13 January 2007


Extreme childbirth: Freebirthing* 06 January 2007 * From New Scientist Print Edition. * Anna Gosline*

Any thoughts??

ONE HOT afternoon in August 1977, heavily pregnant Laura Shanley felt the early twinges of her first labour. Instead of calling a midwife, she calledover some friends. When her waters broke, she didn't dash for the hospital, just the bedroom. On hands and knees she gave birth to her son, John, in oneswift push. Ready to catch him was the only other person in the room, herhusband, David. Over the next few years Shanley, who lives in Boulder,Colorado, went on to have four more babies in the same way.Giving birth at home instead of hospital is not all that unusual. What setsShanley apart is choosing to go it alone without any professional help. Sheis part of a movement that advocates unassisted childbirth, or"freebirthing". The backlash against the perceived overmedicalisation of childbirth in the west has already seen some women reject hospitals infavour of a low-tech home birth with a midwife. Freebirthing proponents gofurther still, shunning even midwives. Almost all doctors and many midwives condemn unassisted childbirth asdangerous. The small but growing number of freebirthers, however, say it isperfectly safe for a woman to give birth alone, or at most, accompanied by apartner or friend. They believe that advice from medical staff interfereswith the normal birth process, and that women have easier labours if leftalone "as nature intended". "Birth is inherently safe and relativelypainless," Shanley claims, "provided that you don't interfere by usingdoctors or midwives."Freebirthers do have a point: childbirth has never been so medicalised. Formost of history women gave birth at home, possibly attended by a midwife ordoctor, but with little to no medical help. In the 20th century,city-dwelling and new, potent painkillers brought women into hospitals to deliver their babies.Here a growing number of interventions were introduced. In difficult laboursit became common for doctors to ease out the baby with forceps, or, later, asuction cup known as a ventouse. Syntocin, a synthetic form of the hormoneoxytocin, came to be used to trigger labour or speed it up. Once a lastresort, the ultimate intervention of a Caesarean section now accounts forabout one in four UK births. There is no doubt that these and other interventions have saved the lives ofmillions of women and children the world over. But campaigners and even somedoctors say they are overused and may even do more harm than good. Syntocin,for example, often makes contractions more painful.The countermovement began in the 1960s, spearheaded by the NationalChildbirth Trust in the UK and the Lamaze Institute and the InternationalChildbirth Education Association in the US. Today such groups lobby forchildbirth to remain as simple as possible, with the management of low-riskbirths ceded to midwives, who have only relatively low-tech forms of help attheir disposal. So far this has extended to the promotion of home births, with a midwifepresent but the nearest doctor an ambulance-ride away. The safety of homebirths is still hotly contested, but some want to progress to what could beseen as the natural childbirth movement's logical conclusion - completelyunassisted childbirth.Freebirthing has no formal organisations, so charting its growth isdifficult. When Shanley wrote a book on the subject in 1994, she says thepractice was nearly unheard of. Now most freebirthers use the internet tospread the word and swap tips. Shanley runs a website for these purposes andover the past decade she has heard from many other women who have givenbirth without help.Linda Hessel, who lives in Corvallis, Oregon, and had her third childunassisted, collects freebirthing stories from the website Mothering.com. About 160 mothers post from the US, Canada, the UK and Australia on the site's unassisted childbirth forum. It is a very small but growing movement,she says.Freebirthing is also growing in Australia, possibly influenced by pooraccess to midwives and the closure of some rural maternity wards over thepast few decades. The high rate of Caesarean sections in hospitals may alsobe a factor, says Sarah Buckley, a general practitioner (GP) in Melbourne.Six years ago, Buckley had her fourth child unassisted - a differentprospect for a GP, to be sure, but she supports the right of all mothers tofreebirth, making her one of the few doctors to do so.So do the freebirthers' claims stack up? Are they in fact giving birth thenatural way? In some ways nature has dealt humans a poor hand when it comesto giving birth. As early hominids evolved an upright walking posture, thepelvis had to pivot up, narrowing the birth canal. And the price we pay forour huge brains? Huge heads. No wonder the passage of a full-term babythrough the birth canal is a tight squeeze. "Birth is not as simple orstraightforward as it is in other animals," says Wenda Trevathan, a medicalanthropologist at the New Mexico State University in Las Cruces."Freebirthers say birth is inherently safe and relatively painless providedyou don't interfere by using doctorsor midwives"The shape of the pelvis may have led to another feature of human births.Thanks to the twisting and cramped interior of the birth canal, humanbabies, unlike those of other primates, tend to turn mid-birth and exit thevagina facing their mother's spine. This makes it harder for the mother toclear mucus from the baby's mouth after its head emerges. And if she pullsthe baby out too forcefully she may bend the spine and neck against itsnatural curve.That's why Trevathan argues that some form of birth attendant may have been de rigeur since bipedalism began to evolve 5 million years ago. "In mostcases, the mother and the baby benefit from some form of assistance," shesays.A glance through anthropological studies reveals that in almost allhunter-gatherer cultures, women tend to have some form of birth attendant.Even among the !Kung people of southern Africa, who say the ideal birth is asolitary (and silent) one, in practice women usually have help, at leastuntil they have a previous birth or two under their belt.Of course a birth attendant who merely helps the baby out and clears theirairways hardly requires midwifery training. But it does suggest thatfreebirthers who set their hearts on complete privacy may be striving forsomething that rarely happens "in nature".What does happen in nature? The World Health Organization estimates thatworldwide 15 per cent of labours have a life-threatening complication. Ithas also been estimated that the "natural" rate of maternal death fromchildbirth is between 1 and 1.5 per cent. The biggest risk is uncontrollable bleeding, even when women give birth in hospital.Birth is even riskier if it is you that is being born: in some developingcountries the neonatal death rate can be 10 per cent. The chief danger tothe baby is lack