Free birth - Risks, Reasons, Reactions
“Freebirth refers to the process of intentionally giving birth without the assistance of a medical birth attendant. It may also be known as unassisted childbirth, DIY birth, unhindered birth, and unassisted home birth “- Wikipedia
Risk is perceived differently by each person, what might be considered a great risk to one, might not hold any risk to another. Within the maternity care system, freebirth is seen as radical, irresponsible and unsafe. Those who choose to birth this way may come up against a lot of barriers and bias, but is freebirth truly unsafe or just uncommon? In this essay I will look at the risks, reasons and reactions to freebirth.
A pregnant person in the U.K has the legal right to either opt in or out of Maternity care, they can choose where they give birth and if they wish to have a health care professional present. “A woman may refuse medical intervention - which would include antenatal and perinatal care - for religious reasons, other reasons, rational reasons or irrational reasons or for no reason at all” (Butler - Scholes, MB 1997, 8MED - L - L - 217 para 30)
So, freebirth is a legal option for birthing people, but the pushback they may encounter from their midwife and other health care professionals may make it seem an unattainable goal. The World Health Organisation cites 10-15% of all pregnancies/births having obstetric complications, and they strongly advocate for skilled care for all parents and babies during pregnancy, birth and immediately after delivery. However, I could not find any data to suggest obstetric emergencies such as shoulder distortia, pph or breech presentation were more prevalent within freebirth, although management of these complications until emergency services arrive could be seen as a greater risk for morbidity/mortality for the birther and their baby. However, these risks are for the birthing person to weigh up and research and should not be used to manipulate them into opting into midwifery care. Some may find the atmosphere of fear, the stripping of autonomy and the cascade of interventions synonymous with hospital birth a greater risk and choose to opt out of a system that is too stretched to offer the person - centered care championed by the Royal college of Midwives (RCM), and choose freebirth.
The backlash for birthing without a medical professional may make it appear to go against the best interests of the birther and their baby, and some who have no intention of birthing within the system may even say they wish to either birth in a medical setting or at home with a midwife present just to reduce the stigma and coercion. Because of this it is hard to find figurative data on how many freebirths happen in the U.K, with most being recorded as ‘born before arrival’ (BBA). Babies born before arrival make up between 0.14 - 0.44% of all births in the U.K (Feeley & Thompson - why do some women choose to freebirth in the uk - 2016) so it can be assumed that those freebirthed is even smaller.
Even though freebirth is still a relatively taboo choice in the U.K, it seems to be becoming more popular worldwide, with a freebirth movement taking place. Social media plays a large role in informing and rallying birthing people, with various facebook groups designed specifically to support those who choose to birth their babies in this way. In Claire Feeley and Gill Thomson’s quantitative study ‘Why do some women choose freebirth in the U.K’ 10 women were interviewed, asking a range of questions to determine why they chose to freebirth their babies. It showed that these women were hugely informed and had greatly researched their options and the risks assigned to their choices. One woman was quoted as saying ‘In the end, it was a risk assessment. We weighed up the likelihood of all the risks that mattered to us, and made a decision based on our level of comfort with each of those risks’ further showing that risk is individual. It also showed that people are no longer comfortable with handing over their autonomy to medical professionals, and are becoming more confident in their bodies ability to birth their babies. Having an undisturbed, physiological birth was far more important to them, than having the ‘safety net’ of a midwife or doctor, and even though a higher morbidity/ mortality rate was incited from the WHO estimate of obstetric complications, overall outcomes were good. Parents are taking back control of their birthing experiences and choosing to freebirth is possibly the most absolute way of doing this.
As shown, freebirth is a legitimately legal option for birthing people, and should be respected as such, there should be no ramifications, such as a referral to children’s services (birthrights) or coercion from health care professionals. Birthing people are going to great lengths to educate themselves before making decisions about where they give birth and are weighing up the risks of each setting in a way that is personal to them. It is understandable that healthcare professionals may be wary of freebirth, where obstetric emergencies can not be quickly managed, but this should not be used as means to coerce a birthing person into a setting that is not right for them or their family. There is however very little research around freebirth and without real data it’s not possible to know what outcomes are really like for those who choose to birth outside the system. So to answer the question is freebirth a radical risk or a legitimate choice, it depends on what side of the fence you’re on, legally yes it is and people do choose to freebirth, but for some the risks are just too high.
May 2020
Resources
https://www.aims.org.uk/information/item/freebirth
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0847-6
https://www.rcm.org.uk/media/3923/freebirth_draft_30-april-v2.pdf
