Thursday, August 16, 2007

BBC interview about freebirth

This interview on freebirth just came out on the BBC. The show's host first interviews James and Julia Wilson, who had a midwife-attended home birth with their first baby, and an unassisted birth with their second. The next part of the program features Dr. Sarah Buckley and Sue McDonald from the Royal College of Midwives.

Here's the transcript of the interview, typed out painstakingly by yours truly:

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Announcer: Those who want to give birth at home had a bit of a boost earlier last year, when the government promised that every woman who wants it will be able to have a midwife-assisted home birth by 2009. But there’s a growing movement of what are known as freebirthers. They’re women who decide to give birth at home without any medical assistance. Kathy Caton talked to Julia Wilson. Julia gave birth to her first child at home with a midwife, but decided with her second to go it alone. What gave her the confidence to go ahead?

Julia: I read quite a bit about what happens in the process of giving birth, so I felt quite confident in myself to be able to handle the situation. Whereas if you leave it up to the midwife and do your birthing experience with the midwife present, she’ll take over and do all the medical side. But I think it can be done by the woman herself. I also spoke to other mothers--not that other mothers could give me much positive feedback. Most birth stories I hear are horror stories, which is very sad.

Kathy: And why did you choose freebirth?

Julia: I had a successful first home birth and that was one of the major reasons. I thought, “well if I’ve done it once at home with a midwife present, then I can definitely do it again. I also dislike hospitals. I’m visually impaired so I like to know my surroundings well. Hospitals also make me feel like a victim. When I go in, I’m automatically the patient, I’m in pain, and I’m suffering some medical problem--which birth isn’t.

James: I’m James. I’m Julia’s husband.

Kathy: We’ve been hearing about the whole freebirthing experience. What were your thoughts on it?

James: I was quite happy with it really. Due to Julia’s visual impairment, anything that made her more comfortable with birth is good for me. Obviously, we’re not really extreme on the side of freebirth. The hospital is right next to the house. If there was a disaster we could always go in.

Kathy: Comparing your first and second birthing experiences, why were you unhappy with how the first birth had gone with the midwife?

Julia: I wasn’t unhappy. I had a lovely birthing experience the first time. But I felt although she was a lovely woman, she was still a stranger in my house. To be doing something so intimate as giving birth--for me--I wanted to have people that I have no inhibitions about. And I did have [them]. It’s only now, looking back, after two births and only having James present the second time, how inhibited I felt the first time.

Kathy: What was your role? What were you doing?

James: I was just present, I think. Holding Julia’s hand and trying not to answer the phone because other people were phoning us. Then after the baby was born, Julia lay back a bit and I got passed the baby, and I gave her a bath.

Kathy: It has been said that freebirthing is irresponsible.

Julia: Well I think that’s quite patronizing to women because they can make that choice themselves. Is it irresponsible? Have I checked that I’m physically healthy? Have I been to the midwife and checked that my pregnancy is going well? If I’ve done these things, then it’s not an irresponsible thing to do.

Kathy: Julia and James Wilson.

So how good an idea is it to go into labor with no medical support? Sue MacDonald is from the Royal College of Midwives. Dr. Sarah Buckley is an Australian GP and the author of Gentle Birth, Gentle Mothering. Sarah, why did you choose a freebirth for your fourth child?

Sarah: Well I’d had three very positive experiences of home birth previously. I’d had a midwife and a GP there. With this baby, my fourth baby, I wanted a different experience. I felt especially a little bit like Julia was saying, that there was some distraction, really, from having other people around. My third labor was actually 11 hours long. There were a lot of people there. I really wanted something that was more intimate, and I felt that labor would flow more easily if that happened. That certainly was the case. I actually had a 1 ½ hour labor with my fourth baby, and we had a bit of a surprise at the end. I think it flowed really because...

Kathy: What was your surprise at the end?

Sarah: She actually came out unexpectedly breech.