of oxygen, for example due to blood flow through theplacenta being restricted in a long and difficult labour.It is unclear, however, how these risk estimates apply to modern-day westernwomen who are generally healthy and well nourished. In fact freebirthersclaim it is better general public health that has led to the dramatic dropin maternal and infant deaths over the past century (see Graph).There is some evidence to support this claim. In the late 1970s, MarjorieTew, then a research statistician at the University of Nottingham in the UK,analysed the national birth statistics from 1958 and 1970. She found thathospitals had far higher infant death rates than either home births orindependent birth centres run by GPs, both of which used fewerinterventions. Contrary to the prevailing views, Tew concluded thatobstetric interventions hindered, rather than helped, the already fallingdeath rates. The underlying cause of the drop, she said, was better publichealth, nutrition, living conditions and infection control. It was arelatively low-tech medical intervention, the use of antibacterialsulphonamides to treat post-birth infections, that caused the biggest dropin maternal mortality over the past century.Home advantageThe accuracy of Tew's controversial conclusions hinge on whether heranalysis took adequate account of the fact that women would be more likelyto go to hospital if they were at higher risk in the first place. Tew didadjust for many risk factors including having a multiple pregnancy, a babyin the breech or head-up position, high blood pressure, previous Caesareans,and bleeding during pregnancy. However, there may have been other riskfactors omitted from the data.Tew's findings were so radical that it was many years before her work waspublished in an academic journal, and even then it was largely ignored. Inthe meantime the push for hospital births continued, and today they are thedefault setting for childbirth in the west.In most western countries even a standard home birth with a midwife presentis seen as a risk. In the US - where even uncomplicated hospital deliveriesare carried out by doctors, not midwives - most obstetricians are againsthome births. Two past presidents of the American College of Obstetriciansand Gynecologists have equated home births with child abuse. At one of itsmeetings last year the college gave out car bumper stickers saying: "Homedelivery is for pizza"."US obstetricians gave out car bumper stickers saying: 'Home delivery is forpizza'"The UK government has recently voiced support for making home births aneasier option, but they still account for only 2 or 3 per cent of births. InEurope only the Netherlands stands out, with a 30 per cent home-birth rate.The big question, of course, is whether home births are safe. On the onehand, there is the lack of doctors and their sometimes lifesavinginterventions. On the other, hospitals can be stressful places. Adrenalin(epinephrine in the US), the fight-or-flight hormone produced in response tostress, seems to slow labour, which could explain why decades of researchhave linked stress and fear to longer and more difficult births.The best way of answering the question would be to randomly assign a largenumber of women to either home or hospital births. But few would put up withhaving their care chosen for them. Instead, researchers can only study theoutcomes of the choices women make for themselves. This risks home birthsappearing safer than they really are because they tend to be selected bywomen who are white, well-off and well-educated - all factors that lowertheir risk of difficult births - as well as being at low medical risk.One of the biggest and best studies in this field was published last June,(BMJ, vol 330, p 1416). It attempted to follow every North American womanplanning a home birth under the care of a certified midwife in the year 2000and ended up including 5418 births.No mothers died and the infant death rate was 1.7 per 1000 - a similarfigure to low-risk hospital births in the US. Home-birth campaigners havehailed these results as vindication of their stance. Critics, on the otherhand, point out that 12 per cent of the women had to be transferred tohospital, usually for maternal exhaustion or because their labour wasn'tprogressing. And 3.4 per cent were admitted as an emergency, mainly forfetal distress or maternal haemorrhage.While this debate seems likely to run and run, many of even the staunchesthome-birth supporters shun freebirthing. Marsden Wagner, the WHO's formerdirector of Women and Children's Health, says it is a step too far. "Thereare a very few cases when things go bad," he says. "Midwives are trained toknow when things are going in the wrong direction."If the evidence on the safety of standard home births is unclear, it isalmost non-existent for freebirthing. There seems to be only one study ofwestern women who intentionally had unassisted births, published in 1987.This looked at a strict Christian community in Indiana called the FaithAssembly Church, who refused all medical attention for religious reasons. Itdocumented 344 births over seven years.The figures make grim reading. The neonatal death rate was 19 per 1000 livebirths, compared with 7 per 1000 for the rest of Indiana. Maternal mortalitywas 8.7 per 1000, 20 times higher than for other women in Indiana.Studies published in medical journals seem unlikely to influence thefreebirthing community, however. From their websites and message forums itis clear that these women reject orthodoxy in numerous ways. Many advocatelong-term breast-feeding and home-schooling; some also shun infant vaccinesand prenatal medical care. Without ultrasound scans and other checks,someone could unwittingly plan an unassisted birth while carrying twins or abreech baby - as happened with Laura Shanley's third child. Even that maynot deter the most radical freebirthers, who scorn medical assistance evenfor serious complications. But not all go so far. "These variations aresomething that I would want to know about," says Hessel, "and I might makedifferent plans accordingly."Freebirthers' attitudes to emergency back-up also vary; some women areprepared to head to hospital if the labour goes awry, others don't. Hesselknows of three infant deaths that might have been prevented if the mothershad sought help soon enough.Naomi Stotland, an obstetrician at the University of California, SanFrancisco, has stopped trying to understand the freebirthers. They feel, shesays, "that they are very in touch with their bodies and they can tell whensomething is right and something is wrong".There will never be a randomised trial of freebirthing. "It's not somethingthat is easy to prove or even study scientifically," says Stotland. "These are belief systems about birth." And belief is a powerful thing.
Anna Gosline is a science writer in Vancouver, Canada
From issue 2585 of New Scientist magazine, 06 January 2007, page 40-43


