I’m trying to unravel my complicated responses to the article that came out in the Guardian last week about the Freebirth Society. Of course, the article has snowballed and it seems everyone I talk to now is indignant and shocked about the phenomenon of “freebirth” that the articles seek to condemn.

Let’s try to have a look at this Gordian knot of issues, and try to understand what exactly is happening.

Essentially, this phenomenon, specifically the Freebirth Society, is a product of a perfect storm that was created by a few very different variables. Obstetric violence is a reality. Although women are subjected to violence during birth all over the world, the affluence we enjoy in our part of the world gives us extra time to contemplate on what birth would look like if there wasn’t pervasive infantilization, abuse, or even just downright rudeness to contend with while we are producing a new human. Finally, add in the social media, where opinions and indignation can spread like wildfire, and you have fertile ground for a movement such as this.

One of the difficulties with this article and its offshoots, is that the authors confuse the Freebirth Society with the tiny but growing movement of women who are trying to find a way to give birth that doesn’t include routine unnecessary (and dangerous) interventions (see this article in the New York Times), that also doesn’t put themselves or their babies at risk. But let’s make no mistake: both the FBS and the community of women who are trying to find a more moderate path are reacting to a real problem in the real world.

What is the problem? Our c-section rates are too high (at least double the recommendations by the WHO). Our epidural rates are close to 100% for first time mothers. In the US, maternal/infant mortality rates are abysmal, especially for women of color (across economic lines) which indicates that perhaps modern obstetrics is not serving us well. And the fact is that thousands of women go to their doctor’s appointment and get ignored, or have their first baby and get manhandled, or have a c-section for a fatuous reason, and these women want something better.

Manhandled? I’ve heard doctors speak sexually to birthing women. I’ve seen hundreds of procedures done to birthing women with no consent asked or given. I’ve seen hundreds of vaginal exams done without consent and for absolutely no reason, it seems, except to shame the woman that her body isn’t working properly.

Fatuous reasons? “Your baby is too big” (then it’s a seven pounder). “You’ve been seven centimeters for two hours”. “Our software shows a high risk of shoulder dystocia.” “I’m leaving for vacation next Tuesday so come in on Friday to have your baby”.

Here’s the problem, though. Shit can and does happen. It isn’t always groovy to have your friends and some nice music. That’s why humans have always had midwives: women, usually older, who have witnessed many births and can tell when something is going sideways and can know what to do or when to get assistance. Unfortunately, the women who are turning from modern interventive obstetrics are also turning from midwives who, they claim, are just handmaidens to the obstetric machine. This is becoming more common, as the younger generation of midwives graduating from medical schools are trained with the same eye to risks and precautions that the young physicians are, and they graduate looking more like their physician colleagues than midwives from even a generation ago.

The percentage of women giving birth outside the hospital (this includes those who have a registered midwife in attendance) in Canada is less than 3%.1 We don’t know how many of this population are choosing to give birth outside the medical system with no registered medical professional in attendance, but let’s give it a generous number of 1%. Internationally, that number seems to hover between .5% and 2.5%, but these also include women who didn’t plan to give birth outside the system (for example, those who birth precipitously).

So why are we making such a fuss about such a tiny portion of women? I believe the same three variables I mentioned above are at work seeding and maintaining our outrage, with another important one added in to create a perfect storm in a teacup. Obstetric violence is real. It is true that obstetrics is one medical field where informed consent is often lacking; where unnecessary drugs and procedures are common; where the medical staff are usually not interacting with someone who is ill. In a way, it’s easier and more sexy to write an article about a small portion of women who are doing something really dramatic about a problem that everyone knows is endemic and isn’t going away very soon. Our affluence and ridiculous amount of leisure time make us more vulnerable to such sensationalist articles, and we need to be enraged about something, so why not get all het up about some independent-minded women?

And, of course, the social media make it easy for everyone: the FBS were champions at identifying who wanted to hear their stories, and making them accessible. And who wanted to hear their stories? Those women who were seeking a different way to give birth: one that didn’t include “being talked down to”, “too many vaginal exams, by several people at a time”, threats that the “baby will die”, overeager active management of the third stage resulting in dramatic PPH… the list goes on.

And the journalists, on the other hand, witnessed the train wreck that was the dissolution of the FBS social media empire, and rushed in to “investigate”. I am critical about how the article was written, and of some of the “facts” presented. First, I don’t believe that the absolute devastation of losing a child or having a child born with severe developmental delays should be described in detail in an article. Simple as that. In my opinion, that kind of sensationalism does no good and can only do harm. How? It doesn’t accurately tease out the physiologic facts from the drama. Yes, 17 minutes of shoulder dystocia is unthinkable (who was counting?). But do we really need thousands of people convinced that birth is an absolutely terrifying and dangerous event? Or do we want to focus on the matters at hand? Further, the statistic produced at the end of the first article may be true, but it isn’t backed up with evidence. And it uses the same dramatic anecdotal “facts” that the FBS does to convince people of the truth.

There’s one more piece to the puzzle, however. Look at the title of this article! “Influencers made millions pushing ‘wild’ births – now the Free Birth Society is linked to baby deaths around the world.”

We don’t actually know if giving birth without a medical professional in attendance is safer or more dangerous than giving birth with a doctor or midwife present. The data has not been gathered, and all we have at this point is polemics. We all have our opinions: I have mine, you have yours, and your neighbourhood OBGYN has theirs. But until we can actually look at the data and draw our conclusions, we are left with stories. For some, the most shocking part of the story is that the state of maternity care in our affluent society is pushing women to make possibly risky decisions. For others, it is that babies are being born either still or severely compromised, and our hearts are breaking. For some, the shocking part of it is that women are continuing to be maltreated in hospitals and birthing centres, and then demonized for making unpopular choices. And for some, and it seems the journalists are playing to this crowd, it’s that a woman who was passionate about her belief that women should give birth in a joyous manner, used her talents as an influencer and an organizer to “make millions”.

There are bigger problems in the world, to be sure. But we all get born, and I have worked in this field for almost all of my adult life. Here are my three suggestions:

First, that we pull our heads out of the sand and look at the real state of obstetrics here in Canada, and ask the question: is it really serving young families?

Secondly, that we gather actual data on out-of-system births so that we have facts instead of emotions upon which to base our opinions (and policies!).

And, third, that we recognize that the phenomenon of women choosing to birth outside the system is here to stay. How can we best serve these women? By alienating and demonizing them? Or by asking them what they want, what they need, and how (if at all) we can help?

1

https://www150.statcan.gc.ca/n1/daily-quotidien/220928/dq220928d-eng.htm