Okay, I’ve got some questions. When a woman is planning a birth that is the complete opposite of the standard all-intervention hospital birth, she is asked a million questions. “Why would you want to give birth at home? Who will cut the cord? Who will catch the baby? How will you know if there is something wrong? What if something terrible happens?”. Having a homebirth is already seen as a crazy choice, so freebirth is clearly bonkers. So when a woman plans a homebirth she often plans to call a midwife because that is the done thing and it answers lots of the common question (seen above), but I have some different questions.
Giving birth at home IS the biological norm. Women in the UK only started giving birth in hospitals in the 1950’s – that’s only 70 years ago, and despite its popularity it has not made birth safer. For the millions of years before that women gave birth at home, or wherever they found themselves at the time. We are mammals and, just like other mammals, humans need to feel safe, warm, undisturbed and unobserved. The very nature of the medical profession is to observe, looking for problems, and to observe is to disturb.
The societal norm these days is to see your GP when you discover you are pregnant and then attend a series of medical appointments for various measurements and tests. Nobody really asks questions of the women who are engaging with the maternity system fully and planning to give birth in hospital. Does anyone tell women that this is optional? No. Pregnancy is not an illness, so why is the standard path a medical one? The majority of women will follow this path, either because they haven’t been told that it’s optional, or because society says that is what she SHOULD be doing, so to please everyone around her she goes. She smiles and nods and agrees to all of the measurements and tests so that she doesn’t come across as being awkward. But what is she gaining from this path? Nobody asks.
Some women will question the number of appointments or decline the “extra” things (it’s all extra really, because doing nothing would be the baseline). Even these women are challenged on their decisions, either by medical staff or family, friends or partners. They feel they have to justify declining unnecessary things that don’t bring them any benefits, and each time they try to justify it they are met with coercion. Nobody asks her what she actually wants from her pregnancy, what she needs or how she would like to honour her own milestones. Even when they are being selective about which parts of the system they want to engage in, they hesitate to push for what they truly want in case it gets someone’s back up. These are the women who, when asked if they think they might call a midwife, say that they will wait until “the very last minute” or, better yet, hope that the midwife doesn’t make it in time. So my question to you, wonderful women, is this: if your hope is that they miss the birth, what are you inviting a midwife for?
If this is something you have thought about, you’ve likely kept it to yourself. Well I’m here to tell you that you are among MANY women who have told us the very same thing (usually in a one-to-one session when their partner isn’t there and nobody else can hear them). When women say this we rejoice because we know that she is beginning to voice her ideal birth and she’s starting to question the societal pressures that encouraged her to medicalise her pregnancy from the start. Starting from your ideal birth is key. Think about it. Voice it. Plan for it. Hoping that your midwife will get stuck in traffic is not the same as planning to be undisturbed during labour.
So lets dig deep into the question:
We often ask women to picture their ideal birth and use this as a baseline, adding things in only if it feels right. Doing it this way round, instead of looking at the standard medical pathway and trying to fit your wants and needs into that template, is much more likely to produce a genuine plan that reflects how you want to give birth. For many in society a midwife is a pillar of birth, so it’s automatically assumed that there will be one present wherever a woman gives birth. I encourage you to challenge this idea and pick it apart until it makes sense. A midwife is a medically trained individual. Birth is not a medical event, so it doesn’t make perfect sense despite the association in our heads. There are things that a midwife can bring that someone else couldn’t, like gas and air for example, or other medication that you don’t have at home. Here are some of the answers we hear when we ask women this question, and things to consider when weighing up the risks and benefits.
“To make sure everything is okay”
You are getting continuous information from your baby and you would be the first to know if something was wrong. If you are able to listen to and act upon your intuition, you will know if something is wrong and you’ll know what you want to do about it. How do you want her to check if everything is okay? There are lots of standard measurements midwives tend to want to take when they are present at a birth, including your blood pressure, your baby’s heart rate, your temperature, cervical dilation etc. (it’s a long list!). Lots of the women who give this answer have also said that they don’t want any intervention, so they would decline these checks anyway. So it’s worth thinking about whether you would accept or decline any/all of the checks a midwife would want to do, how much stock you put in those measurements, and what you would do if they contradicted what your intuition was telling you.
“In case something goes wrong”
What does “something going wrong” mean to you? This is different for each woman. There are lots of things that are labelled as “things going wrong” that are actually just a normal part of labour and birth that, given enough time, would resolve themselves. Meeting your basic needs is necessary for birth to go smoothly, being undisturbed is one of those needs. If you’re worried about things going wrong, it’s worth figuring out what that looks like for you and how to avoid it.
“In case of emergencies”
There are only a handful of true birth emergencies and they are very rare. It would be easy to think otherwise if you look at the homebirth transfer rates, but remember that the majority of transfers are due to things that are not emergencies, such as length of labour, labour stalling, “baby getting stuck”, getting tired… all of which are either the normal rhythm of labour or would just require more time and the woman’s basic needs being met. If a midwife is at a birth and a true birth emergency occurs, she would call an ambulance. You have this power too, and as stated above you would know if you needed emergency care.