Anonymous said...

hi my name is jay i have questions for you why dont you show people what can go wrong while doing this. i understand why people want to do this but to much can go wrong they should at least have someone there in case of an emergency they can always be in the other room or what ever. I think it is crazy for woman to do this not because of you for the baby

Anonymous said...

I fully support homebirth and or any other birthing situation that a person chooses.
What I do not support is putting your precious newborn at risk.
Yes there are many risks associated with the hospital but to not have any sort of professional backup is simply a selfish act of ignorance. Are you looking to have a healthy baby or prove a point????

Jacqueline said...

I think most women freebirth because they know their bodies and their limits. Plus as an American that knows about the Westernized health care system, it can be a scary thought to have a baby in a hospital. There are many complications that could happen while at home and for that matter in the hospital. I have several friends and family have babies in hospitals that have lifelong damage incur because of the intervention of doctors and their tools. I think it is brave and courageous to have a baby at home. I am for freebirthing. Though I do go to doctors for check ups and to have sonograms, I plan on trying to have my baby at home before I rush for this so called "help."

Anonymous said...

I think freebirthing should be outlawed. You are putting the life of your child at risk and that is what matters. Not to mention you could bleed out or have other serious complications. I think it is totally selfish on the part of the mother to do this. It is not an act of love or bonding with the child, it is an act of stupidity because if something were to go wrong....then what? No one ever thinks about the consequences just of themselves. I have had three wonderful birthing experiences in hospitals and my children are fine and my fourth child is going to be born the same way.

Anonymous said...

Every woman who is pregnant is responsible for getting their children into the world safely. The primary concern should be that you have a happy, healthy baby. As maternal as you can be, you can never take the place of a doctor with training. I feel like your desires to have things a certain way that feel 'right' to you are much less important than your responsibilities to the child to have the safest delivery possible. I think it is safe to say that some people in rural countries who lack proper hospital care would kill to have access to the care you deny...your freedom to choose free birthing would be meaningless to you next to your grief if you lost a child because of your decision.

Gail Dahl said...

Congratulations on an idea whose time has come. Childbirth isn't risky. It is a normal, natural function of a woman's body. Congrats and best wishes, Gail J. Dahl, http://web.mac.com/pregnancsecrets

Anonymous said...