Kathy: One might have thought that you would have wanted some medical expertise. Now I know you’re a doctor. But for a breech baby to come out, surely having a doctor there would have been helpful.

Sarah: Well as I said I’m a doctor myself. My partner’s also a doctor. I think what happened at that moment was my instinct kicked in, and I did the thing that was totally appropriate. Now I’m certainly not advocating--actually I don’t advocate freebirth for anyone; I think it’s a really personal decision, and I wouldn’t advocate freebirth in that situation for other people either. But if I compare what might have happened if I’d had a more medicalized form of care, it would have been very difficult at that time, in the year 2000, to avoid a cesarean. It was the peak of the cesarean epidemic, if you like, for breech babies. So if I compare what happened for me with that baby with that possibility of a highly medicalized outcome, I think overall I made a very good choice. I think that the outcome for my daughter and for me and for my whole family was really enhanced because we made a very, you could say, extremely low technology choice.

Kathy: Sue, we’re getting the feeling that even a midwife present at a birth is an intrusion. Can you accept that?

Sue: Well, not totally because I think midwives are really very important to women, and you need to see them as a guide and support for the whole experience. But what Julia’s and Sarah’s stories both illustrate is the importance of, first of all, the midwife being able to get a relationship with the woman and work out together, as partners, what the woman wants for that pregnancy, for that labor and that early parenthood. It’s that sort of interaction and discussion that needs to take place in order for the woman to really get the experience she wants so that she doesn’t feel it’s an intrusion.

Kathy: What would you say a midwife crucially adds? We’ve heard from two women who’ve successfully done it on their own. Okay, one of them is a doctor and had a breech, but it was successful.

Sue: I think it’s about relationship, and I think it’s about guiding and supporting women through the experience. Obviously, both Julia and Sarah have done a lot of work and a lot of reading in preparing themselves, and that can be supported by midwives. And midwives don’t have to--and usually don’t--take over the whole business. They’re there as support and advice. And educating women rather than pushing in and taking over the whole experience.

Kathy: Sarah, it’s difficult to be confident, isn’t it, that a woman knows her own body well enough to know when something is wrong. They don’t all have your medical training.

Sarah: No, that’s right. Can I just comment on what Sue said? It concerns having other people around. One of my understandings around this is scientific. I think if we look at the hormonal physiology of labor, which I do in a lot of detail in my book, we can see that having strangers around or the woman feeling uncomfortable in labor, actually raises the levels of her hormones of fight-or-flight: adrenaline and noradrenaline. They actually physiologically slow labor down. Not only that, they can divert blood away from the uterus and baby to the major muscle groups, because they’re there for fight-or-flight. They’ve evolved through millions of years of evolution to help women to have a safe labor and birth. The trouble is, with a lot of people around--and I know some midwives can have a very low-key presence--but just that presence of strangers as Julia describes it can activate that fight-or-flight reflex. So I’d say that it’s very important for women to feel totally comfortable and totally relaxed and, as I say, private and safe and largely unobserved in their labor. That’s actually quite a difficult environment to set up even for the best midwife. Midwives are my heroes. I wouldn’t say anything against them, but it is quite a difficult situation. Especially with the regulations; the midwife is largely there to observe the woman and make recordings. That’s part of her job to do that. So it’s a difficult role.

Kathy: Sue, can you see that? Mammals are sort of designed to go and crawl off into a quite place completely alone for their bodies to react completely naturally. Could that be the case with the human woman?

Sue: It’s absolutely so. There’s been quite a lot of research into this whole area. Indeed, the whole move towards home births and midwifery-led birth centers actually supports that. I absolutely agree with Sarah, because it is very important that you have that private feel. But you don’t need to have a lot of intervention and interference, because the midwife is there to monitor the labor and the wellbeing of the mother and baby, but she doesn’t have to be intrusive. Really, all that she’s saying is very similar, I think, to what I’m saying. About getting models of care that are truly woman-friendly and really finding out what is right for that woman, that baby, and that family.

