Primal Scream
A cry in the night not like the worried whistling of a hare or the sorrowful lament of a deer A cry as old as time itself the wild growling of a mother bear in her cave like loud thunder in the mountains unrestrained like the stormy sea Lightning as if the sky touched the earth then silence and in that silence the quiet cry of a newborn
The poem above was written while making preparations for my first freebirth.
These words are printed on the exact spot my son was born a few weeks later (although during warmer weather).
Our life on this earth starts with birth and ends with death. We are all born and we all die at some point. There is nothing which touches us more in our being than birth and death, the beginning and end of our life.
To take away some of the threat of mortality, humankind has introduced rituals, traditions and taboos. Standard procedures that reassure us when there is nothing else to reassure. This book is about birthing and about the time in which a woman is ‘with child’. About the time in which we would like to drift in the sea of life in the expectation of new horizons, if it weren’t for all the health warnings and advice from well meaning people on the shore.
When people hear that a woman has birthed her baby – without hospital, without midwives or any other help, possibly even intentionally – they are usually incredulous.
How daring! Isn’t it extremely dangerous, irresponsible even? How does the woman know what to do? What does she do with the umbilical cord?
The reaction is much less dramatic, trite even, when telling the exact same story about a cat. Even though she has done exactly the same: without hospital, without midwife, without help. All by herself.
And generally she won’t have just birthed one baby, but four or five. In a dusty, or at least non sterile, corner in the house. She opened the amniotic sacs of her babies one by one and ate them, severed the umbilical cords and licked every newborn clean.
After this loving welcome, one kitten after the other crawled along mama’s cosy fur and found a teat, on which it will spend many snuggly hours from now on.
Didn’t this mother cat do well? She never had any notes or an estimated date of birth. No one listened to her babies’ heartbeats or monitored her contractions. No one checked her dilatation. No one told her when to start pushing.
No one protected her perineum or prepared a coffee compress. She also didn’t prepare for birth by massaging her own perineum in the weeks preceding birth. And she also didn’t attend a course on how to look after a bunch of newborn kittens.
Despite all this, she knew exactly what to do, instinctively. And what did she need to be able to do this? Nothing. Except for a quiet, dry place.
It is not only cats who birth like this. Birds, rabbits, mice, foxes, deer, monkeys and elephants seek out a safe place for the birth of their babies: a nest in a tree, a cave, a crack in a rockface, a grassy den or, alternatively, they are surrounded by members of their pack or herd. This is where they birth their offspring protected from predators and interruptions, entirely unspectacularly, without technical surveillance or medical help, under their own steam. Freebirth is a tried and tested phenomenon in the animal kingdom.
Only we humans somehow fall out of this norm, especially the modern human. Is that because evolution made us walk upright and gave us bigger heads for our growing intelligence and therefore made birth more difficult?
But how do we explain all the reports from different indigenous people (during a time when they were hardly touched by Western civilisation) about quick, effortless births that astonished so many Western observers? Births alone in a remote hut, alone during the night, during work in the fields, births in the presence of a trusted wise woman… easy births certainly seemed the norm rather than the exception.
Why this was possible then and not now is not the subject of research trials, however. No one believes that a quick, easy, joyful birth is possible anyway.
We would much rather advocate quick pain relief in the form of an epidural to render a woman’s abdomen and pelvis without sensation.
The impression is that easy births are rare. Positive births are all about luck, and maybe it’s not really all that important anyway. ‘The main thing is that the baby is healthy.’ is a saying heard often.
Does it not matter anymore how women experience birth in modern society? In the name of safety and responsibility for our children, women are often deprived of a positive and empowering birth experience. Why take risks and trust mother nature when expensive technology, experienced doctors and close monitoring can do a better job?
My first foray into modern obstetrics happened before my first pregnancy. During my time in medical school I had various shorter placements in hospitals as well as a whole year at a later point in my studies.