I really think that women should think twice before choosing freebirthing. when i had my son 2 years ago, I had him in the hospital, luckily for me. Its not like i enjoyed having everybody seeing me in that way or checking me every hour to see how far i had dilated. But my son ended up having some medical problems that I wouldnt have known about if i had had him at home. Whats worse is that my blood failed to clot so I was bleeding out. I wouldnt have known that. The doctors tested my blood and found this out. I didnt like tons of needle pricks but it was for my own good. Women need to put aside their own "comfort" for the safety of their child. thats a horribly selfish reason for why women choose freebirthing. so what if the doctors and/or midwives are telling you what to do? chances are, they know a heck of a lot more than you do about childbirth. for centuries, women died in childbirth as well as their babies bc of lack of medical help. in the 19th century, 40% of all laboring women died. Honestly, babies are safer in the hospital with medical help and intervention, if need be, than out.

Anonymous said...

I was looking up peoples opinions on freebirthing. This article needs to be paragraphed out to make it more readable. Cheers

Anonymous said...

for the person who said "childbirth isn't risky" If childbirth was without risk, then there would never be a maternal or neonatal death, ever. Obviously, these unfornate events occur so there is always some risk with childbirth. Even in the most healthy pregnancy, there can be unpredictable complications-blood loss, severe lacerations, malpresentations, cord compression, meconium aspiration, etc. etc. etc. If you want to have your baby at home, fine, but at least have a certified nurse midwife present who can help in these emergent situations, or get the mother and baby to the appropriate facility. To do a 'free birth' is completely irresponsible, and is placing both mother and baby at risk for irreversible harm. Think of how you would feel if something terrible happened to your baby as a result of birthing at home with no assistance. Husbands, think of how you would feel if your wife died as a result of a massive hemmorhage that you could not predict or get help for fast enough. The risk is real, and people should think twice about free birthing.

Jan Sawyer said...

Freebirthing is the height of parental selfishness. This is not a good sign of things to come for a child born to a self-centered parent.
Freebirthing may be "enjoyable" for the mother. But the potential fetal consequences are astronomical. So who is freebirthing benefitting? Certainly not the child.
A cord prolapse is disasterous.
A compressed cord is disasterous.
A hemhorrage is disasterous.
An expulsion of meconium, is potentially diasterous.

I work on these cases EVERY SINGLE DAY. It happens regularly, and these children would be born SEVERELY brain damaged if immediate intervention were not effected.

So I ask this question for all you freebirthers out there: If you encounter one of these events, and your child is severely brain damaged or dies, can you live with this incredibly arrogant decision you've made on behalf of your helpless child?

I wouldn't.

Shonda said...

I am completely for freebirthing but I also respect all of your opinions. None of us will agree on the samething thats why there called opinions. but when i have my child it will be by freebirthing and I will consult a midwife to learn what to do if anything goes wrong and it should not be outlawed if abortions aren't outlawed then neither should freebirthing. Women have a choice how and were they give birth. Yes things can go wrong but the same thing can go wrong in the hospital also. I am for it and i will do it with all my children. And i'm not selfish.If I was selfish i wouldn't have children

Anonymous said...

I am pregnant, this will be my third child. My first was born at a birthing clinic with midwives and my second at a hospital with doctors.
By far, hands down, my experience with the midwives was MUCH more easy, stress free, and alot less scary and intrusive. I hated my experience with the hospital birth.
I have thought about freebirthing. And given it much thought.
I have watched the documentary, researched it, etc.
My conclusion is this:
It is far better of a decision for me to find a midwife that respects my feelings and understands that I want as little as possible assistance from her and to have it at home.
If I can have a midwife there that knows not to interrupt unless an emergency occurs, I don't see the hurt in having her BE THERE.
I do understand the need for a woman to feel secure and in control during labor and birth.
I think that I notice that most women having children at home have considerably shorter labors than women in hospitals.
This option, of having a midwife there that doesn't assist unless necessary, is available. Having the midwife there means a bit better of a chance that help is closer if something were to go wrong.
With these thoughts, I believe that I would be selfish if I were to not have a midwife present. I do believe that women that don't opt to, are taking dangerous chances in order to be more comfortable or worse, to prove a point.
God forbid, that a baby is lost because of their decision, but if one does, I hope to see the mother prosecuted just as if the mother had deprived her baby of life sustaining air. Murder.

Anonymous said...

Just because a baby dies during a freebirth does not make it the mothers fault. Babies die in the hospital. In some situations the baby could have died either way. I agree with the thought that women should have some assistance, however not necessarily medical. I had a beautiful freebirth with my daughter. My husband caught the baby and my mother was their to help. We all had educated ourselves previously. Absolutely nothing went wrong. I didn't tear. My baby didn't even get jaundice. I had had prenatal care from an OBGYN and knew that this was a low risk pregnancy and the baby was healthy. In my experience I would say a homebirth is the best way to go either with or without a midwife.

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