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Reasons to NOT Choose Freebirth

By Lisa Morgan

There are many diverse reasons women choose freebirth. Sometimes women choose freebirth out of necessity, rather than a geninue desire for freebirth in itself.

The purpose of this page is to acknowledge sub-optimal circumstances surrounding freebirth decisions, and to explore why freebirth may not always be ideal. Regardless of how women arrive at freebirth, often women discover the experience suits them, and plan for it the next time around for more positive reasons.

Here are some reasons to NOT choose freebirth;

Birth Trauma

The medical system of hospitals, doctors, nurses and midwives has much to answer for. In Australia despite the Maternity Services Review (2009), and reforms over 2010-2015, women are still dissatisfied. Complaints include women being subjected to coercion, a lack of control over the birth process, and dissatisfaction with outcomes (Aust. Dept of Health & Ageing, 2009). Women's experience and agency are being ignored, with women saying they feel bullied, patronised and coerced (Aust. Dept of Health & Ageing, 2009).

All up, traumatised women who are unhappy with their treatment and experience, often seek escape. For example, I have personally heard some women say "I'd rather die than birth there again!". The Australian Midwifery College also report encountering similar comments from women (Squires, 2011).

This is very concerning to me as this seems to indicate there are women who may hesitate or avoid transfer if something occurs during their freebirth to indicate medical help may be warranted. This is NOT safe. As Mareeba midwife Judy Chapman stated, if freebirth is not the woman's first choice, it is not safe (Davis, 2010). To freebirth safely, women need to be able to trust they can safely seek outside assistance should it ever be required. If this trust is not there, risk of adverse impact including further trauma increases.

Futhermore, with birth trauma often comes fear, pain, distrust and doubt, which ideally is addressed prior to birth regardless of birth chosen. Freebirthing because of unresolved trauma is not a solution, as unresolved issues tend to present during labour. When this happens, the physiological process of birth can be impacted.

For more, see What is Birth Trauma? and the page on Choosing Freebirth.

Lack of Midwife

Thanks to the Australian Government, independent midwives are becoming even more difficult to obtain (Australia Dept. of Health & Ageing, 2010). The problem with the Government's idiocy is that freebirth is now being used as a political vehicle to get the Government to cater to the needs of independent midwives and homebirthers. I agree this is a sound strategy on the part of homebirth advocates and women's rights advocates.

However given this argument still comes from a medicalised perspective, one which rejects womens rights to own their own bodies, it seems like an argument that is gonna come back and bite women in the butt at a later date. Yes, of course some women are saying "Screw you!" and freebirthing! But, this should not be confused with freebirth as a valid and preferred birth choice for some women.

There are some women who are dedicated homebirthers, and prefer a midwifery model, where one on one care is provided by an independent midwife. Research shows this model of care is optimal compared with hospital (See The Research: Homebirth).

As freebirth is not usually the first choice for homebirthers, fears, anxieties and doubts can be common. This can result in impromptu transfers to hospital during labour or after birth if these women are not confident, supported or prepared. This gives rise to the impression of "failed" freebirth or homebirth when the reality is usually a lack of support or preparation, as opposed to a true emergency. Transfers can also be stressful - see Transfers to Hospital.

Also see Choosing Freebirth, and I want a midwife but... for more information.

Conflict with Midwife

Unresolved conflicts with the midwife providing care for homebirth can result in a breakdown of the midwife-client relationship. Consequences of conflict can range from women neglecting to notify their midwife when labour starts, to firing their midwife and not being able to find a suitable replacement. Potential issues under this scenario include the same issues discussed in "Lack of Midwife" above.

For more, see the page on Choosing Freebirth and check out The Midwife Relationship which has some tips for resolving midwife issus.