I knew I wanted to have children and used the opportunity to take up a placement in the obstetrics and gynaecology department of my local hospital. I didn’t have any preconceived ideas about birth, was curious and excited about every birth I was allowed to attend. Once I even saw twins born. And once, but only once did I witness a birth in an upright position, rather than with the woman on her back, as usual. I observed the organisation of the nursery and assisted with caesarean sections. I had to suction the amniotic fluid as soon as the amniotic sac was opened.
The doctors were all relatively nice. The midwives were all very different. I still remember one very young midwife who attended the upright kneeling birth mentioned above with me. Her cheeks always turned bright red as birth approached and she never had to check the mother’s cervix to know it was fully dilated. This gut feeling impressed me amidst all the technology and monitoring.
My next experience of obstetrics was during my year long placement. I was married by then, pregnant with my first baby and was therefore hardly allowed to do anything clinical such as take bloods. Watching was allowed though and watch I did.
This time my placement was in the biggest hospital in town. I spent two month in the very labour ward I was born in myself. The midwives were the type famous in the former East Germany and tone in general was regimental.
The women were shouted at and insulted if they didn’t follow the midwives’ instructions. A generous episiotomy was routine and seemed very painful although the women were usually reassured that it wouldn’t be. The student midwives tried to trump each other with the the numbers of episiotomies they had performed.
There were many situations I found horrifying and the decision to have a homebirth was an easy one. The risk of having to birth in this hospital was not one I was willing to take. My husband was in agreement as the hospital was only 5 minutes away from our house at the edge of the woods and was easily accessible in the case of an emergency.
Through recommendation I found and older, experienced midwife. I had a good feeling about her and felt like nothing could go wrong. The year long placement I was doing at the time was very stressful. 4 months of it took place in Accident and Emergency. It was exciting and educational but I got very constipated.
I found a very reliable remedy for this, which brought relief in 15 minutes flat: the forest. As soon as I went for a walk there, I felt like everything started to move again, as it were. As I wandered amongst the trees and felt relief take over, I thought again and again: I have to birth my baby right here. I’m just going to escape, without anyone knowing where I am and come back with a baby. No trouble, no stress, no expectations, demands or clocks. That would be amazing. If I can get rid of constipation so easily here, it must be the ideal place to push out a baby.
While I pondered this, I came to the conclusion that it just would not be practical. Too many people out running and walking their dogs and at the end of the day there really was nowhere secluded enough. Despite that, the thought stayed with me.
So our first child was born in our rented flat and not in the forest. I thought I had done everything I could to achieve a positive birth and felt positive. As my estimated date of birth passed I refused to go for monitoring with a CTG (a machine that records the fetal heart as well as uterine activity) every other day.
My midwife thought I might be the type of woman who might well birth alone and call her out too late. And she was right. Secretly I had considered that as an option. But because we wanted to be nice, we called her in the morning to say that contractions had started, just to give her the heads up. Then, two things happened we wouldn’t have been able to predict: our midwife was at another birth and the back up midwife from the birth center turned up at our flat despite us telling her we didn’t need anyone yet.
So there she was, the back up midwife. I didn’t click with her and just wanted her to go away as quickly as possible. She was on the way out again, leaving us the phone number we could reach her under, when… suddenly my contractions became a lot stronger. She stayed. Unfortunately I didn’t have the courage and nerve to throw her out and thought: grit your teeth and get it over with.
But this didn’t quite turn out as I’d hoped. Soon I was fully dilated and a second midwife was called in anticipation of the birth as is common during homebirths. Then I didn’t progress for hours. Only contractions and pain. PAIN! And then, after careful palpation the realisation: the head was engaged but had not rotated into the right position.
Now the sword of Damocles ‘Caesarean in hospital’ hung over me. I had surrendered the responsibility for my birth to the midwives and they also didn’t know what to do in this situation. Realising that they were clueless, it became clear I needed to take back my power and do whatever could save me from the operating table. If my body knew how to get the baby out, I needed to listen to it, not to the midwives with their seemingly ineffective advice to lie down and change position from the right to the left and back to the right frequently.
