Two years ago, back in 2020 when homebirth services had been taken away from women, birth centres closed, many women were faced with choosing to either give birth on an obstetric unit where the risk of PPH, tears, episiotomies and instrumental birth is much higher, or at home unassisted. The NHS decided to create a leaflet to give women information on unassisted birth. The NHS asked the MVP (Maternity Voices Partnership) to ask women what content was important to them.
The MVP representative posts on a freebirth group: “Hi all, the NHS are producing a leaflet for freebirthers to give them information about notifying and registering their baby’s birth. I’m helping review this tomorrow morning. Is there anything you feel particularly needs to be included? What about the language? We want it to be supportive but also make sure people are aware that it is a legal duty to do these things. Your ideas would be most welcome.”“I’ve been asked to talk to freebirthing women about what should be included so we can co-produce something with the NHS. I’m hoping when we get a draft together I’ll be able to share it for further input. It’s a blank slate at this stage to request whatever info we think is needed to get it included in the leaflet.”
There were over 60 responses to this one post in a group for the North West of England, but I’m sure there were many others in other areas. Responses included things like:
– “clear information of how to notify of a birth yourself”
– “Would it cover health visitation/gp registration/vaccines too? They were all things we had issues with” she goes on to say this was a struggle because her doctor refused to register her baby without having newborn checks (which is coercion because the checks are completely optional!)
– “There needs to be a clear statement that the RCM / NMC / NHS recognise that freebirth is a right. All treatment / care / tests offered are optional.” – Okay, they did state this is a legal right at the beginning, but then proceeded to ONLY talk about the services they offer
– “Definitely how to notify of birth. I’m still struggling to find information in my area, no one seems to know anything?” “I’ve asked the head of midwifery for the information but she just told me how dangerous freebirthing was and how my husband could be prosecuted if he acted as midwife.” – so despite them saying in this leaflet that self-notifying is a legal requirement and that your midwife can help you with this, women’s lived experience is that they actually won’t.
– “It was a big worry for us not knowing how/who to inform and felt like i couldn’t bring the freebirth option up in front of any healthcare provider.”
– “a note about there being freebirth groups that may offer support can’t imagine NHS would suggest you could have support as they do not want women to have freebirths.” – You’re not wrong, they definitely don’t mention any support outside of the NHS, and what they have mentioned is not support.
– “Include that trying to get women to give reasons why for their decisions or change their minds is harassment and a violation of human rights for privacy (the 1998 human rights act) and human right to not be subjected to mental distress and degrading treatment.” – YES! But instead they have said that if you’re considering a freebirth you should talk to a consultant midwife… and we all know where that leads.
So here is my take of the NHS leaflet ‘for those considering giving birth unassisted by a midwife’. It’s taken me a while to write this because when I first read it I felt like I had wasted 4 minutes of my life. I’m writing this now because I have been supporting women in GM to freebirth for a few years now and have attempted to find information for them multiple times which is proving almost impossible to find. I re-read the above post and the comments of suggested content for the leaflet, then re-read the leaflet and felt compelled to write something about the clear lack of interest in what women actually want.
This two-page leaflet is dreadful. None of the things that women want to know are included! It states that freebirth is a “a legal choice in England.” and that their “commitment is to listen and respect your informed choices.” but then goes on to only talk about the services that the NHS offer… nothing to do with freebirth at all and it’s clear that they have not listened to women in the slightest when creating this leaflet. Nobody said in the comments that what they would like from this leaflet is more information on what maternity services can do for them – because they already know this. This information is really easy to find, and is the default for most women. The maternity service is something that we are expected to engage in and use, so we already know what they offer. But here they lay out a handy list of all of the things you’ll be “offered” despite the fact that you have already declined them:
Of course, they have promised to give unbiased and evidence-based information, but then only list the “benefits” of having a midwife present. It doesn’t list any of the risks of having a midwife present at your birth, but that’s unsurprising given the source. This is not unbiased or evidence-based information, nor is the information often given to women in her appointments.
They are not respecting women’s choices. In fact, they specifically say that if your choice to freebirth is based on fear of bad treatment from maternity services (which is a very valid fear), that you should engage with them MORE, and medicalise your pregnancy further by speaking to a consultant midwife. That does not say “respecting your informed choice” to me. To me it sounds like “you clearly don’t know what you want so come and talk to us and we’ll tell you what you need”.
The most common thing women said in the comment here was that they wanted information on how to self-notify the birth of their baby without involving medical professionals. Women are still struggling to find the right information on self-notifying, which is just ridiculous. I have tried to contact the relevant services to ask the question for clients and nobody seems to know the answer.
So, after they’ve given women absolutely no information about freebirth, they have rounded it off by reminding them that the NHS will continue to pester women throughout their pregnancy and postpartum:
This is not reassuring.
They have at least touched on the legal requirements in this section, but alas no useful information but instead just redirect women back to maternity services. From experience, and from hearing many women’s stories, it is not as simple as asking your local midwifery team who you should contact to self-notify, because they don’t want to give that information away.
It’s really clear from this leaflet that NHS maternity services do not support a woman’s choice to freebirth. If they did, they would have actually given us useful information. The information that women actually asked for, and have been asking for for a long time to no end. Information that is needed to fulfil our legal duty to notify of a birth within a ridiculous time window. How can something be a legal requirement and yet is made so difficult to actually do? Why is it that, despite the fact that it is our legal right to decline all medical care, there is a nifty requirement in law that can seemingly only be fulfilled by engaging in the very service that we have the right to opt-out of? Why is the NHS the gatekeeper of this information? Women want to be able to notify of their birth without engaging with midwives or health visitors or doctors. Why? Because women know that intervention leads to more intervention. Women know that social services are often used as a weapon. Women know that birth is a normal bodily function and not a medical event, and therefore should not need the presence of a medical professional at any stage. Women want to be in control of their own body and take care of their baby, and they know how to do that.
We are attempting to put together a list of contact details for the different areas in Greater Manchester and further afield, so if anyone who is reading this managed to find the right info for your area, even if you’re outside of GM, please message us!