Growing free birth trend due to “broken” maternity system

Vivienne Wynter

I had never heard of free birth until the owner of the Sunshine Coast yoga school I belonged to (Zenko) died suddenly during childbirth in June 2022 after posting #wildbirth #freebirth on her Facebook and Instagram pages. Free birth or wild birth is where a woman chooses to have her baby outside a hospital or birthing centre. It’s different from home birth, because the woman chooses to have no medical professional in attendance, not even a midwife. Some have a doula present to give emotional support. Some women choosing free birth do so without any prenatal care, doctor visits or ultrasounds and call this a free or wild pregnancy.

My beautiful yoga teacher, Lauren Verona, died from an Amniotic Fluid Embolism (AFE) after giving birth at home to a healthy baby girl. This condition is when amniotic fluid from the womb gets into the mother’s bloodstream, preventing her blood from clotting and sometimes causing cardiovascular collapse. Lauren started having difficulty breathing after the birth and her doula called an ambulance. She went into cardiac arrest during the ambulance ride and died in hospital. AFE is rare (reported in around 1 in 8000 women) and unpreventable. Her family say doctors told them the outcome would have been the same had she birthed in hospital. I am not implying her death was due to a free birth and mention her because it’s how I discovered this practice.

Yoga school owner Lauren Verona posted about free birth on her socials

I was shocked and grieving that this happened to a healthy, fit woman I knew and liked. It might sound trite but when we met for a cuppa she always had green matcha tea or soup while I had coffee. She glowed with health and vitality. I started researching and found the maternal death rate in Australia is very low, with an average of 5.5 women dying per 100,000 according to the Australian Institute of Health and Welfare (AIHW).

Underground free birth movement growing

I also found that that the global free birth movement is growing and largely underground and it’s happening in Queensland and Australia. There are no actual statistics because the statisticians only gather data on home births, not free births. However, there is evidence that the number of Australian women choosing free birth is increasing. According to the AIHW Mothers and Babies report, home births increased from 0.3 per cent of total births nationally in 2019 to 0.5 per cent of total births in 2020. So we are talking about fewer than 1 per cent on the official record, but home birthing advocates, midwives and doulas say the number of home births and free births is actually higher and women are not reporting them to the perinatal data collections.

Homebirth Australia (HBA) coordinator Kristyn Begnell says her organisation and midwife organisations are reporting increasing numbers of enquiries from women. “We believe the real number to be much higher than this (the AIHW data), as homebirths are under-reported,” Ms Begnell said. “Since the onset of COVID 19, midwives have reported they are much busier. HBA has received many more enquiries from women than in previous years. “Some of the women I have spoken to personally, who were unable to secure a Privately Practicing Midwife (PPM) for a home birth, did go on to free birth,” she said. Ms Begnell said she noticed free birth being mentioned more on social media, though this could be due to growing awareness of the practice. “A lot of people were forced to look for alternatives they would not have considered prior to COVID 19,” she said. “I have spoken to women who were so traumatised by their previous experience in hospital, that free birth was a much more appealing option than returning to hospital,” Ms Begnell said.

A 2018 study by Thornton and Dahlen on “born before arrival” (at a hospital or birth centre) births found the rate is increasing around the world, including in Australia. Some of these births occur on the way to a hospital or birth centre and some are intentional free births. The study found these births, compared with hospital births, are associated with higher rates of perinatal mortality, postpartum haemorrhage, neonatal hypothermia and neonatal intensive care admission. The study suggested a proportion of these ‘accidental’ births may be free births with transfer to hospital following the birth due to maternal and/or neonatal complications. The study says: “Free birth appears to be rising in Australia and currently there is no data available to determine where these births are happening.” My search of social media and the internet found millions of mentions of free birth and wild birth and a global Free Birth Society which coaches women in the practice and posts photos and videos of women free birthing, including in Australia. The society offers free birthing “toolkits” for sale online.

Free Birth Society coaches women around the world on free birthing

In the same year my yoga teacher died, a viral video of a woman giving birth unassisted in the Pacific Ocean in Nicaragua, led experts to warn of the dangers of birthing without a doctor or midwife present. This woman and her baby boy had a positive experience, but experts warn this may not always be the case.

