With independent midwives being outlawed next month, many expect a rise in women giving birth at home without medical help. But does ‘freebirthing’ result in happy, intervention-free labours? Or is it a dangerous practice that risks babies’ lives?
Sarah Currie is just days away from giving birth, so when we meet our conversation turns, naturally enough, to the delivery. She is planning a home birth; we talk about where it might take place (she thinks the sitting room), about pain relief (she’s going to walk around) and how long the labour might last. One thing we don’t talk about is the midwife, because there won’t be one. Currie, 27, decided a few weeks ago that she wanted to have her child without medical assistance.
If that sounds mad, bad or dangerous (or perhaps all three), then hear her out. Two years ago, Sarah, who lives in Peterborough, gave birth to a daughter called Anabella-Grace (her older children are Jack, seven, and Eleanor, three). She’d been planning a hospital birth, as her previous two had been, but towards the end of her pregnancy she became interested in home birth. The midwife said she wasn’t considered “safe” for it because her first child was born by caesarean section. But Sarah looked at the research and decided she was willing to take the risk, which she thought was very small.
She booked a home delivery and called the midwives, as agreed, when she went into labour. “But the person who answered the phone said the community midwives were already at a birth so no one was available. She asked if I would come in to hospital. I had my heart set on a home birth, and everything was going well. No one had warned there might not be a midwife. So I said: ‘I’m staying put.'”
The labour progressed well, but less than 10 minutes before her baby was born, a team of paramedics arrived. “They didn’t interfere,” Sarah says, “but it could have been very different. Some paramedics might have freaked out; they might have tried to get me to do something I didn’t want to do. And they changed the atmosphere, because an ambulance arriving in the middle of a normal birth isn’t ideal.”
When Sarah got pregnant with her fourth baby and was told there was a distinct chance the same thing might happen, she looked into her options. “I read up on unassisted childbirth, or freebirth. It seemed to me that the risks weren’t high, assuming you had a healthy pregnancy and no underlying health conditions. So I decided to go for it. I was absolutely committed to a home birth – being in your own space makes all the difference, as far as I’m concerned – and that was my priority. If the health trust could have promised me a midwife, I’d have opted to have one; but as they couldn’t, I thought this was the best way of getting the birth I wanted, with no uninvited paramedics this time.”
Few babies are freebirthed in Britain – the best guess is that there might be somewhere between 20 and 30 a year – but there’s evidence that it is on the increase. The Nursing and Midwifery Council issued a statement on the practice last year, pointing out that a midwife has no “right” to be at a baby’s birth, and that any decision to freebirth should be respected; it prefaced its position by saying that freebirthing was rising in popularity.
Laura Shanley, author of Unassisted Childbirth, who runs a US-based website on freebirthing, says her site is busier than ever, with plenty of interest from the UK. “It’s become much more of a topic than it used to be,” she says. “And in the US there are states where assisted homebirth isn’t allowed, so women have no choice but to freebirth if they want a home delivery.”
That’s not currently the case in Britain, but there is a change coming here that may inflate the freebirth figures. Independent midwives, who have long supported women who want home deliveries and who, unlike NHS midwives, can guarantee availability on the day, are effectively being outlawed: they have been unable to sort out an insurance deal, and from October it’s going to be illegal, under EU legislation, for any healthcare professional to practise without insurance. There are about 170 independent midwives in Britain, and they attend around 3,000 births each year. It’s distinctly possible that at least some of the women who would have opted for a home birth will instead decide on an unassisted delivery.
Women such as Valentina Cruz, 37, who lives in Aberdeen. Six months ago, she gave birth to her second child using an independent midwife; her first delivery had been an emergency section after what she describes as a “cascade of intervention” in hospital. Her second child’s birth, at home, was straightforward. If she got pregnant again, she’d think about freebirth, she says. “It’s not something I’d actively want, but if there were no independent midwives – and the NHS midwives didn’t support my home birth plan last time because of my previous section – then I’d be a lot less scared about having my baby alone at home than I would be about going into hospital.”
