Call the midwife! No matter how bad you’ve heard care can be, ‘freebirthing’ is not the answer

‘Humans have evolved to need assistance during birth. There’s a reason that a whole medical speciality exists around pregnancy and childbirth.’ Photograph: Science Photo Library/Ian Hooton/Getty Images

“Could you do a poo like this?” There’s a sentence I will never forget. I was in my second trimester and doing a hypnobirthing course. The question is supposed to be a metaphor for childbirth: being surrounded by doctors with clipboards would apparently make you too tense to poo, or give birth. To which my rejoinder was, “Well, surely it depends how much you need to go.”

Other than National Childbirth Trust (NCT) classes – in which the instructor told us that the ideal birth is at home, without pain relief (not their official line, they say) – this was my first glimpse of the anti-medical approach to childbirth. I thought about it again when I read about the concerning rise of “freebirthing” – when a woman gives birth at home without assistance from a doctor or midwife – and the fact that the Royal College of Midwives has stated that “midwives are understandably concerned about women giving birth at home without assistance, as it brings with it increased risks to both the mother and baby”.

Freebirthing is the logical conclusion of the “natural” – or unmedicated – birth dogma that so many of us encounter in pregnancy. That movement has always portrayed itself as a plucky underdog fighting back against the sexist male medical establishment (with good historical reason). In fact, if you give birth in the UK today, it’s likely that you will encounter some variation of the message that unmedicated birth is the ideal form of childbirth and that interventions are to be avoided at all costs.

This is compounded by a new and growing movement on social media, led by influencers who idealise vaginal birth without pain relief. I have no doubt that it has played a central role in the increase in women rejecting medical assistance in childbirth. And yet, despite questions such as “Could you do a poo like this?”, tons of women have babies regardless of the “offputting” presence of doctors (they may even poo during). Sometimes doctors even play quite a vital role.

As doctors and midwives have pointed out, home births and freebirths are two different things. “Home births, supported by a midwife, may be suitable for healthy, low-risk women who are having a second or subsequent child and have had a straightforward pregnancy,” said Prof Asma Khalil, a vice-president at the Royal College of Obstetricians & Gynaecologists. “However, for women having their first baby, evidence shows a home birth slightly increases the risk of a poor outcome for the baby.” Home births without midwife support are far more dangerous. There is so much that can go wrong – with you or the baby – that will require immediate medical assistance.

Rather than judging women who choose freebirthing, I’d be more inclined to try to understand their reasons. Home births assisted by midwives were suspended during the pandemic, and services in many areas are yet to be restored. Thousands of women were forced unnecessarily to labour in hospitals alone without their partners, and trust has been lost. Birth centres are understaffed, meaning many women end up with hospital births that they did not choose, and in general services are at breaking point. Midwives are leaving the profession in droves. I understand that some natural birth advocates are coming from a place of birth trauma. Their attempt to process – and to help other women – is in some ways admirable, but it’s also sad that so much birth trauma remains untreated. Furthermore, the gulf between expectation and reality will only make PTSD more likely. What’s needed to address this is more funding and better communication, not to write off medical support during birth altogether.

Women should be empowered in their birth choices, insomuch as it is possible while keeping them and their babies safe. But they need all the facts at their disposal. In the void created by decreased funding for free classes, along with increasing disinformation on social media, freebirthing is flourishing. Despite the proliferation of videos with titles like “woman gives birth alone crouching in bush without making a noise once”, humans have evolved to need assistance during birth. There’s a reason that a whole medical speciality exists around pregnancy and childbirth. I was taught nothing of the “obstetrical dilemma hypothesis” – the idea that humans evolving to walk upright resulted in a narrower pelvis, while at the same time the brain quadrupled in size. Instead, I was told in hypnobirthing class that childbirth was doing “what my body was designed to do”, and that problems in labour would be the result of my own failure to relax and “breathe the baby out”.

“Primitive” women and how they give birth have historically been praised by natural birth advocates and those racial overtones continue to this day. According to the UN, 300,000 women a year are dying in pregnancy or childbirth worldwide, most of them in lower-income countries from avoidable complications. To celebrate a lack of medical intervention is perverse. The goal of obstetric medicine is to achieve a much lower maternal and neonatal morbidity and mortality than would occur “naturally”. The stark findings of the Ockenden report into poor maternity care at Shrewsbury and Telford NHS trust demonstrated the tragic consequences for women and babies of a policy of “normal birth at any cost”. Even women who have been through a horrendous birth experience in hospital should be careful not to idealise freebirthing or imply it’s the answer.

But then, don’t we all bring our own personal experience to discussions around birth? There were so many doctors in the room while I was giving birth that they were able to form little cliques. There’s something quite sobering in the knowledge that 100 years ago, or without medical expertise, you and your baby could both be dead. Had I been set on the natural birth that this movement pushed me towards, my son would probably have died. A freebirth might have killed both of us.

My experience made me grateful for doctors, but the “woo-woo” hypnobirthing training also got me through agonising back-to-back contractions when no pain relief was forthcoming. I can see the benefits of many different approaches, and I admire all mothers no matter what sort of birth they have. I have friends who’ve had elective C-sections and friends who are advocates of Ina May Gaskin and fought tooth and nail not to give birth in a hospital. Yet the friends who went for the “pretending you’re a mountain lion” approach still saw the benefits of being able to get a blood transfusion quickly. The rise of freebirthing has serious implications for women and babies. A listening, compassionate approach to prenatal education must be part of the solution.

Rhiannon Lucy Cosslett is a Guardian columnist