It was written before much of the research establishing the safety of homebirth was published (e.g. The Birthplace Study). Also the article tends to assume the efficacy of the mainstream e.g. the author questions the demographics on which Tew based her work but not those of the religious sect in Indiana. In addition, Gosline's description of the human female pelvis fails to mention its wonderful flexibility and dynamism, rather making it look like an evolutionary mistake! The article is also unhelpfully titled - identifying women who choose to freebirth as "extremists" is hardly objective journalism. But it's an interesting introduction visiting a basic range of issues.
Extreme
childbirth:
Freebirthing
From
issue
2585
of
New
Scientist
magazine, 6
January
2007,
page
40-43
by Anna
Gosline, a
science
writer
in
Vancouver,
Canada
ONE
HOT
afternoon
in
August
1977,
heavily
pregnant
Laura
Shanley
felt
the
early
twinges
of
her
first
labour.
Instead
of
calling
a
midwife,
she
called
over
some
friends.
When
her
waters
broke,
she
didn't
dash
for
the
hospital,
just
the
bedroom.
On
hands
and
knees
she
gave
birth
to
her
son,
John,
in
one
swift
push.
Ready
to
catch
him
was
the
only
other
person
in
the
room,
her
husband,
David.
Over
the
next
few
years
Shanley,
who
lives
in
Boulder,
Colorado,
went
on
to
have
four
more
babies
in
the
same
way.
Giving
birth
at
home
instead
of
hospital
is
not
all
that
unusual.
What
sets
Shanley
apart
is
choosing
to
go
it
alone
without
any
professional
help.
She
is
part
of
a
movement
that
advocates
unassisted
childbirth,
or
"freebirthing".
The
backlash
against
the
perceived
overmedicalisation
of
childbirth
in
the
west
has
already
seen
some
women
reject
hospitals
in
favour
of
a
low-tech
home
birth
with
a
midwife.
Freebirthing
proponents
go
further
still,
shunning
even
midwives.
Almost
all
doctors
and
many
midwives
condemn
unassisted
childbirth
as
dangerous.
The
small
but
growing
number
of
freebirthers,
however,
say
it
is
perfectly
safe
for
a
woman
to
give
birth
alone,
or
at
most,
accompanied
by
a
partner
or
friend.
They
believe
that
advice
from
medical
staff
interferes
with
the
normal
birth
process,
and
that
women
have
easier
labours
if
left
alone
"as
nature
intended".
"Birth
is
inherently
safe
and
relatively
painless,"
Shanley
claims,
"provided
that
you
don't
interfere
by
using
doctors
or
midwives."
Freebirthers
do
have
a
point:
childbirth
has
never
been
so
medicalised.
For
most
of
history
women
gave
birth
at
home,
possibly
attended
by
a
midwife
or
doctor,
but
with
little
to
no
medical
help.
In
the
20th
century,
city-dwelling
and
new,
potent
painkillers
brought
women
into
hospitals
to
deliver
their
babies.
Here
a
growing
number
of
interventions
were
introduced.
In
difficult
labours
it
became
common
for
doctors
to
ease
out
the
baby
with
forceps,
or,
later,
a
suction
cup
known
as
a
ventouse.
Syntocin,
a
synthetic
form
of
the
hormone
oxytocin,
came
to
be
used
to
trigger
labour
or
speed
it
up.
Once
a
last
resort,
the
ultimate
intervention
of
a
Caesarean
section
now
accounts
for
about
one
in
four
UK
births.
There
is
no
doubt
that
these
and
other
interventions
have
saved
the
lives
of
millions
of
women
and
children
the
world
over.
But
campaigners
and
even
some
doctors
say
they
are
overused
and
may
even
do
more
harm
than
good.
Syntocin,
for
example,
often
makes
contractions
more
painful.The
counter movement
began
in
the
1960s,
spearheaded
by
the
National
Childbirth
Trust
in
the
UK
and
the
Lamaze
Institute
and
the
International
Childbirth
Education
Association
in
the
US.
Today
such
groups
lobby
for
childbirth
to
remain
as
simple
as
possible,
with
the
management
of
low-risk
births
ceded
to
midwives,
who
have
only
relatively
low-tech
forms
of
help
at
their
disposal.
So
far
this
has
extended
to
the
promotion
of
home
births,
with
a
midwife
present
but
the
nearest
doctor
an
ambulance-ride
away.
