Wednesday, September 17, 2008

UK concern over 'Freebirth'

Following on from my earlier blog....Freebirth seems to be reaching epidemic concern - this article "Pregnant women are opting for risky 'freebirths' in the UK Telegraph states that
Advocates of the freebirth approach claim that it is "more natural" than giving birth surrounded by midwives and doctors. It would usually take place at home.

Freebirth involves giving birth without medical assistance, which has led to concerns that women could find themselves in dangerous situations if something goes wrong.
The Royal College of Midwives suggest that
Mothers-to-be are making the radical choice because ministers have failed to deliver their pledge to let them have their babies where they want.
Some women aren't certain about homebirths and others want them but the service can't provide..... "The worry is that women will do it themselves. If you're not offering women choice then that is the danger."

I have noticed over the last 6 months that the topic of Freebirth has become more topical and anecdoteally there have been a number of women choosing this option.

Freebirthing is a trend that is becoming increasingly popular in America. It is not known how many freebirths take place in Britain or Australia, however it is becoming of concern. Off course America's Medical Association (AMA)adopted a resolution at its annual meeting last weekend (June 08) to introduce legislation outlawing home birth -

"It's unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons-or just because they didn't make it to the hospital in time," said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. "What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution."
This is an interesting concept happening in America, apparently this motion is a swipe at Ricki Lakes documentary The Business of being Born on homebirth - The Big Push for Midwives are an organisation of midwives fighting for the rights of midwives and women. "Our goals are to fully integrate the Midwives Model of Care into the health care systems of our states, to highlight the importance of family health care choices and to defend the ability of CPMs to provide legal and safe prenatal, birth and postpartum care to families in every state".

It does seem to be a worldwide trend that midwives and women are constantly fighting for the right to choose the model of care and birth they want. Why is this so difficult? This is the 21st century, we as women have the right to autonomy, the right to choose whatever model of care we desire.
It is interesting to note that America is pro-fetus, Britain pro-woman, Australia & New Zealand have not had many test cases, but tends to follow the UK, however can be swayed by the USA.
I am so pleased I do not live in America.

If you know any freebirth stories please share them.


Rixa said...

Yes, I agree the situation in the States is far worse than in the UK (speaking as someone who lives in the States). Home birth midwifery is still illegal in many states, with the exception of nurse-midwives, but they almost always practice in hospital. I am writing my PhD dissertation about unassisted birth and so have been immersed in that community for a while.

infomidwife said...

Thankyou Rixa for your comments, it is nice to be in contact with someone from the States. I keep a close watch on whats happening in the States as it does have a golbal effect. It does amaze me that you have a total ban on homebirth, the natural progession from this stance would be to push it underground, therefore an increase in Freebirth. It is evident from my netsurfing that there is a lot of information for women regarding freebirthing spreading via the internet. I would be keen to keep in contact and share information. I am currently trying to get figures of Freebirthing in Western Australia, however it is proving difficult and will keep you posted.
Do you nurse-midwives work as independant midwives for homebirth? and do they have insurance?

Sandy (Singapore) said...

As an Aussie expat 14 years ago I had my first child in the US in Fairfax, Virginia (I am also an RN but not a midwife). I did not opt for a free birth but a standard hospital delivery. An uneventful pregnancy but on arriving at the birthing suite in the very early stages of labour I found the nurses there actively encouraging an epidural despite that I was not in pain yet and really did not want to go that route unless I had to. I had leads insitu and was not allowed to sit on a chair during the labour. Very clinical experience although at the time I thought it was fine. What a contrast only 2 years later when I had my second child back in Melbourne Australia. The nurses first offered a hotback for pain (which was bliss by the way)and the majority of my labour was done in a comfy chair. I really think the litigation aspect in the US is a concern for them there. Women are penalised because of it unfortunately. The 'land of the free' perhaps, but maybe not if you are a woman in labour.

infomidwife said...

Thanks Sandy for comments, it is interesting to hear different points of view.
It is interesting to see the different terminology used, the US refer to midwives as nurse-midwives, in the UK they are midwives and no one calls a midwife a nurse. Wilst in the UK the demarcation line is clearly drawn and everyone knows it. However in Australian Midwifery is still not widely accepted or known - it is still finding its feet, many nurses still refer to midwives as nurses and find it hard to make the change, however I think with the Bachelor of Midwifery now becoming the norm in Australia, we will begin to see the change and Midwifery will begin to stand alone. Women and nurses alike will know when they are pregnant -(antenatal, intrapartum, postnatal), they will know they are being treated by a MIDWIFE not a nurse.
My understanding is that Singapore has very few midwives.

ErinladyRN said...