Lack of Money

Independent midwives and homebirth cost anywhere between $1500 to $8000, and only a small amount ($300-$700) is able to be claimed back through some private health insurance funds. Yes, this is even with the so called maternity reforms being put in place by our benevolent Government (yes, that was sarcasm!). These reforms do not allow women to claim back on homebirths, only births attended in hospital, with an independent midwife (Australia Dept. of Health & Ageing, 2010). I am not sure why they think this is a step forward, as I personally don't see the point in paying $5000 to have an independent midwife attend my HOSPITAL birth, when I can have a careprovider attend my HOSPITAL birth for FREE!!!!!!!! But I disgress.

So, for some women, midwife fees are prohibitive even if their midwife offers payment flexibility. Lack of money for homebirthing women is a problem as the only free options are public hospital birth or freebirth. Some women may not be confident enough to freebirth and opt for hospital when they really, really don't want to be there. Other women opt for freebirth as it means they can homebirth, but find they need support. Neither alternative is optimal.

I want a midwife but... is a page which offers suggestions for tackling barriers to having a midwife attended homebirth. Also, check out the page on Choosing Freebirth.

Problems with the System

Sometimes the problem is the hospital system and the refusal of people involved to facilitate birthing women's needs.

Policies are inflexible and unyielding, and while there are understanding workers within the system who respect women, they can only buck the system so much. This pushes women to look into other options, like homebirth and freebirth. Should midwifery care not be realistic or attainable, potential homebirthers can become freebirthers.

Also, it is a problem that once women are in the system, it is difficult to 'opt out'. If a woman chooses to opt out she may face struggles with the hospital over her rights. Some caregivers abuse DOCS laws which allow for DOCS to investigate if there is suspicion of harm to a baby after it is born. Read here about legal issues. In addition, deciding to not birth in hospital in technocratic societies can result in claims of child neglect and denial of medical care.

This gross abuse of birthing women's rights is the the reason freebirths are seen as "underground births" where women are forced to keep their birth decisons secret and birth "underground" away from scrutiny. If women truly own their own bodies, then there would be no illegal instituations regarding freebirth or homebirth for that matter. See here for more on the politics of childbirth.

High Risk

There are women who are categorised as 'high risk' according to certain policies held by governing bodies. As independent midwives answer to such governing bodies, this restricts their ability to be flexible according to women's unique situations. As such, midwives may not accept postdates women (over 42 weeks is the medical definition of postdates), or women with breech babies, twins, or women with previous caesarean(s) in their history.

I want to stress each birth and each woman's situation is unique. There may be validity to the high risk label given to some women. There are also many situations where such women are better off with a homebirth midwife's support and expertise. In other situations, there are women better off in hospital, with an obstetrician.

Risk is a variable to consider carefully as it is a statistical probability, which only individual women can decide what it is worth or worth not. In addition, what may be risky for one, is less risky for another individual. The medical paradigm cannot evaluate this as it does not consider women as individuals, and as such cannot be aware of the factors which individual women are aware of for themselves.

Women who freebirth because they can not get the birth they want supported elsewhere, run the risk of a complication happening during their birth that they cannot handle at home. There is possible trauma, injury or death to mother and/or baby, which in some cases could have been avoided by birthing with a midwife, or within a hospital.

In turn, if these women are in the unlucky statistical percentage who experience the adverse event, they are likely to be investigated, prosecuted, harrassed or otherwise villified for their decision to freebirth. This also happens even if the problem could not be prevented by a hospital birth, and has resulted in deaths of mothers or babies within hospital previously. Society is harsh on those who do not conform and submit.

References

Australia Dept. of Health and Ageing. (2009).  Improving maternity services in Australia [Electronic version].Canberra, A.C.T.: Author. Source

Australia Dept. of Health & Aging (2010). National maternity services plan 2010 [Electronic version]. Canberra, A.C.T.: Author. Source

Davis, S. (2010, February 18). Home birth protest hits the streets. ABC Local, <Cairns Post>. Source

Squires, R. (2011, October 23). Fear as women push for freebirth. The Sunday Telegraph. Source

 

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