Experts say broken maternity system is to blame

Studies into free birth and home birth have concluded that a lack of maternity care in regional areas of Australia, traumatic experiences in hospitals and lack of access to midwives for home births are key reasons many women choose to free birth. Many of the women say they are simply trusting their own bodies to know how to birth without medical assistance. An increasing number of free births within Indigenous communities is also noted, for different reasons. The practice of First Nations women birthing on country has different factors worthy of a separate article, though lack of access to and trust in maternity services are factors.

The “born before arrival” study says: “There is evidence in the Australian setting that when women are not offered choices in birth settings, they will choose to birth outside of the system.” “We have undertaken research into why women are making this choice and past birth trauma, a distrust of mainstream services and a physiological paradigm around birth tend to be drivers. Research conducted in the Northern Territory supports the fact that ‘free birth’ occurs more frequently in indigenous communities where birthing on country options are not provided to women and birth is routinely expected to occur at hospital settings as far away as 500 km from their homes.” Experts also say the number of home births and free births increased in the past three years, because some women didn’t want to birth in a hospital where mother and baby were potentially exposed to COVID 19. Restrictions on midwives (making them difficult to access) are also part of the problem.

When a Queensland woman died of a postpartum hemorrhage after a free birth in 2017, the Homebirth Australia coordinator at the time, Grace Sweeney, said her death could have been avoided if she had access to a midwife. “What we’re seeing around Australia is a restriction on the practice of homebirth midwives,” Ms Sweeney said. “We’re seeing increasing rates of regulatory red tape and … regulators being quite hostile to home birth midwives. “That means many women want to access home birth midwives, but they’re not available to them, so they go on and have free births.” Many women have satisfactory experiences having babies in hospitals and birth centres. I’ve not heard a story of birth trauma from my relatives, though I have heard them from friends.

Many women and their babies have no complaints about giving birth at hospital

Birth trauma and obstetric violence are factors in the free birth trend, with growing recognition that the mainstream maternity system sometimes traumatises, disrespects and harms birthing women and their babies. Recognition of obstetric violence – or to put it another way – unnecessary medical intervention during childbirth – is not confined to the home birth movement. A study in The Lancet suggests overuse of childbirth interventions is associated with psychological and physical harms. Some advocates also define obstetric violence as situations where power dynamics are used against a birthing person to obtain compliance. It can include the language or attitudes care providers use, performing interventions without consent, threatening to discontinue care, infantalising the mother or otherwise exerting coercive control. When women are made to feel weak or powerless, trauma can result.

This Queensland mother says she chose to have a free birth due to traumatic experiences in hospital. Her free birth experience was calm and peaceful, though she and her partner took their twin baby boys to hospital after the birth for a check-up.

Jodie Miller, the Queensland author of ‘What does it feel like being born? A memoir of pregnancy, birth and bureaucracy’, says she understands why women choose to birth outside the system. “Hospital protocols do not promote healthy physiology: bright lights, activity, watching eyes, all trigger adrenaline with potential to interrupt the natural hormonal cocktail that facilitates normal birth,” Ms Miller said. ‘Then care providers may blame women when labour slows down. Unpleasant interventions become inevitable. It’s a woman’s choice. Free birth is not the choice I would make, but I understand why some women make that choice.” “Precipitous births happen all the time, usually very safely. When the woman’s hormones and head space align, all things being healthy, birth goes very well. One would hope a woman prepares her mind, body, and family, using all the information she can gather, such as scans, prior to making the decision to free birth. This assumes some sort of prenatal care, ideally with continuing oversight from a known midwife.”

Some advocates for women and birthing say hospitals are not the ideal environment

Perhaps unsurprisingly, most doctors are not on the record as being in favour of free birth or wild birth. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) says: “The safest place to birth your baby is in a hospital, where you have access to highly trained staff and emergency facilities.”