So I listened intently to my body and instinctually started moving my hips from side to side while standing and encouraging my daughter to move into a better position. Luckily, this is when MY midwife arrived. She massaged my swollen anterior lip of cervix (very painful but effective). The baby’s head had finally turned and soon I was holding my baby in my arms. Completely exhausted but very very happy.
After the initial oxytocin haze I started to analyse the birth. What went wrong? How could I have avoided all those hours of pain? Why was it that everything became so much more difficult as soon as the midwife arrived?
I read voraciously on the internet, informed myself about freebirths and it didn’t take long until I had an epiphany. I was obviously not the only one who was affected so profoundly by the presence of certain people that an undisturbed birth became impossible.
Apparently, inviting strangers to one’s birth can be a risk in itself.
At the same time I asked myself: If I ever had another baby, how could I make that birth a positive one? How could I be sure that the person attending me wouldn’t inhibit me, mistrust my body or take away the emotional strength I needed to birth my baby?
I slowly came to the determination that my next birth would only be attended by people who did not fear birth. Would I find someone like that?
Shortly after the birth of our daughter, we moved to Sweden. Directly behind our house a deserted forest sprawled and I only had to go out the back door to relieve my constipation.
One day, on a stroll through the forest, I found it: the place our son was to be born. The ground was covered in soft moss and it was surrounded with fallen spruce trees mimicking walls. Next to it was a babbling brook. The forest was wild here, no hikers, mushroom collectors or runners ever to be seen. I was thrilled! From then on I made my way to this place frequently and imagined what birthing there would be like…
Once my husband had come round to the idea of birth in the wild I led him to my place.
My second pregnancy was very different to my first. I was just pregnant.
Antenatal care in my first pregnancy, specifically the frequent scans, had unsettled and irritated me. Now I was completely free and organised care for myself. Unbelievably freeing. I did, however, also have periods of doubt on this new path. Where would this decision to do my own maternity care lead me?
I was well and I could feel my baby move inside me, so I kept following my path. At first I considered going to the traditional appointments from a certain point in my pregnancy but as the point approached, I bristled. I felt like my bubble was going to burst if a stranger started measuring and judging our progress.
At some point I dropped the plan to access traditional care and was pleased to avoid the stress.
I had given up in my search for the perfect homebirth midwife ages ago. First of all there are hardly any homebirth midwives in Sweden and she would have had to travel far to reach me and secondly I would have had to pay EU2000 for her to attend the birth with no guarantee that she would actually be able to get to me on time. Thirdly, I would have had to convince the midwife of my forest birth plans.
So I did it without a midwife. And because I liked it so much I did the same for my third, fourth and fifth babies.
My medical degree played only a small role in my decision to walk this path alone. My studies did help me to see obstetrics with all its limitations and not to have false expectations.
As it stands we still haven’t uncovered all the secrets of life. We still can’t explain how the immune system works exactly or have the knowledge to eradicate common diseases like cancer or allergies.
When it comes to birth, medicine has a lot to learn still. We use an arsenal of monitoring tools and medical interventions to compensate for what we don’t understand about true physiological birth, which in turn hinders or even halts the process of birth. And all this not because birth is so complicated, but because it seems so unpredictable that even experienced birth professionals fear it all their lives – fear that has to be eased with many interventions.
Luckily I know someone who knows exactly how birth works: my body. And it has proven this to me five times so far.
This is why I will always listen to my body to achieve a positive and safe birth. I don’t want someone to make decisions for me when I can make better ones for myself.
Read on the next few pages how I experienced the freebirths of my second, third, fourth and fifth babies:
My first freebirth (second baby)
A good year after our eldest was born I was pregnant again. We had since moved to Sweden and I was yearning for a birth without anyone in attendance. My husband was less convinced. He had his doubts until the end.
