the last of which involved the risky off-label prescription of misoprostol to help her to deliver her miscarried baby and nearly cost her life. Though it is often argued that the most important outcome of birth is that both mother and baby are alive, Vicki’s experiences demonstrate the complexity of the situation. The reckless use of misoprostol coupled with the unnecessary caesarean birth of her third child is, Vicki believes, the cause of the placental abruption that led to the crash section that delivered her fifth child at just 33 weeks; “If the first completely unnecessary section had not been done, and if the prescribing doctor had known his stuff, I would never have been put in the position of needing life-saving surgery. I did need that section, I was losing blood by the litre, and we would not have survived much more, but it was so completely the result of poor medical management in the past. We are lucky to be alive, and I know many women say that, but I know that it truly is the case for me, and I also am more than aware that whilst it was not intervention in the moment that caused the danger, it was birth intervention in years past that did. I am angry that it seems OK for medics to cause that level of danger and damage, but women are deemed selfish for wanting to avoid that for their baby and themselves.”
However, she went on to birth her sixth child unassisted, once again, and believes this was another healing experience for her; “There is nothing quite like birthing your baby into your own hands completely by instinct, without anyone else disturbing the process. It was so completely normal, and yet so amazing. Dinner, bath, birth baby, eat cake, bath, bed with my baby, my husband and my toddler. So few women get to do just that, with no one else fussing, flapping or interrupting our bonding. It was so much more than perfect.”
Other women, like Sarah, have been birthing unassisted from the very beginning. Though her first birth was a BBA that saw her blamed and chastised by the attending midwife, and her second an almost BBA with the midwife arriving just as her baby was being delivered, her third and fourth births were planned freebirths with the fourth also being an “unassisted pregnancy”. The decision was based on the realisation that she was likely to have another BBA, and her sense of empowerment grew with each birth; “With each baby I have learnt more, found more support and trusted myself more”. She even describes her first birth, despite her poor treatment in the aftermath, as being “awesome” and believes the connection between birth and mothering is important; “I feel that when you trust your primal instinct, which begins in pregnancy, you can then trust that deep down you know your kids. When that’s been undermined I suspect it’s very difficult to not keep second guessing yourself”.
These sentiments were shared by Hannah, who had two unassisted births after the birth of her first child in a hospital “[I was] very able to read my baby! We are doing elimination communication that I never thought I would do but it has come naturally as I can read his signs well. I felt a distance with my firstborn that the Syntocinon created between us but my two homebirthed I was blissed for ages! I think, after a difficult birth, time is the healer in the relationship but after my first I felt my instinct had been stolen at the same time the birth was robbed! With my third freeborn I have less fear as a mother and, mostly, love.”. The birth of her second child was attended by a doula which she describes as being the most enlightening experience of her life and what led her to becoming a doula, herself “I have a history as a rape survivor which stole much confidence in my instinct and power as a woman. After my daughter’s birth I felt I could do anything and started my doula journey soon after! I knew before my third baby was born that I would freebirth, partly because my work as a doula led me to support women who birthed quickly before midwives arrived and every time I would be blown away by how easy and straightforward their experiences were.”
The role of the doula
Though many women who choose to birth unassisted opt to do so completely alone or with only family present, some prefer to enlist the help of a doula. Samantha of Blooming Miracle believes the connection between the doula and the mother is essential for the best possible freebirthing experience “One mother might approach me and say she was planning a freebirth and wanted to hire me and I’d feel OK with it. Whereas someone else might be planning a freebirth and want to hire me but I would feel nervous. If I felt nervous I would politely turn them away – whether they have a midwife there or not, they do not need me and my adrenaline there.”
Lisa of Everyday Miracle agrees “I have been asked to support a few UCs since becoming a doula. I have not always agreed to, though. The relationship between a family and their doula is 2 way and you need to feel a deep understanding and trust whether it’s a UC or not. For the births I have supported, where the family planned not to call midwives, I have felt the same connection as I do with any of my clients.” She also believes the role of the doula is no different in freebirths than any other birth “Emotional and practical support. Instinctively knowing when a woman or her birth partners need a word of comfort, touch, something practical like a drink, changes to the environment / position etc. to encourage progress, holding that space. When you are at a UC the only difference is that there is no advocacy required as there’s no one else there and we are only on the woman’s agenda. It’s actually when you can ‘doula’ in its purest form.”
Criticisms for freebirth centre around safety, with opponents often citing the only formal investigation into Unassisted Childbirth, conducted in 1984 by the Indiana State Board of Health. The investigation focussed on members of a religious community who rejected all medical care during and outwith pregnancy and childbirth and found a perinatal mortality rate 2.7 times higher, and a maternal mortality rate 97 times higher than the state average.
Laura Shanley, however, believes that freebirth is the safest way and blames living and social conditions for high mortality rates before the dawn of medical intervention in hospitals “Poor women were generally underfed and overworked during pregnancy, while wealthy women were often deprived of fresh air and sunshine because brown skin was considered socially unacceptable. Wealthy girls were corsetted from the age of eleven, so that by the time they turned fourteen, their pelvises were literally deformed. These physical factors, combined with various psychological ones (fear, shame, and guilt) led to the problems that some women encountered.” These factors, such as religious shame and guilt, coupled with a complete rejection of all medical care may well explain, in part, the results of the Indiana investigation. Laura goes on to say “Throughout history, normal, healthy women have rarely died in childbirth. In fact, when birth moved from the home to the hospital in the 1920s, the infant and maternal mortality rates actually rose. A major study done as early as 1933 showed that hospital births were not as safe as home births. Studies done in the last twenty years, prove this is still the case. (Mayer Eisenstein, MD, The Home Court Advantage, 1988.)”
Acknowledging that fatalities can occur wherever a woman gives birth, she delicately explains “No one, however, regardless of their “expertise,” can guarantee that a baby will be born safely. Some babies die. It’s simply nature’s way.” a sentiment that is shared by birth advocates all over the world. Samantha adds “Freebirth is not for everyone. Maybe, for those people, it would be unsafe. They only have their own perspective.
Nothing in life is “safe”. There is risk in everything. All we can do is decide which risks we feel most OK with. That is a personal thing and can’t come from what other people dictate to you.”
But, on the issue of personal responsibility it is perhaps Lisa’s thoughts that offer the most insight “[freebirthing women] are generally much more informed and educated in terms of what makes birth safer. i.e for most women less is more, interference is risky and actually doing nothing or very little makes for a safer birth. Freebirthers, for the most part, believe this with every ounce of their being. They trust birth but they also take responsibility in a way that the vast majority of the population are unable or unwilling to. They’re actually further from being irresponsible than most. They’re the ones actually taking full responsibility for their births and their babies. They’re often the most well read and researched ‘Birthers’ out there. They’ve faced their fears and thought about how they would deal with scenarios most of us don’t dare to consider. In my opinion they’re some of the most responsible people as they’re not prepared to hand it over to an ‘expert’.”