The hardest thing about being in hospital, Cruz says, was feeling that the staff didn’t trust her body’s ability to give birth without intervention. The vast majority of women, freebirthers believe, could give birth more safely and happily without medical involvement. “In my antenatal classes, women looked at me as though I was mad when I said I was planning a freebirth,” says Kate Tregellas, 36. “But so many of them had difficult deliveries, forceps and ventouse and even caesareans; they went into hospital and seemed to end up on this conveyor belt to intervention.
“Giving birth to Alfie was incredible. I was on my own, in the shower, and he came out in two pushes. My partner James was in the other room and he came in straight afterwards, and then our other children, Freya, who’s seven, and four-year-old Lilly, came in to meet their new brother. And Alfie was absolutely fine. He didn’t cry and he breathed straight away.”
Like Currie and all the freebirthers I spoke to, Tregellas rejects the idea that she was putting herself or her child at unreasonable risk by giving birth without medical assistance. Far from neglecting their antenatal care, all had had regular checkups. “I had plenty of contact with midwives throughout my pregnancy, and my final checkup was the day my labour started,” says Joanne Purdie, 36, who last summer gave birth to her first child, Holly Elfin, on board her barge on the Leeds-Bradford canal. “We had layer after layer of safety nets in place. The midwives and an ambulance crew even did a site visit so they knew where to come in case there was an emergency during the delivery.”
Purdie and other freebirthers believe that labour works best when it’s not interfered with. “A woman’s body knows what to do,” she says. “I’ve watched cats giving birth, and they do it in a straightforward way because they’re left to do what nature wants them to do.”
Perhaps surprisingly, Mervi Jokinen of the Royal College of Midwives (RCM) and president of the European Midwives Association agrees: “If you look back through history, women would go to a place on their own. That’s thought to be the best way to birth from a physiological point of view. Birth is like going to another planet: you need to zone out, you need to find space, so your body can get on with it. If women are frightened, or disoriented, their body goes into ‘fight or flight’ mode; and that means the hormones can’t work effectively and labour slows right down.”
Some of the women I spoke to got the distinct impression that the midwives they were in touch with supported their choice morally, even if they couldn’t be seen to condone it openly. Natalie Rickman, who lives near Hexham, Northumberland, gave birth to daughter Isla on the same day in July as Kate Middleton had her son George. But while the duchess was surrounded by obstetricians and midwives, Natalie was at home with just her husband, Peter, an architectural technician, and a doula by her side. Isla was her third baby; she’d had a traumatic hospital delivery first time around, a much easier water birth the second, and says that by the time she got round to her third birth, she was “confident I could cope on my own”. Natalie didn’t spell out her plans to her midwife, but thinks she probably put two and two together. “She seemed supportive. She said things like, ‘You probably won’t even need us.'”
As things turned out, she did need a midwife’s help, but only after Isla’s birth, when her placenta got stuck. “We called the midwife, who came over straight away and was very impressed that we’d done it all on our own. It was only the GP, who came over a few days later to do the newborn check, who seemed gobsmacked.”
It may be true to say that some midwives are sympathetic to women’s desire to freebirth, but very few would advocate it. Jokinen’s position is that it’s a midwife’s job to help a woman find a way to be as confident, relaxed and in tune with her body as she can, so that she can give birth as naturally as possible.
“Very few women actually want to freebirth.” Jokinen says. “Most want some support and help, and that’s where midwives come in. Plus there is the fact that, even after the most problem-free pregnancy, there’s always a remote chance that something can go wrong during the delivery. While some women might know instinctively what do to, others wouldn’t, and the problem might be something that they couldn’t deal with, such as a haemorrhage after the baby’s born.”
Dr Daghni Rajasingam, consultant obstetrician at Guy’s and St Thomas’ and a spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), agrees. Even when women have had low-risk pregnancies, she says, there’s always the chance unforeseen problems can occur at delivery. “Some emergency situations are difficult to predict. There are problems that need intervention within minutes – for example, if the baby is getting distressed, if the baby’s shoulders get stuck, or if the cord prolapses. In any of these situations, you need a professional birth attendant who’ll know what to do and can arrange for you to transfer to hospital if you’re giving birth at home.”
But obstetricians, Rajasingam says, “aren’t in the business of alienating anyone”. When a woman is attracted to freebirth, it’s frequently because of a previous traumatic birth experience in hospital. “It’s all about information and empowering her to understand the facts and figures. I would listen to her reasons for wanting to give birth in that way and do all I could to ensure that she was supported in whatever way she wasn’t supported last time.”