My EDB was the 1st of July. After a false start just before that date contractions started a week later. I was lying in bed on the 8th of July at 11pm and felt a ‘pop’.
I stuffed a towel between my legs, finished writing in my diary and thought: how interesting that it is starting like this! I told my husband, and because I could feel more and more amniotic fluid draining, I finally got into the shower where even more waters gushed out.
We were giggling like overexcited teenagers, but because nothing else was happening, we decided to go to bed as usual and try to get some sleep.
I couldn’t sleep though. The baby was awake and moving around and contractions came every 5 minutes. I didn’t have to consciously breathe through them yet but lying down was uncomfortable. I roamed the house.
Everyone was asleep and I felt anxious not to disturb anyone. Around midnight I went into the garden. It was quiet, I could smell the flowers and both our cats kept me company.
I vocalised through the more and more intense contractions, walked around, visited our rabbits and sat at the edge of the patio. As contractions got stronger and stronger I felt the need to go to my special birth place.
I had a basket that contained everything I felt I might need for the birth and with that I walked the 5 minutes along the forest path until I reached my spot. With its fallen trees, round stones and soft moss it seemed just as perfect for birth as it had months before.
I spread out the picnic blanket, listened to the silence around me and thought how very surreal this moment felt.
The contractions of transition came soon, and the initial chill soon disappeared. I couldn’t stay still during contractions. After a tough transition and a few pushes, the head was born. The baby did an almighty kick inside me, I felt the shoulders turn and – whoosh – he was out.
I could just about see that it was 3.19am on this early Swedish summer morning.
A boy! I lifted him up, felt his heart beating and rubbed him dry. He didn’t cry, but looked around curiously. I wrapped him in a towel, took a photo and called my husband on my mobile. He arrived shortly after and already knew we had a son by looking at his face.
We slowly walked back to the house. After a few steps I birthed the placenta on the forest floor.
At home I had a shower, we snuggled into bed and slept the rest of the night until morning.
My second freebirth (third baby)
My third pregnancy, a little over a year later, was uncomplicated and again, I didn’t have any official antenatal care. My EDB was the 31st of May.
I assumed I would go over my dates again which is why I assumed the very noticable contractions on the 30th and 31st were of no significance. The false alarm from my previous pregnancy was still fresh in my mind. The contractions on the 31st were much stronger than the ones on the day before though.
As I was putting the kids to bed at 9pm I had to breathe through the contractions. My husband took over after 15 minutes. I went to answer some emails and told everyone on the homebirth forum of my harmless but regular contractions. Shortly after 10pm my husband came downstairs and suggested we shower and go to bed as normal and see what happened in the meantime.
In the bathroom I was cold and sweaty at the same time, my legs were shaky. My husband was concerned and asked if this was normal. I reassured him: Yes, this is normal in transition.
My rational brain had realised: Transition. But I hadn’t really taken it in. It was far too early. The contractions felt far too weak. Anyway, we still wanted to take belly pictures and I had a shopping trip planned for the next day.
We decided to take some belly pics. We managed three during which I was complaining that a birth here and now was really not convenient. During the last picture I needed to push. I realised I needed a poo and ran towards the toilet. Next urge to push at the bathroom door and my waters went.
Now I realised. But I wanted to birth in our tipi in the garden! We put it up especially. So I grabbed the bag with birthy paraphernalia I had put together throughout the day and ran.
A few meters into the garden I needed to push again. A few steps further the next contraction and I could feel the head already. I was 15m away from our tipi but I could not move.
Finally my husband appeared. He brought coal and lighters to make the tipi cosy and luckily he also brought the video camera. Soon the head was born and with the next contraction, the whole little guy. I squatted down and let him slip into the grass. It was 10.56pm.
I picked him up and he looked at me with big eyes. We covered him with a towel as he started to complain about the cold. Then we sat in the grass and looked on in wonder.
It had been so quick.
Finally we went back to the house. The placenta had come out on the grass. Then I showered and all three of us snuggled into bed.
