The rise of freebirthing
I’ve never given birth, but I imagine it’s quite scary, especially the first time you do it.
It’s natural, it’s a miracle, but it’s also a great big unknown. How painful will it be? Will it last for hours? Is it going to be the bloody, screaming affair I see on TV?
That’s what would be going through my head, which is why it surprises me to hear that more and more people are deciding to face childbirth alone.
Freebirthing is the rising trend of people giving birth at home alone. There are no doctors or midwives around to help. Only a partner, friend or family member.
Why would anyone turn down the safety and help of medical professionals? I spoke to Dr Lesley Kuliukas of Curtin University to find out.
Why go it alone?
Freebirthing has its outspoken advocates and critics. But like most things, you’ll find the truth somewhere in the middle.
While few may freebirth for its ‘natural’ appeal, many do it out of fear, a lack of information or a lack of options—especially second-time Mums who have been traumatised by their first hospital birth.
“Women aren’t getting the service that they want or require or they’ve been traumatised by a previous experience and that’s what’s making them look outside of the system,” says Lesley.
Hospitals are busy and very risk-averse. This can lead to excessive interventions during hospital births, and women aren’t always given a choice.
“Vaginal examinations with no consent. Episiotomies with no consent. These things happen today in hospitals in WA,” Lesley tells us.
These are valid fears for expecting parents. Who wants to be poked, prodded or cut up without their consent? Who wants strangers rushing in and out, looking at their bits and making decisions about their body? Especially during one of their most vulnerable moments.
But while these things may be unpleasant, they are safe. Hospital protocols exist to protect people. Is it really worth risking the life of parent and baby to birth alone at home?
The dangers of freebirthing
Ultimately, if there’s no one with medical expertise present at a birth, there’s no safety net if disaster strikes.
“Women in the throes of labour can’t pick up potential problems themselves and so issues that could lead to morbidity or even mortality aren’t going to be addressed appropriately,” says Lesley.
“The situation could deteriorate and end up very badly for either the woman or the baby or both.”
The thing is, most freebirthers are aware of the risks but decide they’re worth taking.
Being able to choose the birth plan they want means a great deal to some expecting parents. And they’re going to birth at home, even if it quite literally kills them.
So why can’t we just make it safer for them?
Birth ‘as nature intended’
With over 30 years’ experience as a midwife across the board—private, clinical and centre-based—Lesley understands these parents’ plights.
Despite having worked in hospitals, she too believes hospitals aren’t always the best environments for giving birth.
Hospitals are largely designed for sick people. Pregnant people aren’t sick, but they have to follow the same inflexible rules as other patients, even when it works against their interests.
They’re put in a bed, but Lesley says labouring women should be up and moving to optimise blood supply to the baby. They’re under bright lights with strangers coming in and out, but this can disrupt natural labour.
“If you think of where an animal labours and gives birth, they always find themselves a warm, dark, safe, secure, familiar environment, and if that’s disturbed in any way, the labour stops physiologically,” Lesley explains.
“The same is true for women. We’re animals as well, and unless we find ourselves in this familiar, comfortable, safe place, our bodies will not work. They won’t work efficiently.”
“If you think of where an animal labours and gives birth, they always find themselves a warm, dark, safe, secure, familiar environment”
Lesley says that, if labour stops, hospitals get around it using hormones that force labour to continue. But this can be the start of a “cascade of interventions”, including epidurals, forceps or caesarean sections. Every additional intervention carries its own risk and can lead to a traumatic birth experience or even postnatal depression.
Lesley believes having a baby at home—as long as it’s a low-risk pregnancy with an experienced person present—can be a much more satisfying experience.
“It’s not safe for [women with high-risk pregnancies] to give birth at home, but for young, fit and healthy women who are low risk, then it’s just as safe to have a baby at home as it is in hospital. And in fact, it’s better,” she says.
“We know that babies born at home have better Apgar scores than babies born in hospital. But most importantly of all, women’s satisfaction levels are much better.”
“If you have midwifery care … someone who’s qualified and experienced and able to help you, then problems will be picked up and dealt with appropriately and in a timely fashion.”
Educate to empower
Lesley believes fewer women would freebirth if they knew they had the option of a private midwife.
“A lot of people don’t even know about the private midwife route … When a woman first becomes pregnant, the general path is that she goes to her GP,” explains Lesley.
“[The GP’s] first question is do you have private health cover? If you do, this is the path you take. If you don’t, here’s your referral to the public hospital.”
“Whereas really, at the beginning of pregnancy, a woman should be shown all of the choices available to her.”
Lesley says history and enculturation have left a lot of people believing hospital births are the only choice.
“A lot of women do what their sisters have done, what their mothers have done, what their friends do, without being aware of what other options there are available to them,” she says.
“We’re very lucky in WA that we’ve got a community midwifery programme that is publicly funded and that enables women to birth at home with a qualified, experienced midwife. And that’s fantastic, but not many women know about it.”
We also have a family birth centre, which offers an experience with the comforts of a homebirth within the safety of a hospital. It runs out of King Edward Memorial Hospital and has the facilities for waterbirth and offers women choices, such as their birthing position, pain relief options and whether to have their other children present for the birth (all in the limits of safety, of course).
Lesley says her own 10 years of experience working for the family birth centre was eye opening.
“What I found was that, very often, women coming in to have their first baby would labour like a woman coming in for her second or subsequent baby, simply because she’s in the right environment.”
“It makes such a difference, it really does.”
The centre recently celebrated its silver anniversary. Midwives there have helped women birth over 7000 babies in its 25 years of operation.
The freedom to choose
What it comes down to, Lesley believes, is choices. If someone wants to give birth in a hospital, they should be able to make that choice. If they want to give birth at home and it’s safe to do so, they should be allowed to choose that too.
“What we don’t want to do is make women feel like there’s not the option available for them that pushes them into freebirthing. That’s the very worst thing,” she says.
She says changing the way we approach hospital births could help too. Making labour wards more “woman-friendly” could make the experience less daunting for those afraid of hospital births.
These sentiments were echoed by the World Health Organization in 2005 when they quoted Professor of Obstetrics and Gynaecology Mahmoud Fathalla: “The question should not be “why do women not accept the service that we offer?”, but “why do we not offer a service that women will accept?””
If we are to drive change, Lesley says people need to start reporting their negative birth experiences. If anyone has a traumatic birth that leaves them considering freebirth, they need to let someone know. In WA, you can submit complaints to the Health and Disability Services Complaints Office.
There are no 100% guarantees with childbirth. Complications can arise in any scenario. But every person should be given the opportunity to have the best possible birth experience for them, as long as it doesn’t compromise the safety of parent or baby.
The birth of a child should and can be the most special experience of a person’s life.
Lesley sums it up perfectly.
“It can actually be the most beautiful thing really, it’s just absolutely stunning. It’s nature at its earthiest.”