Hi. I am new to blogs but feel the need to comment on this topic. I am an RN who lives in the States - Pennsylvania to be exact. I currently work in a hospital on a labor and delivery unit. I must say that I am extremely frustrated with how things are generally done in my community. I chose to work at my current hospital because it is the only one within an hour's drive that permits Midwives to practice. In the state of PA it is illegal to practice as a lay midwife (a midwife who is not a nurse) and it is illegal for a nurse midwife to practice outside of the employment of a physician - to my knowledge. It is not illegal to practice in the homebirth setting, however it is damn near impossible because so few doctors are willing to back a midwive who will perform a home birth due to the fear of litigation. As you may know Pa, I think, has the highest malpractice insurance rates in the country and also the highest 'pay outs' for malpractice in obstetrics, particularly in Philadelphia - from what I have been told. Anyway my point is that homebirths are not 'banned' at the moment but they are rarely done.
Now in my community there is a large population of Mennonites and they generally employ the services of a lay midwife to attend them at home illegally, and she must have good outcomes because she rarely shows up on our doorstep with a probelm. I am painfully curious to see how she does things, and I am also painfully curious to see how births are attended in other countries such as your own.
According to the literature I have read, maternity care in the states is shameful. With our resources there is no excuse for the mortality and morbidity rates currently reported. I make the argument all the time on my unit (a place where fear of intrapartum imminent death or harm abounds) that there is something to be said for other countries where homebirth is the norm and they have better birth outcomes than we do. But no one listens.
On my unit labor induction is the norm. Iv fluids and continuous fetal monitoring are the norm as are second degree tears and episiotomies. Epidural anesthesia is the norm and for the infrequent mother who opts not to receive an epidural they most often get some form of IV pain med, It is very rare to have a mother recieve absolutely nothing during her labor. Most mothers, because of the wide spread use of pain meds and the need for continuous fetal monitoring are not permitted out of bed. I drives me crazy and I can't figure out why it is this way. Now for the births attended by the midwives it is somewhat less severe, but even in some of their cases it might as well be a doctor managing the labor because it appears no different.
A few of the nurses I work think I am a fanatic. One of the more polite doctors has described me as "the best patient advocate on the unit" And I am proud of that. I find the practices mentioned above to be barbaric. Somewhere in the depths of my soul I know that childbirth doesn't have to be this way; labor should only be 'managed' by the woman experiencing it. I know this even though I have never seen a birth outside of the hospital where the woman was in complete control. Am I crazy?
On the topic of freebirth: I can easily see how one might be tempted. I had both of my children before I became a labor and delivery nurse. I had them both in the hospital. My first was a vacuum assisted delivery and was very traumatic especially since I wanted to go all natural and was doing very well until I wasn't progressing fast enough and they talked me into pitocin which started the cascade of events leading to the vacuum. My second birth was a cesarean because my midwife and OB felt that my second baby, bigger than the first, would certainly never fit and they frightened me with tales of shoulder dystocia.
So now although I would love to have another baby, despite my belief that my body can do this I am terrified. I am terrified not of the process but of what they will do to me when I get to the hospital, especially since this time I will be the dreaded VBAC. And the thought has ocurred to me to just stay home and play dumb when all of a sudden I have to push. I had this thought long before I ever heard the term 'freebirth'. I hope this may have answered some of your questions regarding birth, midwifery practice, and freebirth in the States.

Carolyn said...

When the only option for care during birth is a very medicalised experience there are bound to be some women who will reject that and if unassisted, or freebirth is the only other option then they will take that option. As midwives we have a huge responsibility to make sure that women do have the option of completely intervention free birth if they wish. The evidence suggests this has the best outcomes for both the mother and child. When midwives never get any chance to see this in practice, when all they see is obstetrically controlled birth how do they make the move to support women to birth without intervention? I would suggest to any midwife in this position that she goes to youtube and looks at some of the wonderful births that are available to watch there. Perhaps this will give her the strength to take a chance and see what birth can really be like.

As midwifery educators we too have a responsibility to provide our students with learning resources that will help them to support women to birth without intervention. I recently found this animated learning resource on the stages of labour from Wisconsin. I thought what a great resource until I started looking at it further. Each stage is associated with some intervention, e.g. this is when the membranes will be ruptured, or this is when we will begin pitocin. It makes me despair
I have seen other learning resources for midwifery students from the US and this idea that intervention is the norm seems to pervade them all. I know there is some great work being done in the American continent and there are some wonderful midwives there. How do these midwives get a balanced picture when these are the learning resources and this is how they are taught the birth is?

infomidwife said...

Hi Carolyn, ncie to hear from you, sorry it has taken so long to respond to your comment - but snowed under in marking - I agree with you entirely - I have watched some birth centre births is the USA and all seemed really normal until every woman in 2nd stage labour received oxygen routinely, they just have a different way of working - and 'normal' means different things to different people.
However I do think as midwives we should be able to offer low risk women intervention free births.

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