My third freebirth (fourth baby)
My fourth pregnancy, again a year later, went by without problems and without antenatal care.
Five days after my EDB I had a few definite contractions throughout the afternoon, just as I did a few days before. They got stronger in the night so I had to breathe through them but stayed 15 to 30 minutes apart, too far apart for imminent birth.
I forced myself to stay in bed and sleep in between contractions. At about 2am I couldn’t bear to lie down anymore. I started to prepare the living room – it was too cold for an outside birth at the beginning of April. But while I sorted and tidied the contractions disappeared. So I went back to bed, where they came back in the same intensity as before.
Same the next morning. Occasional strong contractions. Soon it became harder and harder to fulfil the children’s demands and breathe through contractions at the same time.
Again and again I escaped into the bathroom, locked myself in to breathe through a contraction and came out again to give the boys a banana, wipe a bottom or do whatever else small things need doing every minute with small children around. Now the contractions were closer together and required some vocalisation. The boys started to bother me.
Annoyingly, grandma was fairly far away that day and the back up, our neighbour, could not be reached. So my husband suggested he take the children away so I could birth in peace.
Such a suggestion from my husband! I was amazed.
But who would take photos and film? And I had promised our eldest that she could be present for the birth, but now she irritated me so much with her defiant behaviour that I just wanted to get rid of her together with the boys.
My husband eventually reached another neighbour. Around 11.30am she took the boys over. The eldest was allowed to stay after promising to behave.
Finally there was peace and quiet in the house. I paced the living room. My husband returned quickly and settled down with our eldest and a book. Soon I was drawn into the playroom next door. I didn’t want to be watched during the powerful contractions of transition. I tried singing which had always helped a lot but this time it brought no relief.
Then the first contraction that felt a bit pushy at the end. Finally!
‘You can start filming now.’ I let my husband know. Pushing felt best with me leaning onto something while standing up. It was hard, powerful and not entirely pain free.
Then I felt the head and in the next moment our baby slipped into my hands. A girl! We all marvelled at her, not least her proud big sister.
Then grandma came. She got the boys from the neighbour’s house and they got to admire their little sister within an hour of her birth.
My fourth freebirth (fifth baby)
My fifth pregnancy, a little over 2 years later, was entirely unremarkable, just like the others and I was able to enjoy it – after the tendency towards sinus infections in the first few weeks, already familiar to me – until the very last day of being pregnant.
I didn’t even encounter problems with my weak pelvic floor or painful joints – probably thanks to my standing work desk and therefore the avoidance of non ergonomic sitting.
We had been living in Alsace for a year, which means closer to areas with good midwifery care provision. However, in reality, the state of homebirth midwifery is nearly as abysmal here as it was in Sweden, and I didn’t really need a midwife anyway.
Because my belly was rather big very early in this pregnancy I let a midwife have a feel around the middle of pregnancy to make sure I knew how many little ones were growing in there. It turned out to be only the one baby. What I could feel turned out to be uterine muscle which was much more developed in this fifth pregnancy than it was before.
Apart from this appointment with the midwife, I was happy doing my own antenatal care. I calculated this baby to be due in January – a winter baby.
One day past my due date I lay awake at night with regular contractions coming every seven minutes. I nearly needed to breathe through them but when morning came everything calmed down again.
My uterus only became noticeably active 6 days after my due date but not strongly and with no regularity. When I went to bed at half past midnight I had a strong contraction. 15 minutes later another one. Then 12 minutes later, then 10 minutes, 7 minutes, 5… It was easy to breathe through them while lying down and because I was cold I didn’t want to leave my bed. I quickly got a pair of socks as I had cold feet and put child number 4 who was sleeping next to me, on the potty. My spontaneous mantra to remain relaxed during the contractions was: ‘These are only powerful uterine squeezes.’
The last contraction however made me flee the bed. We had invited a film crew for this birth and they had to be called on time. When I got up, I felt shaky and my brain analysed: Transition. Am I already this far? Now everything had to be done quickly!