The Australian Medical Association is not in favour of free birth, with Federal President Michael Gannon, a Perth-based obstetrician, calling free birthing “madness”. Commenting on the death of a baby girl during a free birth in Perth in June 2022, The Australian College of Midwives also warned of the risks of giving birth without a midwife. The college’s principal midwifery officer, Kellie Wilton, told birthing was inherently safe when supported by a trained health professional. “As you can see in these tragic circumstances, there’s no trained health professional there to be able to recognise when there’s a deviation from the norm. There was no one there to identify the emergency situation early,” Ms Wilton said.

Is free birth legal?

Laws vary between states and territories, but there are no Australian laws explicitly prohibiting a woman giving birth outside the medical system, in a location she chooses, with or without anyone present. It is unlawful for a doula to give more than emotional support to a woman during a home birth or free birth. The Australian Government Department of Health and Aged Care lists free birth in neutral language as an option for pregnant women, though it warns: “Many of the risks of free birth relate to conditions being undetected or undiagnosed without a midwife, obstetrician or health professional present. It’s not uncommon for obstetric emergencies to happen even in the absence of risk factors. This is why birthing with a trained maternity care provider present is considered the safer option.” So we know free birth is a legally recognised option, that free births are increasing and that it’s mostly underground and under-reported.

Where to next?

Some midwives, home birth and free birth advocates are calling for improved government support for and data gathering about women choosing to free birth and improvements to the mainstream maternity services. A 2020 study on home birth and free birth in Australia concluded “Shortfalls in the Australian maternity care system are the major contributing factor to women’s choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and expansion of birth options which prioritise midwifery-led care for women of all risk.”

Ms Begnell from Homebirth Australia says more women should be supported to home birth if that’s their choice.

“Our mission is to break down the barriers facing Australian women accessing a home birth. There are simply not enough Privately Practicing Midwives to meet the demand. The constant vexatious reporting of PPMs keeps them bogged down in paperwork and audits, leading to distress and burn-out.”

The authors of this study Birthing outside the system interviewed women who chose wild and free birth and concluded that women choosing this option: “… perceive that hospitals are not the safest place to give birth as they carry a unique set of additional risks to the mother and baby when compared to birthing at home. “… there is very little evidence available to examine the outcomes from free birth as it continues to be undertaken outside the gaze of mainstream maternity care, only coming to attention when sensational cases hit the media headlines.”

The same authors conclude in a separate study Home birth, free birth and doulas: Casualty and consequences of a broken maternity system that the rise in home and free births is due to a “broken maternity health system”. “In Australia private home birth remains unfunded and uninsured and publicly funded home birth models are not widely available. The recently released Report of the Maternity Services Review (MSR) excludes home birth from the funding and insurance reforms proposed. “The rise in the numbers of women employing doulas and choosing to birth at home unattended by any health professional is in part a consequence of not adequately meeting the needs of women for continuity of midwifery care and non-medicalised birthing options.”

Some advocatees say women should have more choice about how to birth their babies

It’s not all about women rejecting medicalised maternity services though. Some women simply don’t have physical access to maternity care. There’s growing reporting of women having a free birth because of the lack of birthing services in regional areas, a problem acknowledged by the Queensland Government.

Ultimately it’s a woman’s choice, so I’ll wind up with words from two women who chose a free birth and had very different experiences. American woman Judith (who preferred not to give her surname) gave this interview to NBC News in 2020 about her choice to free birth. Her experience ended when she was 45 weeks pregnant and had a stillborn baby after she presented to hospital. She told NBC News her lifeless baby boy looked perfect and that in the hours while she held him to say goodbye, she said ‘I’m so sorry’ over and over.  Judith says in the interview: “I think I brainwashed myself with the internet.”

At the other end of the spectrum of experience, Tina is an Australian woman who blogged in 2021 about her decision to free birth on the Free Birth Society website. She had a healthy boy and says: “Bringing this baby into the world at home on my own terms, without medical assistance, has been a given for me since the birth of my first son. And as much as I had to do a lot work to get there, it was also the simplest, most natural thing in the world. I can’t imagine it any other way.”

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