The
safety
of
home
births
is
still
hotly
contested,
but
some
want
to
progress
to
what
could
be
seen
as
the
natural
childbirth
movement's
logical
conclusion
– completely
unassisted
childbirth.
Freebirthing
has
no
formal
organisations,
so
charting
its
growth
is
difficult.
When
Shanley
wrote
a
book
on
the
subject
in
1994,
she
says
the
practice
was
nearly
unheard
of.
Now
most
freebirthers
use
the
internet
to
spread
the
word
and
swap
tips.
Shanley
runs
a
website
for
these
purposes
and
over
the
past
decade
she
has
heard
from
many
other
women
who
have
given
birth
without
help.
Linda
Hessel,
who
lives
in
Corvallis,
Oregon,
and
had
her
third
child
unassisted,
collects
freebirthing
stories
from
the
website
Mothering.com.
About
160
mothers
post
from
the
US,
Canada,
the
UK
and
Australia
on
the
site's
unassisted
childbirth
forum.
It
is
a
very
small
but
growing
movement,she
says. Freebirthing
is
also
growing
in
Australia,
possibly
influenced
by
poor
access
to
midwives
and
the
closure
of
some
rural
maternity
wards
over
the
past
few
decades.
The
high
rate
of
Caesarean
sections
in
hospitals
may
also
be
a
factor,
says
Sarah
Buckley,
a
general
practitioner
(GP)
in
Melbourne.
Six
years
ago,
Buckley
had
her
fourth
child
unassisted
-
a
different
prospect
for
a
GP,
to
be
sure,
but
she
supports
the
right
of
all
mothers
to
freebirth,
making
her
one
of
the
few
doctors
to
do
so.
So
do
the
freebirthers'
claims
stack
up?
Are
they
in
fact
giving
birth
the
natural
way?
In
some
ways
nature
has
dealt
humans
a
poor
hand
when
it
comes
to
giving
birth.
As
early
hominids
evolved
an
upright
walking
posture,
the
pelvis
had
to
pivot
up,
narrowing
the
birth
canal.
And
the
price
we
pay
for
our
huge
brains?
Huge
heads.
No
wonder
the
passage
of
a
full-term
baby
through
the
birth
canal
is
a
tight
squeeze.
"Birth
is
not
as
simple
or
straightforward
as
it
is
in
other
animals,"
says
Wenda
Trevathan,
a
medical
anthropologist
at
the
New
Mexico
State
University
in
Las
Cruces.
"Freebirthers
say
birth
is
inherently
safe
and
relatively
painless
provided you
don't
interfere
by
using
doctors or
midwives".
The
shape
of
the
pelvis
may
have
led
to
another
feature
of
human
births. Thanks
to
the
twisting
and
cramped
interior
of
the
birth
canal,
human
babies,
unlike
those
of
other
primates,
tend
to
turn
mid-birth
and
exit
the
vagina
facing
their
mother's
spine.
This
makes
it
harder
for
the
mother
to
clear
mucus
from
the
baby's
mouth
after
its
head
emerges.
And
if
she
pulls
the
baby
out
too
forcefully
she
may
bend
the
spine
and
neck
against
its
natural
curve.
That's
why
Trevathan
argues
that
some
form
of
birth
attendant
may
have
been
de
rigeur
since
bipedalism
began
to
evolve
5
million
years
ago.
"In
most
cases,
the
mother
and
the
baby
benefit
from
some
form
of
assistance,"
she
says.
A
glance
through
anthropological
studies
reveals
that
in
almost
all
hunter-gatherer
cultures,
women
tend
to
have
some
form
of
birth
attendant.
Even
among
the
!Kung
people
of
southern
Africa,
who
say
the
ideal
birth
is
a
solitary
(and
silent)
one,
in
practice
women
usually
have
help,
at
least
until
they
have
a
previous
birth
or
two
under
their
belt. Of
course
a
birth
attendant
who
merely
helps
the
baby
out
and
clears
their
airways
hardly
requires
midwifery
training.
But
it
does
suggest
that
freebirthers
who
set
their
hearts
on
complete
privacy
may
be
striving
for
something
that
rarely
happens
"in
nature".
What
does
happen
in
nature?
The
World
Health
Organization
estimates
that worldwide
15
per
cent
of
labours
have
a
life-threatening
complication.
