In a recent post on the blog Journey of an Aspiring Midwife, I read these words:
“Freebirthing is a trend of non-medical birthing, usually in the home, without the guidance of a midwife, OB-GYN, or other medical professional. . .Freebirthing is an option that appeals to expecting mothers who are already living a natural lifestyle and who trust their bodies to birth in a natural, peaceful way.”
Wondering what reasons women would have for choosing freebirth, I did some more internet research. Laura Shanley is one of the best-known proponents of freebirth. Her website, Bornfree, is full of resources and information for those interested in freebirth. Laura writes about midwives:
“It amazes me that the same women who berate obstetricians for portraying birth as a dangerous ordeal, do the exact same thing when confronted with a woman who is considering having an unassisted birth. “Trust yourself,” the Wise Women say, “but not to the point of giving birth without me!”
These words concern me. I am concerned, first and foremost, that any midwife has given the impression that she is indispensible to a woman knowing how to give birth. Women have an instinctive knowledge of how to give birth, just as they instinctively know how to perform any other bodily function. Second, I am concerned that women who want to be able to give birth instinctively are finding it so difficult to be supported in that choice that they decide on a free birth.
What’s wrong with free birth? The thought of it sounds lovely, doesn’t it? Birthing your baby into your own hands or the hands of your partner, just the two of you. . .
I’d like to share two freebirth stories. The first woman, Julia (not her real name) had several children, and had experienced a severe shoulder dystocia with her last baby. Her homebirth midwife refused to deliver the next baby at home because she felt the hospital would be safer in the event of another shoulder dystocia where the baby could not be delivered. Julia was certain that her birth would go fine, because she had optimal nutrition, took all sorts of herbs to support normal childbirth, exercised, and educated herself on checking dilation and heart tones. Julia had borrowed equipment from a friendly midwife, but declined to have her nearby in case she needed help. The midwife received a frantic call late one night. It was Julia’s 10-year-old daughter, screaming that the baby had come out feet first and the baby’s head was stuck. The midwife told her to call 911 and that she would be enroute. She arrived before the EMTs, and proceeded with emergency maneuvers for delivery of an entrapped fetal head. She was able to deliver the baby within a couple of minutes of arriving, but the baby was not responsive and had a heart rate of 40. She proceeded with CPR and accompanied the baby to the hospital with the emergency squad. The midwife and the baby’s father estimated it had been ten minutes from the birth of the baby’s body until the head was finally delivered. The baby suffered severe neurological damage and died several days later.
The second story involves a young woman, Zoe, having her first baby. Zoe initially received prenatal care from a midwife, but decided about halfway through her pregnancy that she trusted her body to give birth perfectly, so why see a midwife? Zoe’s husband, Todd, was eager to join her in a freebirth, just the two of them at home alone. Zoe’s midwife, Ruth, did not hear from them again until one afternoon when the phone rang.
“Ruth?” Todd spoke quickly. “Can you come and help us? Zoe’s had the baby OK, but she keeps bleeding and I can’t get it to stop.” Ruth quickly instructed them to call 911 and said she was on her way. Grabbing her birth bag and meds, Ruth sped to Zoe’s house. When she walked into the bedroom, she found Zoe on the bed in a huge pool of blood. Todd was standing next to her, holding the baby. “We tried to get the baby to nurse to help stop the bleeding but she won’t. Zoe is getting dizzy.”
Ruth quickly went through the steps of emergency postpartum hemorrhage management. She started an IV and administered pitocin to help contract the uterus. She checked the placenta, which appeared intact, and massaged the uterus. By the time the EMTs had arrived, the bleeding had slowed to normal, but Zoe’s vital signs were very unstable. She had lost so much blood that it became necessary for her to be sent by life flight to a tertiary care center after she developed DIC, a complication of extreme blood loss.
My point in sharing these stories is not to portray birth as a scary, dangerous event that requires a health care provider to ensure a good outcome. Bad outcomes occur even with the best of care.
Those who support the idea of free birth assert that birth is normal. I reply, “So is death.” The Manual for Neonatal Resuscitation states that 95% of babies will be born without need for any type of resuscitation. It is for the other 5% that I have concern. The two stories I shared with you were of women who took optimal care of themselves, did everything right, educated themselves on what to do in an emergency. . .but when it came down to it, their experience and intuition was not enough to resolve the problem. Sometimes birth becomes dangerous through no wrongdoing on anyone’s part, and it is for those times that it is wise to have a skilled provider available if needed. I see the midwife’s role as more like a lifeguard than a director or a coach. She is there only if needed. The rest of the time, her job involves watchful waiting.
As a midwife, I’ve worked with a number of women who ascribed to the freebirth philosophy. Some chose to give birth without assistance, but many asked me to be present in their home, in another room, available if needed. I am happy as a midwife to do this. I have loaned my equipment and emergency medications to women, and instructed partners in how to give uterine massage and an injection of pitocin if needed. The birth is not about me, and the best compliment I can have from a women is, “I’m glad you were here if we needed you, but I did it myself!”