Tuesday, 24 July 2018

Freebirthing - seeking sovereignty?

At the Oslo ICM conference (1996), a German historian, Barbara Duden said that that 'modern health care was disabling women for normal birth'. Her book, 'Disembodying Women' explained how the proliferation of specialities in maternity care was constructing the 'fetus as an endangered species and the woman's uterus as a faulty ecosystem' and modern healthcare as the rescuer of that fetus from the dangerous womb.  I was deeply affected by Barbara Duden's presentation and immediately bought her book and read it avidly cover to cover.  Her words resonated with me and as a midwife, I wondered where all this measuring, surveillance and intervention in the childbearing process was going.  

                Photo from freebirthing article - look at that vernix! 

An article on Freebirthing, published in September 23, 2016, by Claire Feeley, midwife and PhD researcher from the University of Central Lancashire, stated that women were getting fed up with the fear and risk-obsessed maternity care system and were taking their autonomy and control back.  Claire's research findings suggest that the rise in freebirthing is because women perceive that doctors and midwives are not listening to women and ignoring their needs.  I have been hearing even more about freebirthing recently; more women are taking control over their bodies into their own hands, believing that the lack of respect and kindness coupled with the proliferation of interventions assocated with mainstream maternity care to be more dangerous than giving birth without midwifery or medical support. Midwives are finding their practice increasingly bound by rules, guidelines, protocols and the threat and/or reality of being reported to the regulating body, whose processes are ponderous and have been experienced as soul destroying and emotionally damaging for many.  Is this another reason why women are bypassing midwives for their care? 

As those of us who've been around for a while know, risk status is a poor predictor of outcome.  Women designated with high risk pregnancies by the system often birth well; occasionally, women designated as having 'low risk' pregnancies can end up with all sorts of misadventures. When I was in private practice, women who were labelled 'too fat' or 'too old' by the system and therefore didn't fit birth centre guidelines would find their way to me for their maternity care. Those women would birth well and easily; their sense of self and their capacity to birth their babies unimpeded by their size or age. 

The one truism that is still evident today is that when women feel strong, centred and confident, they invariably birth well. We also know that where there is a strong, autonomous midwifery profession, birthing women do well. A skilled and competent midwife, who recognises the DNA mediated intelligence of the birthing process and women's capacity/ability to birth, is alert to deviations from normal and refers appropriately. Such a midwife can be just what a woman needs as she provides information and discussion and supports that woman to find and embrace her sense of self and self-empowerment, enabling that woman to birth her baby well in her own unique way.  Is it time that midwives were fully supported to practice in a way that enables women to be informed, autonous and self-directing in their pregnancies?  Absolutely. It's a human rights issue. A fully informed and supported woman makes the right decisions in the right way, at the right time for her own and her baby's needs.


Pamela Harnden said...

Hi Carolyn,
As you know I agree with everything you have written. And you are well aware that I am one of those midwives broken by the system. I despairingly read the standards for practice written by the NMBA and know for a fact that the majority of midwives working in the system are paying little regard to the standards that allude to 'autonomy''informed consent' 'respectful care' I could go on and on. There is no accountability for these midwives. They claim to be working to their 'full scope'. I could choke on the hypocrisy.

Carolyn Hastie said...

Thanks for commenting Pamela. The system should be building us up, not breaking us. I'm so sorry that's your experience and feeling. The system is a juggernaut. Perhaps a pugmill describes it better? I think that we all get caught up in it, and like a pugmill, we get processed, homogenised and churned out at the end with no lumps, bumps or defining characteristics. It defies logic that something so precious, something so intrinsically human and crucial to the continuation of the human species is not treated reverently and with profound kindness. We know, the evidene is clear, that relationship based continuity of care is safest for women and their babies. Why then is it OK for women to be herded like cattle into antenatal clinics, wait for hours and have a cursory 'visit' where various 'shroud waving' comments are thrown about? Why is continuity of care so dismissed, labelled 'Rolls Royce' care when all women deserve the best care, with patient, competent, kind, respectful practitioners which should be the norm? We still have a lot of work to do to change the way we do maternity care; don't give up Pam, it's always darkest before the dawn.

Catherine Bell Birth Cartographer said...

With maternity services being centralised, and rural women having to travel, freebirthing becomes an important consideration.  This is different to 'birth before arrival', as it involves preparation and acknowledgement.  Are women choosing to bypass midwifery care, or is the system bypassing some women?

Another brilliant blogpost CH!

Carolyn Hastie said...

Great question Catherine. The system is unintentionally bypassing many women - it actually seeks to scoop everyone up and get them to comply to the cookie cutter approach to maternity care. It seems to me that some women are opting out of that process.

Unknown said...

Thank you Carolyn for your insights you have gained over the decades of your practice. Interesting to read how you have found risk profile has little to do with outcomes. I wonder too if what lies at the heart of all this risk aversion (and therefore intervention that drives some women away) is the fact that noone is willing to acknowledge that someone could die that day. Yes, the chances are very small, particularly for the mother, but it is still the truth.

In the medicalised view it seems to me there's no place for accommodating the possibility of mortality prior to the event, ie where everyone involved commits to doing their absolute best for the mother and child, but still it is possible. But maybe the people working in the system can't really, hand on heart, make that commitment as they know the system will place all sorts of medico-legal barriers to distance them from the process and de-humanise it, and in doing so, hold back what can truly be offered in the woman's best interests...

I'm not a practitioner at all, so could be waaay wrong on this, and have only been at my own two births, so this is just an 'outsider looking in' perspective. I am also so very thankful for the legions of practitioners who go into that system every day in the face of the systemic challenges to their practice, in spite of their trauma as witness this happening to families because they love birth and babies and women so much.

I think many of these practitioners are not aware of how precious their little gestures of kindness and insight they bring to women such as me who naively step into that system, believing it to be the safest option for their baby, but instead finding themselves on a dispassionate conveyor belt. It may seem minor but it really means so much!

Carolyn Hastie said...

Your comments are right on track 'unknown'. Death is to be avoided at all costs in modern health care. We hear horror stories of terminally ill people having all kinds of tests and heroic interventions when they are totally, in my view, inappropriate. In terms of women and their fetuses/babies, we have lost the somewhat pragmatic and yet, realistic view, that some people die. Our big call is, however, to make sure that when people die during childbearing it is not through something/action/lack of action that could have been avoided/averted. Our big failing, in my mind, is that we (governments/cultures/systems) do not value women, nor women's processes such as childbearing. If we did, then tampons would be free and freely available, family planning clinics, access to safe abortion clinics, a properly serviced maternity care system and one to one midwifery care, coupled with breastfeeding support and government supplied home help etc would be the norm. Then, when those strategies were in place, properly funded and deeply valued, we'd see the death rate plummet. Poor communication, short staffing, lack of teamwork are all system related dysfunctions that are associated with health system misadventure, near misses and untimely, avoidable deaths.