“To do the paperwork afterwards”
This is a less frequent answer because if a woman is saying this she has already ruled out all of the ‘just in case’ reasons and this is purely a practical thing. You can call a midwife after you’ve given birth to your baby and your placenta and ask them to come and do the paperwork. The paperwork is often presented as a complicated thing that can only be done by a midwife, but that’s untrue. You can notify of the birth yourself if you’d prefer by filling in a form and emailing it to the relevant place (we have some info on this if you’d like it).
“To do some/all newborn checks on my baby”
Again, this is an afterwards situation. You can ask them to come over just for this reason and it’s all optional. You will be observing your baby closer than anyone else on the planet, you know them better than anyone else too, so again, you would know if you needed to get them checked over and you always have access to A&E should they need emergency care.
“To bring pain relief”
Very practical. Often when this is the answer it’s because the woman has experienced a painful birth in the past (usually in hospital) and is expecting to need pain relief again. The sensations of labour feel very different when your basic needs are met, and women who give birth undisturbed don’t need medication as their body is producing endorphins at the right rate. Being free to move and make noise and be however you feel is pain relief in itself. There are also lots of natural pain relievers that you can access without having to compromise on who you have in your birth space. Questions to think about: How can you minimise the need for medical pain relief? How can you make sure your basic needs are being met? What are your alternative methods of pain relief? Can you source it from elsewhere? If you need her to bring it, what can you do to protect your birth space once she has arrived?
“I want her to be in a different room and only come in if I need her”
Okay. This answer is the one that is the most telling. What you’re really saying is that you don’t want her there, but you don’t want to say that out loud. Or there is something you want her to bring or do before/after she stays in another room. Firstly, figure out which one of those it is for you. If it’s the former, that’s something to dig deeper into – Who are you trying to appease? What are you scared of if you plan a freebirth? What would you gain from her being in another room? What would be different if she wasn’t there at all?
If it is the latter, then go through the reasons that you DO want her there and make sure that it’s you that is benefitting from it, not someone else. In what situation would you want her to come in? What would you want her to do in the “if I need her” situations? Again, this will be different for each woman. This will help you to write an assertive and clear birth plan for the midwife who does attend.
“So that they don’t refer me to social services”
We hear this one quite often from women who have engaged with the system as little as they feel is possible. They are scared that if they say no to the care they are offered they will get bad care, but the truth is that if you’re scared of that then you’re already receiving bad care. Referrals to social services for declining optional services do happen in Manchester, we’re not going to lie to you and say that they don’t. These referrals are used as a threat, and often they work. Agreeing to something under the threat of a referral means that your consent was not freely given and is therefore not valid. There is no magic formula to avoid being referred to social services for your birth choices, despite the fact that your birth choices are not grounds for a referral. But you could do everything that is asked of you, and then decline one thing and have the same thing happen. So it’s about knowing your rights, doing what you think is best for you, and recognising that you are doing nothing wrong when you decline elements or all of what the (completely optional) maternity system has to offer.
Take what you want from the system, leave the rest
Now that you’ve pictured your ideal birth, and questioned the societal norms of inviting the hospital into your birth space, you might have some answers. Here is the thing – whatever your answer is is the right one for you. The maternity system is an opt-in system. Scrutinising it doesn’t have to be an outright rejection. The way that it is presented is as a system that you must engage in as a standard and then only say no to things that you really, really don’t want (but even then you might be pushed into it anyway). If you start with a baseline of not engaging, doing nothing and enjoying your pregnancy as a normal part of life, then you can see the system clearly and engage if and when you wish to. This is how we treat all other medical systems. We go when we feel unwell, or when we have toothache. We don’t go every few weeks looking for problems. We also don’t live our lives with a paramedic in the next room, just in case we choke on our food, because if we did we probably would choke just because we’re thinking about choking.
If you answer the above questions and have a long list of reasons why you want a midwife to attend your birth, that’s wonderful – you can now write a really clear birth plan for her so she knows what you need. If you answer the questions and decide that having a midwife present wouldn’t benefit you, also great – you can plan your ideal birth knowing what you actually want, and remember that you don’t have to tell people that’s your plan if you’re worried about their reaction. It’s your information to share or not.
If you’ve got more questions, or you want to talk through any of the things that have come up for you whilst reading this (even if those feelings are anger or defensiveness) you’re welcome to come along to our monthly freebirth group or book in a one-to-one holding space session to chat with us.
You get to choose how much to engage in the maternity system. There is no right or wrong answer if it feels right to you. This is not midwife-hating, or telling women what to do, the point of this post is to encourage you to question the standard path and to make sure that the path you are currently on is bringing you joy and confidence. If it isn’t, it’s okay (and never too late) to change it.