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

Midwifery and Bullshit

 

These are not midwifery tools, but they could be. 

I have started offering prenatal support and consultation to women who are looking to give birth in an autonomous way. Several of these women are being followed, or have been followed, by registered midwives here in Canada. I've also spoken to a few practising midwives in this country, and I believe our midwifery establishment is in crisis.

We were an unusual country. Midwifery was illegal in all of our provinces and territories until the 1990's, when provinces started to recognize that it would be useful to register and educate midwives in the medical model. During the twenty years from the 1970's until midwifery was legitimized and regulated, midwives worked illegally to assist mothers at home, and there were a few midwives who were charged with practising medicine without a license. 

During the 1990's, midwifery became regulated and legitimized in several provinces. Midwifery education programs were developed and offered in universities across the country. These programs were very hard to get accepted into, and required a formal academic background over life experience. Most of the original lay midwives who had been practising illegally before legislation were "grandmothered" in to the Colleges of Midwives, but the applicants who were accepted into the programs were generally younger and obviously less experienced. 

Midwives were and are in great demand. The supply is very limited, partly because of the restrictions that competitive educational options and limited employment options mean for anyone who is drawn to the practice. Provincial governments in Canada have succeeded in effectively reducing the number of potential practising midwives, either with restrictive educational possibilities, or by limiting the ways that midwives can practice.

Because of the lack of registered midwives, and because the available midwives were practising in the medical model, several women over the years in various provinces in Canada chose to give birth either unassisted or with Traditional Birth Companions. As well, midwives trained in the US or elsewhere started offering their services as midwives and attended women at home. This was risky, because with the creation of a College of Midwives, anyone offering restricted practices under the provincial midwifery acts could be (and were!) prosecuted by the provincial College of Midwives. So far, this has happened in B.C., Saskatchewan, and Quebec. 

The pandemic of 2020 changed the face of birth. Women who were hiring doulas to accompany them to their hospital births found that the hospital authorities had full power to limit the number of people present, and doulas were left at home in front of their phones, providing encouragement, support and continuity of care from afar (Hats off, shout out, Kudos to all you doulas out there!!!). Home birth was restricted or banned in some areas, and midwives were given even more rules and regulations they had to practice under. 

Hospitals were seen, rightly so, as places for sick people (hmmmm, isn't that what they always were?). A few women, certainly a larger number than in 2019, decided that they would give birth on their own. Others decided that they would continue with midwifery care and fill in the gaps with the council and support of other practitioners.

Here is a little account of what is wrong with midwifery today, gleaned from conversations I have had with women seeking answers, and why I believe it has gone wrong:

• Newborn mothers and babies do not need immediate testing. They need skin-to-skin togetherness, if the immediate indications of their health is good.
• Newborns do not have to latch on the breast like a champion within the first half hour of life. Again, they need skin-to-skin togetherness. Mother will need to eat and drink. Attendants should stick around with gentle attention.
• If you say that you will offer a woman attendance at her home, and you visit her home and bring equipment and preparations ... she is not going to hear your quid pro quos and fine fine print at the bottom of your conversations. She will be deeply disappointed when you tell her that (for whatever reason, that has to do with YOUR infrastructure and organization of lack thereof) she cannot after all birth in the comfort of her own home.
• Women over 40 are not inherently dangerous. They can carry a baby to term and do not need extra testing or worrying conversations about how risky their pregnancy is. That's why she chose you, a midwife, so they wouldn't have to be bullied.
• Midwives have to learn to keep their faces pleasant. So many women have let me know that they got really scared when they saw a young midwife look at their lady parts with horror/fear on their face. A vulva or a newborn's head can look wildly psychedelic, but usually is no reason for alarm.
• The word "should" doesn't belong in your vocabulary if you are attending a birthing woman. 

Women now, a small percentage but nevertheless a percentage, are choosing to give birth at home autonomously instead of seeking the attendance of a midwife or a physician. This fact makes me sad. Why? Because I believe that every woman deserves a safe and sacred place in which to birth her child. Some women want to birth in the hospital. That birth should be as respected and loved as a birth that takes place at home surrounded by a circle of women. Some women want to birth at home, and these women deserve respectful, kind, reliable, and legal midwifery care. 

There is work to be done!!!

Home Birth and Home Death

Babies sometimes just pop earthside but mostly birthing women want to have some company when they are going through this earth-shaking, phenomenally life-changing event.

I was born with a natural talent to accompany women through their birth journeys. I don't even know what I do most of the time but women tell me they feel better when I am present and quietly witnessing their changes. I tell them that everything is fine. I comfort. I nourish. It's just part of me, hey? I am not writing this because I am clapping my own hand.