It
has
also
been
estimated
that
the
"natural"
rate
of
maternal
death
from
childbirth
is
between
1
and
1.5
per
cent.
The
biggest
risk
is
uncontrollable
bleeding,
even
when
women
give
birth
in
hospital.
Birth
is
even
riskier
if
it
is
you
that
is
being
born:
in
some
developing
countries
the
neonatal
death
rate
can
be
10
per
cent.
The
chief
danger
to
the
baby
is
lack
of
oxygen,
for
example
due
to
blood
flow
through
the
placenta
being
restricted
in
a
long
and
difficult
labour.
It
is
unclear,
however,
how
these
risk
estimates
apply
to
modern-day
western
women
who
are
generally
healthy
and
well
nourished.
In
fact
freebirthers
claim
it
is
better
general
public
health
that
has
led
to
the
dramatic
drop
in
maternal
and
infant
deaths
over
the
past
century.
There
is
some
evidence
to
support
this
claim.
In
the
late
1970s,
Marjorie
Tew,
then
a
research
statistician
at
the
University
of
Nottingham
in
the
UK,
analysed
the
national
birth
statistics
from
1958
and
1970.
She
found
that
hospitals
had
far
higher
infant
death
rates
than
either
home
births
or
independent
birth
centres
run
by
GPs,
both
of
which
used
fewer
interventions.
Contrary
to
the
prevailing
views,
Tew
concluded
that obstetric
interventions
hindered,
rather
than
helped,
the
already
falling
death
rates.
The
underlying
cause
of
the
drop,
she
said,
was
better
public
health,
nutrition,
living
conditions
and
infection
control.
It
was
a
relatively
low-tech
medical
intervention,
the
use
of
antibacterial
sulphonamides
to
treat
post-birth
infections that
caused
the
biggest
drop
in
maternal
mortality
over
the
past
century.
Home
advantage
The
accuracy
of
Tew's
controversial
conclusions
hinge
on
whether
her
analysis
took
adequate
account
of
the
fact
that
women
would
be
more
likely
to
go
to
hospital
if
they
were
at
higher
risk
in
the
first
place.
Tew
did
adjust
for
many
risk
factors
including
having
a
multiple
pregnancy,
a
baby
in
the
breech
or
head-up
position,
high
blood
pressure,
previous
Caesareans,
and
bleeding
during
pregnancy.
However,
there
may
have
been
other
risk
factors
omitted
from
the
data.
Tew's
findings
were
so
radical
that
it
was
many
years
before
her
work
was
published
in
an
academic
journal,
and
even
then
it
was
largely
ignored.
In
the
meantime
the
push
for
hospital
births
continued,
and
today
they
are
the
default
setting
for
childbirth
in
the
west.
In
most
western
countries
even
a
standard
home
birth
with
a
midwife
present
is
seen
as
a
risk.
In
the
US
-
where
even
uncomplicated
hospital
deliveries
are
carried
out
by
doctors,
not
midwives
-
most
obstetricians
are
against
home
births.
Two
past
presidents
of
the
American
College
of
Obstetricians
and
Gynaecologists
have
equated
home
births
with
child
abuse.
At
one
of
its
meetings
last
year
the
college
gave
out
car
bumper
stickers
saying:
"Home
delivery
is
for
pizza”.
The
UK
government
has
recently
voiced
support
for
making
home
births
an
easier
option,
but
they
still
account
for
only
2
or
3
per
cent
of
births.
In
Europe
only
the
Netherlands
stands
out,
with
a
30
per
cent
home-birth
rate.
The
big
question,
of
course,
is
whether
home
births
are
safe.
On
the
one
hand,
there
is
the
lack
of
doctors
and
their
sometimes
lifesaving
interventions.
On
the
other,
hospitals
can
be
stressful
places.
Adrenalin
(epinephrine
in
the
US),
the
fight-or-flight
hormone
produced
in
response
to
stress,
seems
to
slow
labour,
which
could
explain
why
decades
of
research
have
linked
stress
and
fear
to
longer
and
more
difficult
births.
The
best
way
of
answering
the
question
would
be
to
randomly
assign
a
large
number
of
women
to
either
home
or
hospital
births.
But
few
would
put
up
with
having
their
care
chosen
for
them.