So I woke my husband who sorted everything: Calling the film crew, filling the water butt (in which I wanted to give birth), lighting the stove etc… Meanwhile I emptied my bladder and bowels into the toilet several times and went to the water butt.
I had my first expulsive contraction as the film crew arrived and my waters went… the baby would be there quicker than the water butt could be filled. So supported by the water butt on the left and the book case on the right I tried not to push wildly with the contractions (though the temptation was most definitely there) but attempted to breathe the baby down a la Hypnobirthing. That’s what I had planned to do and it worked surprisingly well with the contractions.
Then, at 2.41am, a good 25 minutes after I shook my husband awake, our third son was born. He began to breathe as soon as his head was born and when I held him in my arms he complained noisily about his fate. The older siblings had planned to be present for the birth but they were so fast asleep that we could not wake them up. I treated myself to one thing and didn’t regret it one bit: A doula for my babymoon.
This is a very personal book. I will tell you about my thoughts and experiences and you will gain insight into other freebirthers’ thoughts and experiences.
In this book you will find all the knowledge I have gained in the preparation of my own freebirths and in search of answers to other women’s questions, from different sources of information.
What I wrote is also based on the experiences of other women who shared their birth stories on the internet. But I also utilised the written word and experience of birth professionals who dared to take alternative paths in obstetrics. I am mostly talking about Alfred Rockenschaub, Michel Odent, Weston Price (not a birth professional though, but a dentist with important insights on how to stay healthy naturally, even throughout pregnancy, and how to have healthy children), Gregory White, Grantly Dick-Read and Ina May Gaskin to name but a few.
Please don’t expect a recipe for a dream birth! This is mostly a book to inspire instinctive thinking, innovative thinking, lateral thinking and non-conformist thinking. And to empower you to make informed decisions for yourself that come from the heart and are not influenced by fear.
It is there to help you trust your body and intuition more than all the other voices you can hear.
Don’t worry: you don’t need to learn this book by heart to be able to have a self-directed birth. A lot of the information in this book is there so that you can look up specific issues as and when you please.
With this book I want to give you courage to make the best decisions for you and your baby – whatever they may look like.
I don’t want to exclude modern medicine from this book as it can be extremely useful when it is needed or when we choose to make use of it.
The more women are well informed about their rights, the quicker obstetrics will find its deserved place as humble servant to women and their children rather than the know-it-all guardian it is today.
In the next few chapters I devote myself to the most common questions around self-directed pregnancy and birth.
If you still have questions after reading this book, please feel free to continue to thoroughly research them to built a solid base for making informed decisions from.
When I was holding my first positive pregnancy test just over 8 years ago, there was no question as to what I was going to do next: contact my doctor. I immediately made an appointment. I never asked myself why or indeed, if I needed to, I just did it because it is what everyone does.
‘I can’t possibly take responsibility for that!’
This sentence uttered by my doctor made me realise for the first time the big change that had happened when I became pregnant.
I was sitting in the doctor’s practice and had told her that I intended to have all my antenatal care with a midwife. I didn’t particularly like the frequent visits to the doctor (as is common practice in Germany) and I had only chosen this one as she was closest to where I lived at the time. But now I felt patronised by this woman and was fed up. Although I hadn’t yet found one at that point I was sure a midwife would be much more sensitive to my needs. I just needed to get away from this doctor.
The sentence ‘I can’t possibly take responsibility for that!’ surprised me and kept echoing in my head. Why did she feel responsible for my choices? Wasn’t I, pregnant or not, responsible for my own decisions?
Apparently people suddenly knew exactly what was good for me: I was not supposed to lift anything heavier than 5kg. I shouldn’t eat raw meat, raw eggs, raw dairy or certain seafood. I wasn’t allowed to take bloods from my patients in the hospital anymore or in fact get too close to them at all. I was supposed to turn up at antenatal appointments to have my blood tested and my belly examined with ultrasound. The list was endless.
