'Free birth': why women are choosing to have their babies at home, unassisted
When Alice* became pregnant with her third child, she knew she wanted to try something different for her birth. Her first labour was traumatic, but her second lasted only one hour. With Covid restrictions still in place at her hospital, she feared her husband wouldn't make it to the delivery room on time.
Alice began to plan for a home birth with an NHS midwife, but as she reached her due date in December 2021, with the Omicron strain circulating, staff withdrew that option. "Two weeks before my baby arrived, the [home birth] service was suspended as they required the midwives to work on the labour ward instead. There is also a beautiful and well-appointed midwife-led unit at the hospital, which was also closed due to staffing."
At this point, most women would accept they have no choice but to make the journey to hospital. Alice, 33, who works for the NHS, chose a different route: to attempt an unassisted ‘free birth’ – without the help of a doctor or a midwife.
"I was concerned for our psychological safety, having had difficult encounters in pregnancy with a very understaffed, stressed service and being told I would need to birth on a very poorly resourced, brightly lit labour ward without use of water. I felt that theoretically, there was a higher risk of complications having to get to the hospital, move to several different medical rooms during labour, and be seen by several different staff, [rather] than staying at home where it was a calm and controlled environment," she says.
She's not alone. Midwives and maternity experts believe the number of women choosing to give birth without medical help is rising. There are, however, no official figures available: most births that take place outside a hospital without a midwife are recorded as "born before arrival", which can happen routinely due to a quicker than expected delivery rather than because mothers choose to ‘free birth’.
Midwifery lecturer and researcher Maria Velo Higueras, an academic at Robert Gordon University, has been investigating free birth, and lodged Freedom of Information requests to NHS boards in Scotland requesting data on "born before arrival" births in the past five years, but the data returned could not prove a direct increase. However, midwives involved in Velo Higueras's study reported to her that free births appeared to be increasing.
"I have certainly seen a trend in people openly discussing free birth, particularly in online forums, and especially after the pandemic," she says. "Midwives reported that in their experience, the women choosing free birth most recently don't do it as their plan A, but as their plan B if there is no homebirth cover on the day they go into labour. When healthcare systems do not respect women's autonomy or do not provide services that feel acceptable or meet the needs of women, women choose to self-care."
Midwife Leah Hazard, author of Hard Pushed, said colleagues from around the country were messaging her privately, worried about the trend. "[They’re saying they have definitely seen an increase in women free birthing because they either have been denied a home birth with a midwife, because they are concerned about the midwifery care they would receive, or they are adverse to engaging with the system as a whole in its current condition," she said.
Hazard said she was concerned about social media influencers promoting so-called "natural birth" – with potentially dangerous consequences. "It's fine to talk about different choices and styles of birthing, but I do wonder if some of the people who are so adamantly pro-free birth are fully aware of the potential risks as well as the potential benefits.
"I can completely understand and empathise with concerns and I would never judge any parents for making the best choice for them, but I have to say as a midwife I’ve also seen many births where things haven't gone well, including those where things appear to be going very well until delivery itself or indeed the moments after birth. In those situations I’ve been very grateful for being in close proximity to other skilled professionals who can help," she said.
The NHS system also acts quickly to prevent mothers free birthing. Once Alice* was in established labour and insisted that she would not to travel to the ward, her midwifery team changed their minds and opened one room in the closed maternity unit. In the end, her birth took place inside a medical room with the help of a midwife.
A similar change of attitude occurred when Emma, from Bristol, gave birth at home in March 2020. She had refused a hospital delivery due to fears about Covid, but was refused a home birth midwife due to staffing shortages. "I didn't want to be getting in a taxi in labour, and I definitely didn't want to be doing it during the beginning of Covid.
"I thought this is looking like I’m going to have to make some serious decisions," Emma said. "My husband was very much on board with everything. He knew I never made decisions lightly. I have an academic background. I look at evidence. Everything that I read was that the home was the safest place to give birth and I didn't feel that going into hospital was going to be a good place to be."
Emma decided to stay at home and called her sister, who is a doula, to support her when labour got going. When her husband informed the hospital they wouldn't attend, they sent two midwives, despite having closed the home birth service. Emma agreed to some monitoring of her baby's heart, but delivered without any formal assistance."I felt very lucky and I think that's sad," she says. "I shouldn't feel lucky that I can make choices. Unless you are super informed you don't even know about the things you can say no to, and why you might want to say no to them."
Janine Smith, a doula working in the north-east of England, says more of her clients have asked about free birth options in recent months. She also has expectant parents asking how they can help themselves if a ward is very busy, and make themselves safe going into hospital. "I just try to equip the parents with the ability to at least be assertive and to shout out if they feel it's not quite right," she says.
Smith urges women to work closely with midwives, after witnessing what she fears is an "anti-midwife movement" on social media. "My concern about the free birth issue is that it might be people who have already got medical complications. If they feel their options have narrowed, whether it's because they’ve got an anti-midwife stance or because they are high risk, they may feel they have no choice but to do it on their own at home because they have no choice within the medical system."
Without hard data on free birth, it is not possible for researchers such as Maria Velo Higueras to assess the true risks and benefits of birthing without medical support. But she adds: "Women who free birth are not choosing ‘no-care’, they are choosing self-care. They engage in extensive research and planning to ensure the safest outcome for them and their babies… Midwives in my research have also acknowledged this, that women do not choose free birth naively."
*Names have been changed*Names have been changed