Call the midwife! No matter how bad you’ve heard the care can be, ‘freebirthing’ is not the answer | Rhiannon Lucy Cosslett

“CCould you poop like that?’ There’s one sentence I’ll never forget. I was in my second trimester and doing a hypnobirthing course. The question is supposed to be a metaphor for childbirth: being surrounded by doctors with clipboards would apparently make you too tense to poop or give birth. To which my response was, “Well, it certainly depends on how far you have to go.”

Apart from the National Childbirth Trust (NCT) classes – in which the instructor told us that the ideal birth is at home, with no pain relief (not their official line, they say) – this was my first glimpse of the anti-medical approach to childbirth . I thought about it again when I read about it the worrying rise of ‘freebirthing’ – when a woman gives birth at home without the assistance of a doctor or midwife – and the fact that the Royal College of Midwives has stated that “midwives are understandably concerned about women giving birth at home without assistance, as this entails increased risks for both the mother as the baby†.

Freebirthing is the logical conclusion of the ‘natural’ – or non-medicated – birth dogma that so many of us encounter during pregnancy. That movement has always portrayed itself as a plucky underdog fighting back against the sexist male medical establishment (with good historical reasons). If you give birth in Britain today, you are likely to encounter some variation on the message that unmedicated birth is the ideal form of birth and that interventions should be avoided at all costs.

This is exacerbated by a new and growing movement on social media, led by influencers who idealize vaginal birth without pain relief. I have no doubt that it has played a central role in the increase in the number of women refusing medical assistance during childbirth. And yet, despite questions like “Could you poop like this?” countless women are having babies regardless of the ‘unpleasant’ presence of doctors (they can even poop during periods). Sometimes doctors even play quite a crucial role.

As doctors and midwives have pointed out, home births and free births are two different things. “Midwife-assisted home births may be suitable for healthy, low-risk women who are having a second or subsequent child and have had an uncomplicated pregnancy,” said Prof. Asma Khalil, Vice-President of the Royal College. of obstetricians and gynaecologists. “However, for women having their first child, home birth appears to slightly increase the risk of a poor outcome for the baby.” without Support from midwives is much more dangerous. So many things can go wrong – with you or with the baby – that require immediate medical attention.

Rather than condemning women who choose freebirthing, I would be more inclined to understand their reasons. Home births supervised by midwives were suspended during the pandemic, and services have yet to be restored in many areas. Thousands of women have been unnecessarily forced to work alone in hospitals, without their partners, and trust has been lost. Birth centers are understaffedThis means that many women end up in a hospital birth that they did not choose, and that services generally are at breaking point. Midwives are leaving the profession en masse. I understand that some natural birth advocates come from a place birth trauma. Their attempt to cope – and to help other women – is admirable in some ways, but it’s also sad that so much birth trauma goes untreated. Furthermore, the gap between expectation and reality will only make PTSD more likely. What is needed to address this is more funding and better communication, not to write off medical support during birth altogether.

Women should be empowered to make their birth choices, to the extent possible, while keeping them and their babies safe. But they need all the facts at their disposal. Into the void Due to reduced funding for free classes, along with increasing misinformation on social media, freebirthing is booming. Despite the proliferation of videos with titles like “A woman gives birth alone, crouching in the bushes without making a single sound,” humans have evolved to require assistance during birth. There is a reason that there is a whole medical specialty surrounding pregnancy and childbirth. I was not taught about the ‘obstetric dilemma hypothesis’ – the idea that humans evolving to walk upright resulted in a narrower pelvis, while at the same time the brain quadrupled in size. Instead, I was told during the hypnobirthing class that labor was doing ‘what my body was designed to do’, and that any problems with labor would be the result of my own inability to relax and ‘breathe the baby out’ .

“Primitive” women and the way they give birth have historically been praised by natural birth advocates, and these racial undertones persist to this day. According to the UN, 300,000 women worldwide die during pregnancy or childbirth, most in low-income countries, due to preventable complications. Celebrating a lack of medical intervention is perverse. The goal of obstetric medicine is to achieve much lower maternal and neonatal morbidity and mortality than would occur ‘naturally’. The Ockenden Report’s grim findings into poor maternity care in Shrewsbury and Telford NHS Trust have shown the tragic consequences for women and babies of a policy of ‘normal birth at any cost€. Even women who have experienced a horrible hospital birth should be careful not to idealize free birth or suggest that it is the solution.

But don’t we all bring our own personal experience to discussions surrounding birth? There were so many doctors in the room when I was in labor that they were able to form little cliques. There is something very sobering in knowing that a hundred years ago, or without medical expertise, you and your baby could both have been dead. If I had been prepared for the natural birth that this movement was pushing me towards, my son would probably have died. A free birth could have killed us both.

My experience made me grateful for the doctors, but the ‘woo-woo’ hypnobirthing training also helped me get through painful, back-to-back contractions with no relief from the pain. I see the benefits of many different approaches, and I admire all mothers, regardless of the type of birth they have had. I have friends who have had elective C-sections and friends who are Ina May Gaskin advocates and fought tooth and nail not to give birth in a hospital. Yet the friends who took the “pretend to be a mountain lion” approach still saw the benefits of being able to get a blood transfusion quickly. The rise of freebirthing has serious consequences for women and babies. A listening, compassionate approach to prenatal education must be part of the solution.