When a person sees the woman they love looking like she's probably going to die, because her eyes have gone all weird and she's kind of fainting, they feel better when I tell them that this is normal, she is tripping in a special, life-giving way.

And it is truly magical if this event can take place at home. At home, a woman can run through her whole labor process in her own space. She can barf in her own garbage can. She can make love with her partner in her own living room. She can crawl backwards to the fridge to get apple juice.

She can give birth herself, surrounded by people who love her. She can cuddle with her new child in her own room, and she doesn't need a car seat.

I had a friend back in my hippie organic farming days: she had a c-section for her first child because she was breech, so she had her second on her own. She sent her husband and daughter off for a long walk (!), made sure she had enough methergine from the goat's birth kit, and birthed alone. She told me it was frightening. She would have wanted to have a midwife present, and so the third time around, she invited a midwife along for the ride.

Some women freebirth. These are women who birth on their own or with their partner and children. They trust the birth process implicitly and do not believe they need a midwife. Many women who wish to give birth at home do want a midwife, and midwives are generally respectful of the birth process and knowledgeable about serious challenges, even life-threatening ones, that very rarely unfold during birth.

Right now, in Canada, there is an ongoing discussion about end-of-life care. Many people are suggesting that death moves back home. This sounds all warm and fuzzy but let's look at the reality of this phenomenon.

First of all, I wonder why we are not talking more about bringing birth home? Is the dollar playing a part in this discussion? Possibly. It takes a couple of days, max, to have a baby. Midwifery is an economically viable option if you look at the bigger picture of health care in our country. The women giving birth in our country are, in the huge majority of cases, healthy and well-nourished. Group prenatal classes are popular and prenatal visits are easy to schedule.
Even when birthing women give birth in the hospital, where physicians can make their salaries and the women's hospital stay is almost always less than four days, birth costs less than death.

Dying takes a lot longer. Palliative care can be offloaded to families, private nurses, volunteer organizations and the occasional medical professional for the weeks or months before the final days.

Birth at home is a joy, a beginning, it is a moment that is too short to comprehend, passing in the blink of an eye.

Death at home can take weeks, even months. The family can implode, or explode. Money becomes scarce, life can enter a fog. When the final days come, they can be full of body fluids that no one wanted to deal with, disturbing images that no one can forget, emotional moments better left unspoken. I wonder why people think that birth is "too messy", and they romantically envision themselves dying peacefully surrounded by their loved ones? Have we so lost touch with reality that we think that dying in bed is like in a TV show, where the patient just slips away in the arms of her loyal husband? And the nurses stand around the bed with tears in their eyes?

Death can be just as messy as birth, and often is. I have attended many "clean" births, where the baby is born to a minimum of amniotic fluid, blood, poop, and vernix. But some births are bloody. Some births are full of waters. Some are so astoundingly shit-filled you wonder if it was intended divine humor. Some births have a little bit of everything: vomit, stool, meconium, urine, amniotic fluid, blood ...

People I have spoken to who felt that their relative's home death was a good experience were people who could afford to have a private care giver who was discreetly present for the family, or they were well acquainted with the body and its many processes. Others felt that the family was ill-equipped to deal with the physical death of their relative, as they were going through difficult emotional issues, perhaps complicated ones, and the physical realities were hard-hitting.

I thought I was well equipped to accompany my mother through her dying hours. I had nursed my father for the months he was bed-ridden, and I feel confident in my relationship with bodies.

I was wrong. The constant pain was so difficult for me to bear. I was voted as the family member best equipped to administer morphine. I didn't know if it was the right thing to do, even though I did it every two hours for a couple of days. I was the one who changed the pads. So much liquid! Who knew that the body basically dissolves at death. It wasn't urine. It wasn't amniotic fluid. It was vital fluid, leaking and leaking. Every time I changed the pad it was like torture, for me and for her. I was the one who tried everything to counter the pain of oral thrush. Did you know that this is a sign of the end of life? I have assisted many mothers through the intensity of vaginal, breast, and newborn thrush but this was above, beyond and off the charts pain for the woman who gave birth to me. She couldn't eat. She couldn't drink. All she wanted was a big tall glass of water. She was listening to the poetry in her head. She said that there were raucous voices shouting out her poetry. We put on her favourite music. She breathed very loudly. Even now I awake with a start, hearing that noise. Her body was in pain, the morphine didn't quite cut it.

In the end, the last words she said were: "Is it my birthday today?"

It was a good death, as death goes.