No one asked me if I wanted to do all those things or if I even thought that they were necessary, but it seemed predetermined that this was best for me as a pregnant woman.
All that was expected from me was compliance. As long as I complied, everything was ok. But as soon as I declined a blood test or voiced my desire for a homebirth things became stressful.
Clearly it was not me who was responsible for my pregnancy but others: my doctor and later my midwife. Responsibility means to take the blame when something goes wrong. And no one wanted to take the blame for the misfortune of a mother and her baby.
So I did what was expected: I didn’t lift heavy things (unless nobody was watching), I didn’t draw any blood from patients, was careful with ‘germ free’ nutrition, went to midwife and doctor’s appointments without complaints and was very careful to only mention my plans to birth at home to trusted people. Wouldn’t want to scare anyone.
And we have arrived at the subject of fear. The search for something going wrong, something pathological is even more noticeable at the doctor appointments than when seeing the midwife. And fear goes hand in hand with that. Is the little heart still beating? Does the nuchal fold thickness indicate a chromosomal abnormality? Are the blood results etc etc normal? Are all the organs present and correct? Is there enough liquor? Is the baby growing well?
As technology develops we get more and more answers to the questions our grandmothers never had to ask themselves. It suggests safety and control over something that is mostly out of our control and still a mystery to us in many ways.
Our pregnancies are influenced in one way or another by other people’s fears. But the most treacherous of all is a birth professional’s fear. That fear is sometimes masked in advice or sometimes even in tasteless manipulation and threats, when the woman declines consent for certain interventions. This sometimes results in labelling the woman as irresponsible and as a danger to her baby, or calling her in her own home because she is a few days past her EDB and has declined induction or doesn’t want a caesarean section despite her baby being breech.
Obstetrics often uses fear to get women to fit with the norm to alleviate the fears of society in general and not least the birth professional’s. If you find yourself in front of a ‘fear mongering doctor’ presenting you with a worrying diagnosis, you shouldn’t make any immediate decisions or give in to threats.
It is preferable to sleep on it and get a second opinion from an experienced midwife. That way one can calm down and think in peace about what might be truly the best way forward for mother and baby. Once induced or on the operating table it is too late to turn back.
Nobody can force a pregnant woman to go to even one midwife’s or doctor’s appointment or go to a certain hospital for birth. Every woman is free to decide for herself, although in some countries (e.g. Austria) this free decision making is penalised with a partial withdrawal of the child benefit.
No woman starts her pregnancy from a neutral base. Impressions around the subject of having babies are formed long before that. We think we know what a birth is like through our own birth stories told to us by our parents, our friends, people around us and last but not least the media. Somehow the fear we are surrounded with becomes our fear too.
How much trust a woman has in her own body and its ability to birth a baby can vary hugely. Someone who was born at home herself and has grown up with the attitude that birth is something positive and achievable under one’s own steam is likely to be more confident than a woman whose mother didn’t want any more children as her first birth was so traumatic.
When we deal with other people’s fears we also need to face our own. Instinctively we try to avoid it. We are scared to face our fears. We’d rather ignore them and find someone to take care of us and promise that everything will be all right. This is why the promises of modern obstetrics are so enticing.
It is easy to hand over responsibility. However facing your fears is necessary for a self determined birth. This means that one should neither ignore nor deny them, but look them in the eye. It is worth finding an answer to the following questions: What am I afraid of? Why am I afraid of it? How likely is it that my fear will come true? What will I do if my fear does come true? It is very valuable to answer these questions and it might even lead to the realisation that things are not as scary as originally thought.
Someone who is secure in her plans is also less influenced by external fears. For example, these days nobody would fear falling off the end of the world during a sailing trip, even if someone said that it might happen. This is because we are secure in the knowledge that the earth is round and not a disc.
To eliminate as many false expectations and insecurities I will address the very specific fears and worries that come up while thinking of a self-directed pregnancy and birth in the later chapters of this book.
