The death of in Byron Bay in an apparent ““, or free birth, last week has prompted fresh concerns about giving birth without a midwife or medical assistance.
Author
Hannah Dahlen
Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
This follows another case from this year, where a baby was born in a critical condition following a reported free birth.
It’s unclear how common free birthing is, as data is not collected, but there is some evidence increased during the COVID pandemic.
Planned also became more popular during the pandemic, as women preferred to stay away from hospitals and wanted their support people with them.
But while free births and home births might sound similar, they are a very different practice, with free births much riskier. So what’s the difference, and why might people opt for a free birth?
What are home births?
involve care from , who are experts in childbirth, in a woman’s home.
These registered midwives work privately, or are part of around 20 nationally that are attached to hospitals.
They provide care during the pregnancy, labour and birth, and in the first six weeks following the birth.
shows that for women with low risk pregnancies, attended by competent midwives (with links to a responsive mainstream maternity system) are .
³Ô¹ÏÍøÕ¾ births result in than hospital births and women perceive their experience .
What are free births?
A is when a woman chooses to have a baby, usually at home, without a registered health professional such as a midwife or doctor in attendance.
Different terms such as birth or are also used to refer to free birth.
The parents may hire a to be a support at the birth but they do not have the training or medical equipment needed to manage emergencies.
Women may have limited or no health care antenatally, meaning risk factors such as twins and breech presentations (the baby coming bottom first) are not detected beforehand and given the right kind of specialist care.
Why do some people choose to free birth?
We have been studying the reasons women and their partners choose to free birth for . We found a previous and/or feeling coerced into choices that are not what the woman wants were the main drivers for avoiding mainstream maternity care.
Australia’s childbirth – for induction or augmentation of labour, episiotomy (cutting the tissue between the vaginal opening and the anus) and caesarean section – are comparatively high.
One in ten women and some decide to make different choices for .
for a natural birth and birth choices such as home birth or birth also played a major role in women’s decision to free birth.
programs have very strict criteria around who can be accepted into the program, excluding many women.
In other countries such as the , Netherlands and , publicly funded home births are easier to access.
Only around 200 midwives provide private midwifery services nationally. Private midwives are yet to obtain insurance for home births, which means they are risking their livelihoods if something goes wrong and they are sued.
The cost of a home birth with a private midwife is not covered by Medicare and only some health funds rebate some of the cost. This means women can be out of pocket A$6-8,000.
Access to home birth is an even greater issue in rural and remote Australia.
How to make mainstream care more inclusive
Many women feel constrained by their birth choices in Australia. After years of research and listening to thousands of women, it’s clear more can be done to reduce the desire to free birth.
As my co-authors and I outline in our book, , this can be achieved by:
making respectful care a reality so women aren’t traumatised and alienated by maternity care and want to engage with it
supporting midwifery care. Women are seeking more physiological and social ways of birthing, minimising birth interventions, and midwives are the experts in this space
supporting women’s access to their chosen place of birth and model of care and not limiting choice with high out-of-pocket expenses
providing more flexible, acceptable options for women experiencing risk factors during pregnancy and/or birth, such as having a previous caesarean birth, having twins or having a baby in breech position. Women experiencing these complications experience pressure to have a caesarean section
getting the framework right with policies, guidelines, education, research, regulation and professional leadership.
Ensuring women’s rights and choices are informed and respected means they’re less likely to feel they’re left with no other option.
Hannah Dahlen receives funding from NHMRC, ARC and MRFF