Instead,
researchers
can
only
study
the
outcomes
of
the
choices
women
make
for
themselves.
This
risks
home
births
appearing
safer
than
they
really
are
because
they
tend
to
be
selected
by
women
who
are
white,
well-off
and
well-educated
-
all
factors
that
lower
their
risk
of
difficult
births
-
as
well
as
being
at
low
medical
risk.
One
of
the
biggest
and
best
studies
in
this
field
was
published
last
June,(BMJ,
vol
330,
p
1416).
It
attempted
to
follow
every
North
American
woman
planning
a
home
birth
under
the
care
of
a
certified
midwife
in
the
year
2000
and
ended
up
including
5418
births.
No
mothers
died
and
the
infant
death
rate
was
1.7
per
1000
-
a
similar
figure
to
low-risk
hospital
births
in
the
US.
Home-birth
campaigners
have
hailed
these
results
as
vindication
of
their
stance.
Critics,
on
the
other
hand,
point
out
that
12
per
cent
of
the
women
had
to
be
transferred
to
hospital,
usually
for
maternal
exhaustion
or
because
their
labour
wasn't
progressing.
And
3.4
per
cent
were
admitted
as
an
emergency,
mainly
for
fetal
distress
or
maternal
haemorrhage.
While
this
debate
seems
likely
to
run
and
run,
many
of
even
the
staunchest
home-birth
supporters
shun
freebirthing.
Marsden
Wagner,
the
WHO's
former
director
of
Women
and
Children's
Health,
says
it
is
a
step
too
far.
"There
are
a
very
few
cases
when
things
go
badly,"
he
says.
"Midwives
are
trained
to
know
when
things
are
going
in
the
wrong
direction."
If
the
evidence
on
the
safety
of
standard
home
births
is
unclear,
it
is
almost
non-existent
for
freebirthing.
There
seems
to
be
only
one
study
of
western
women
who
intentionally
had
unassisted
births,
published
in
1987.This
looked
at
a
strict
Christian
community
in
Indiana
called
the
Faith
Assembly
Church,
who
refused
all
medical
attention
for
religious
reasons.
It
documented
344
births
over
seven
years.
The
figures
make
grim
reading.
The
neonatal
death
rate
was
19
per
1000
live
births,
compared
with
7
per
1000
for
the
rest
of
Indiana.
Maternal
mortality
was
8.7
per
1000,
20
times
higher
than
for
other
women
in
Indiana. Studies
published
in
medical
journals
seem
unlikely
to
influence
the
freebirthing
community,
however.
From
their
websites
and
message
forums
it
is
clear
that
these
women
reject
orthodoxy
in
numerous
ways.
Many
advocate
long-term
breast-feeding
and
home-schooling;
some
also
shun
infant
vaccines
and
prenatal
medical
care.
Without
ultrasound
scans
and
other
checks, someone
could
unwittingly
plan
an
unassisted
birth
while
carrying
twins
or
a
breech
baby
-
as
happened
with
Laura
Shanley's
third
child.
Even
that
may
not
deter
the
most
radical
freebirthers,
who
scorn
medical
assistance
even
for
serious
complications.
But
not
all
go
so
far.
"These
variations
are
something
that
I
would
want
to
know
about,"
says
Hessel,
"and
I
might
make
different
plans
accordingly."
Freebirthers'
attitudes
to
emergency
back-up
also
vary;
some
women
are
prepared
to
head
to
hospital
if
the
labour
goes
awry,
others
don't.
Hessel
knows
of
three
infant
deaths
that
might
have
been
prevented
if
the
mothers
had
sought
help
soon
enough.
Naomi
Stotland,
an
obstetrician
at
the
University
of
California,
San
Francisco,
has
stopped
trying
to
understand
the
freebirthers.
They
feel,
she
says,
"that
they
are
very
in
touch
with
their
bodies
and
they
can
tell
when
something
is
right
and
something
is
wrong".
There
will
never
be
a
randomised
trial
of
freebirthing.
It's
not
something
that
is
easy
to
prove
or
even
study
scientifically,"
says
Stotland.
"These
are
belief
systems
about
birth."
And
belief
is
a
powerful
thing.
Anna
Gosline
is
a
science
writer
in
Vancouver,
Canada
Extreme
childbirth:
Freebirthing
From
issue
2585
of
New
Scientist
magazine,
06
January
2007,
page
40-43
