Medical supervision during birth saves lives. So why do some women choose a ‘free birth’ instead?

Click to play video: 'What is ‘free birth’?'
What is ‘free birth’?
A woman in California received backlash after sharing to a Facebook group the story of how she delivered a stillborn baby through free birth, which is where a delivery happens without a midwife or medical professional present – Nov 7, 2018

A woman in California chose to deliver her baby in what’s called a “free birth” — a birth at home, without the attendance of a medical professional such as a doctor or midwife.

Unfortunately for her and her baby, it went badly. According to a report in the Daily Beast, after six days of labour, the woman eventually went to the hospital, where her baby was stillborn. It’s unclear what the outcome would have been with earlier medical intervention, but the woman has been roundly criticized online for avoiding it.

The woman was a member of the Free Birth Society Facebook group, which has since shut down and moved to a private website. Before it closed, it had about 6,000 members, the Daily Beast reports. A public Facebook page for the organization currently has more than 12,000 likes.

Medical professionals say that giving birth at home, without any medical help or supervision, is a bad idea.

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“We do not condone or promote ‘free birth’ and always recommend that birthing people have a qualified medical professional,” wrote the Ontario Association of Midwives in an emailed statement.

“It’s not something I would recommend,” said Liz Darling, assistant dean of McMaster University’s midwifery education program. “Although many births can proceed without complication, we do know that sometimes complications can arise in labour, even if somebody has had a healthy and uncomplicated pregnancy.”

“It makes sense to have somebody present at the birth who can check and make sure that things are progressing normally and make recommendations around interventions, if they are necessary.”

While emergencies do arise at times, likely the bigger issues are if labour goes on too long — potentially putting stress on the mother and baby — and the baby not coping well with the labour, due to things like a compression of the umbilical cord or a poorly-functioning placenta, Darling said.

These are the most common reasons why a planned home birth might end up moving to the hospital, she said, and having someone who can monitor for potential issues can help.

Wendy Hall, a professor at the school of nursing at the University of British Columbia, said that while she also wouldn’t recommend an unassisted birth, that doesn’t mean that all home births are unsafe.

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“I’m all in favour of healthy women giving birth at home, but with a skilled provider there. Because I do believe that pregnancy is a healthy experience and women in good health should be offered the opportunity to do that.”

Though only about 1.6 per cent of Ontario births between 2003-2006 were at home, a study published in the journal BIRTH found no differences in the rates of mortality or morbidity in the babies born at home under medical supervision when compared to hospital births.

Midwives have a clearly defined scope of practice and wouldn’t offer a home birth to someone when the risks were too high, she said.

But why would someone not want a midwife or doctor at all?

The California woman told the Daily Beast that she knew she had to give birth alone with her husband, away from “harsh hospital lighting and strangers’ gloved hands.” The Free Birth Society’s new website promotes “autonomous pregnancy,” “ecstatic independent birth” and “joyful connected mothering.”

Darling thinks that it’s not so much about what people find appealing about giving birth alone, as “what is it that they’re not finding in the health care system?”

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Some people have had negative experiences with the health care system or feel like their needs aren’t being met by it, she said.

“Some people, they make this choice after having had a birth experience that was traumatic or something that was very different from what they wanted,” she said.

“Sometimes it can be driven by people feeling like they don’t have autonomy in what’s happening in the care that they’re receiving.”

Research done by Hall’s graduate students suggests that some women who gave birth in hospital felt like they weren’t included in decision-making, or didn’t think they had freedom to move around their rooms and squat or do whatever felt natural to them, or didn’t trust their caregivers, or were simply distracted and uncomfortable by all the people walking in and out.

One way to help women feel more comfortable would be to ensure one-on-one care throughout their labour, she said, whether that was by a nurse assigned to them in the hospital, or a midwife at home. “They’re going to feel that they’ve got more freedom to use space. They’re going to feel more feelings of trust because they’ve got continuity going on.”

“You’re not going to get as easily distracted from labour and you’re going to feel like your care is more personalized.”

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Although she says there’s not an “epidemic” of free births, and many women are satisfied with their care, Darling said that it’s important not to dismiss people like this woman in California as “crazy.”

“I think it always behooves us as health care providers to listen to people when they are really unhappy and reject the care that they’ve received, and think about how could we do things differently.”

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