Kathy: Sarah, on the websites of which there are several, there’s trading of information about freebirth, like how to figure out if the baby is breech. How dangerous is it for women simply to be exchanging information like that?

Sarah: I think when you choose to have this type of birth, what you’re taking on is a large responsibility and with that comes the responsibility to up-skill yourself as much as possible. This is one way that women can up-skill themselves. There are other ways; Julia talked about reading lots of books. There is information available out there. I think that women who choose this take a high level of responsibility, and it’s not just that they’re up-skilling themselves. It’s also in terms of arranging backups, arranging a flexible situation where they have access to advice, for example. Women may have someone they can ring up during labor. They may even have someone present there who has skills. Unassisted birth doesn’t necessarily mean it’s just the woman there. She may have a group of friends there, and that’s still a freebirth if none of them are actually the professional involved.

Kathy: Sue, how do you react to those kind of websites and that sort of exchange of information?

Sue: I think women always have exchanged information abut pregnant and birth, and that’s important for them to be able to have that experience. But on the other hand, there’s quite a lot of information that may be frightening or women may not fully understand. So I think having someone to support them, I think having some medical or midwifery knowledge is very helpful, even if it’s your own previous experience, because it can help you understand some of the terms and the reasons why particular things were done.

Kathy: Sarah, there are women in the developing world who are crying out for medical assistance during their birth. Doesn’t it seem bonkers for privileged Western women to be taking what looks like a setback?

Sarah: Hmm, that’s a good question. I think we’ve really also got to look at the nutritional status and the hygiene available to women giving birth, because I think that’s actually very different for women in Western cultures choosing freebirth than for women in developing countries. Because of their nutritional status, largely, those women are at high risk of complications and I think they do need midwives. If we look at healthy Western women, you could say that the need is low and the chance of complication is low because we are so healthy and well-nourished generally.

Kathy: Dr. Sarah Buckley and Sue McDonald. Thank you both indeed for being with us this morning. If you have a view on this subject, please let us know. Would you consider giving birth alone, or do you think it’s misguided?


  1., 2:04 AM

    I'm very glad to see they brought up that same "third world" thing that the Grazia commenter did...thanks for posting this!

  2. What I like about the tone of the discussion, especially between Sue and Sarah, is that birth choices don't have to be an either/or thing. "If midwife-attended birth is good, then UC bad" or vice-versa. Promotion, discussion, and even passionate advocacy of a certain way of doing things doesn't mean that all other ways have no merit, or that they are wrong for all women.

    So kudos to the BBC for discussing some of the important issues for laboring women (importance of privacy and of being left undisturbed, importance of knowing and communicating with ones caregivers on a more than superficial level, role of nutrition and hygiene in birth outcomes, and so on).

    And imagine if the US government had promised to make a home birth available to all women by 2009! We are light-years away from that. Home birth midwives can't even legally practice their profession in a good proportion of our states, and sadly that shows no signs of changing. I went to our state capitol this spring to lobby for midwifery legislation that would recognize CPMs and was quite discouraged--although not surprised--at the level of resistance from legislators.

  3. Oh good, now I don't have to type it out. ;)

  4. We live in the USA. After 3 hospital births in the early 80's of various medical intervention: csec, vbac with epidural, and natural in hospital in order, we stayed home. I had 2 more babies with midwives at home in the late 80's. After that, my husband and I went on to have 6 more children all Unassissted, or Freebirth: from 1993 to 2003.
    All of the homebirth and freebirth were lovely experiences. The hospital ones were not so lovely. I would say being able to tune in to myself, my labor and my babies was #1 reason we gradually "cut out" all other influences. (persons and procedures/technologies)
    The number of iatrogenic hospital birth complications in the USA is unexcusable.
    I believe that every woman needs to birth where she feels "safe", however, to truly do so, every woman needs to be totally informed of every procedure, complication and risk factor. She cannot do that while in labor, she has to take the time during her pregnancy to read, read, read.


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