But, please, don't sugarcoat dying at home. Don't be led by the nose to doing something alone that should be an event where there are people present who know what is supposed to happen: Yes, this is normal. Yes, take a break for a little while. Yes, let's let her go. No, the morphine isn't killing her.

A sane culture is one where babies are born at home, where midwives are discreetly present for the woman, her newborn, and her family. A sane culture is one where people can die at home, where death midwives are present for the dying, for the living, and for the continuity of the family and the community.

Levatrice....With Woman

Six weeks after I gave birth to the second of my five sons, I was driving our ancient old station wagon back home from dropping off my father-in-law at the airport in Pisa. I was happy. We were heading home to our place in the hills above Florence, where we lived in an old stone farmhouse. My husband taught English and was mostly gone in the evenings. I took care of the little ones and tried to speak Italian.

I remember where we were on the road. I suddenly realized, and I turned to my husband, and said: "I want to be a midwife".

I volunteered with St. John's Ambulance when I was thirteen. I learned everything a young girl could about first aid, and I competed in contests, fake blood and all. I volunteered every Sunday at the Grace Hospital - maternity care, 70's style. The moms were in wards, the babies were behind glass, and the dads could watch them from the hallway. My duty was to take each dad to his proper mom, and to distribute evening snack: apple juice and tea biscuits. I loved it: I loved the new babies, the new mommies, the warm, tea biscuity smell of babies, poop, and women's bodies.

I had a butcher-shop experience at that child's birth: unable to understand the language, I turned to victim mode and suffered uncaring doctors, making jokes over my body; a midwife smoking cigarettes; general anaesthetic, and a baby I didn't even see for over 24 hours.

Midwifery seemed like a good idea.

By 1988, I had enrolled in the Apprentice Academics program. This was distance learning, the good old fashioned way. I read the texts, wrote the assignments, followed my guide, and we sent envelopes and packages back and forth acroos the Atlantic.

By 1991, we had four boys and our small mixed organic farm (complete with large stone house to rebuild - just the two of us....with a little help from our Wwoofers - but that's another story); a large garden, chickens, ducks, geese, a vineyard...life was good! But I still dreamed of midwifery and studied my textbooks at night, collected my Birth Gazettes every month from the postman. I wrote a couple of articles....kept in touch with the lovely women at the Farm.

In 1997 life changed and we ended up in Montreal. I was working as a doula and witnessed many births over the years. These were hospital births.

I am a levatrice - this is the antique Italian word for midwife. I don't use the words "midwife" or "sage-femme", because if I did, I could be accused of practising medicine without a license. But I don't practice medicine. I attend women in childbirth.

I am in the final lap of a years-long process that will end with two exams. When I pass them, I will be able to put the letters "CPM" after my name. Certified Professional Midwife. (Update - I passed my skills exam - only my written to go!)

I teach many young women about how to care for a woman when she is giving birth. These women ask me about the best path to midwifery. There is no best path. My path has been long and interesting, and I am blessed to be able to say that I do what I love.

But at the same time, I am nervous every time I go to a woman's birth. I am excited, and honored, and a little afraid, to be taking part in such a powerful event. And so, I am nervous about my exams. I want to pass, but a little voice inside says that maybe I'm not learned enough.

So, this is the card that was shown to me:

Three of Wands (R) - Learn to be receptive to your needs for a new direction - recognize when your talents, skills and efforts are being wasted. There will be resolution after some struggle - but, much work is still needed. The proper balance has not been obtained because you are preoccupied with your "inner" thoughts to the exclusion of outer advantages. You are actually looking away from the power that is available to you. You have become too giving and this allows others to take advantage of you. You need to check everything before moving ahead. A careless approach can ruin everything. You may experience the failure of some project due to "storms" or problems that are greater than you had anticipated.
You are trying to become involved with the environment after a lengthy time of detachment and reflection which has been disturbed by negative memories. You must be alert to the new opportunities that present themselves and use them wisely. Remain open and receptive to new business ventures and partnerships with reputable people. Be willing to operate from a place of integrity as you move forward - assured in your mind that your heart, mind and spirit are in balance and you are clear on how you wish to handle upcoming situations and the important choices you will be making.
There can be flaws that interfere, keeping dramatic progress on the path just out of reach. The desired qualities for this stage may be present in abundance, but for some reason, the project at hand is off target. Check, possibly right project, wrong motivation or right motivation, wrong project. Guard against over optimism and spiritual vanity as you would against pessimism. Guard against complacency as you would against a nomadic restlessness forever more and more.

I would like to send gratitude to everyone who has accompanied me along this path - and also to invite everyone to a huge party when I finally get that CPM. Maybe that's what it's all for....