Perhaps with a midwife such as Jokinen or an obstetrician such as Rajasingam, many pregnant women who are drawn towards freebirth might find a different way forward. Certainly everyone – from politicians and health service chiefs to heads of midwifery, the RCM and RCOG – marches to the drum beat of “choice”. Every mother-to-be has the right to “informed choice”, they say, and her word is final. But, in practice, hospitals are deeply rule-bound places and childbirth has a habit of not going entirely to plan. Often, decisions need to be taken quickly. It’s not so much that caregivers are trying to deny pregnant women choice, they would argue, but that their overriding instinct is to deliver the baby safely.
And “safely” isn’t always how freebirth turns out. A year ago, an Australian coroner criticised a woman called Janet Fraser whose baby, Roisin, died after an unassisted birth at her home in Sydney. He said Roisin’s death was probably caused by the cord becoming tangled round her neck during the delivery, and called Fraser, her partner Trevor Stokes and a friend who was with them “amateurs” who were not prepared for performing CPR on a newborn baby. Fraser “chose to rely on her own sociopolitical views about birthing and Roisin’s chance of life was deferred to that decision”, the coroner said.
Fraser – a long-time advocate of freebirth who ran a website called Joyous Birth – was unrepentant. She told the inquest she believed her birthing decisions were appropriate and proper. “There are no risk-free options,” she said. “I chose the option with which I was most comfortable.”
While in theory British women can have a freebirth if they choose to, the authorities sometimes intervene. Melissa Thomas, 27, who lives in Derbyshire, decided on a freebirth for her second child last year. She spoke to the local supervisor of midwives, who appeared to be supportive, but then a letter arrived from social services requesting a home visit. Soon after, her son Oliver was born in an uncomplicated, unassisted delivery. After the birth, social workers came on several unannounced visits, on one occasion even turning up with the police. “It was terrifying. I was looking after a newborn baby, and suddenly I thought my children might be taken into care. My husband dealt with it all really well and eventually they went away. Two days later, some midwives arrived, and they seemed very regretful about how it had been handled.”
Fear of being hounded by social services means some women fudge their decision to freebirth by booking a home delivery and then leaving it too late before calling the midwife; their babies’ arrivals are recorded as BBA, or “born before [the midwife’s] arrival”. Another category is known in freebirth circles as an “oopser”, as in, “Oops, I forgot to call the midwife and now the baby has appeared.”
I was an oopser myself: 11 years ago, my fourth daughter was born on the floor of my study, and the midwife (whom I’d called just before I started pushing) arrived about half an hour later. It was an empowering and life-changing event, and for me, as with so many women who freebirth, it healed the scars of a previous emergency caesarean. My baby was born easily and I believe that she benefited from a drug-free, intervention-free, natural delivery.
That baby was my last, so I’ll never know what route I’d have taken if I’d gone on to have another pregnancy. I have to admit there was a minute during my baby’s delivery when I was gripped by fear about having to go it alone; and I’m very aware, as many of the women I’ve spoken to are, that women who choose to freebirth are often criticised and pilloried for it.
There’s also the question of what would happen if something went wrong. After Kate Tregellas gave birth to Alfie, she feared she was haemorrhaging; James called the hospital, who sent an ambulance and a midwife. Tregellas says the ambulance arrived in a matter of minutes, the bleed wasn’t serious and she stayed at home. But what if things had been different, and the ambulance couldn’t get there quickly enough?
Sarah Currie admits she was occasionally spooked by someone else’s horror story, or pulled up short by a friend’s reaction to her planned freebirth. But in the event all went well, and a few days after our meeting she gave birth to Temperance. The baby was delivered, as planned, on the sitting-room floor after a labour spent walking around the house. “If I’d been at all worried, I’d have moved to hospital,” she says. Sarah laboured through the night and Temperance was born at dawn; Sarah’s partner, Adam, cut the cord, and the other three children came downstairs about half an hour after the birth to meet their new sister. A few hours later Sarah phoned her midwife, who came over the next day. “She did the newborn checks and was very respectful of my choice,” Sarah says. “What the experience has taught me, more than anything, is to trust my instincts.”