For example: What are the signs by which I can tell my baby is well, without having it confirmed by a midwife or doctor? What if the cord is round the baby’s neck during birth? What do I do with the cord and placenta after the birth? What if the baby gets stuck or there is a sudden emergency? For me personally, birth lost almost all of its uncertainty and unpredictability, when all those above questions and similar ones had been answered.
Women are very susceptible to specific and non specific fears in the first and last trimester of pregnancy due to the hormonal changes pregnancy brings. Even when all questions have been answered in a rational sense. In my fourth pregnancy I was still sometimes overcome with strong fear without any rhyme or reason.
I want to tell everyone who has experienced a similar thing: These fears are annoying, but they are normal and simply part of becoming a mother. It is ok to simply face them and say: ‘I already know you. You are of no significance to me and you are going to be gone again soon. Until then, I can deal with you.’
It isn’t always easy to deal with those fears though and I can understand how many women seek reassurance by visiting their doctor or midwife. At the same time we are such slaves to our fear that we quickly become dependent on reassurance we don’t really want. With regards to self direction in pregnancy and birth, it is helpful to learn a relaxed attitude towards our fears.
In phases of my pregnancy in which I felt unsettled inside I avoided sharing my fears with people I assumed had the same fears. Everything they were likely to say would have fueled my insecurities.
This is a subject that reaches to the core of our being. It is good to feel loved, wanted and protected in this world – never mind what people say or think. A reliable sense of self is very helpful when dealing with the deepest uncertainties of humanity, and stops you drifting aimlessly.
Fear is a bad advisor, that is the saying. Whenever possible we should avoid making decisions when afraid or in a blind panic. Whatever got us worked up: It is always better to calm down and soberly assess what makes us afraid.
Usually things look less worrying once calm and usually a solution we overlooked during our initial ‘fight and flight response’ becomes clear.
Fear is not a bad thing per se. It can warn us of certain situations or impending danger. This is why it is important to be able to assess, validate and distinguish our fears. Are we really in danger? Is this fear irrational? What else, apart from my fear, indicates that something is wrong?
During birth, just before the pushing stage, fear plays a natural role. In this moment, hormones are released that lead to an exceptional state that can be experienced as fear. There is no actual danger but the fear is often part of the natural process that enables the woman to let go and birth her baby. This phase is generally short and is transformed into courage and determination to get the baby out when the urge to push kicks in.
Sometimes when something is actually wrong, for example a uterine rupture after a previous caesarean section, the woman does not only experience that short lived fear of transition, but continues to be scared and unsettled in combination with other signs that indicate a deviation from the normal process of birth.
To be able to assess fear during birth accurately, it is important to understand the aspects of normal birth.
‘An obstetrician/a midwife didn’t study as long as they did for nothing. You can’t teach yourself everything they know. Their speciality is attending births, so you can expect them to do a good job. Why do you want to go down the difficult and risky path of doing it all yourself?’
This, or something similar is what a woman has to listen to if she doesn’t want any traditional maternity care in pregnancy or during birth. It takes six years to become a doctor and to become an obstetrician and gynaecologist adds another 5 years.
A midwife will generally study for three to four years (depending on country) and has attended many births at the end of her training.
So how can someone who has got no idea decide to birth their baby without professional help?
I was lucky in that I was able to attend some births during my time in medical school before my first birth. I wasn’t able to learn the best techniques or maneuvers but I could observe how babies are delivered nowadays.
I also experienced how women were bullied into inductions and caesarean sections and how they were given drugs during their births without explaining what they were and what they did. I have also met old school midwives who would physically force women to lie on their backs (most important is that the CTG records accurately), insult them (well, the baby got IN didn’t it?) or perform an episiotomy despite the woman stating she doesn’t want one. It was also not unusual for the midwives to push on the woman’s belly with their elbows during the pushing phase.
This was just under 10 years ago. I very much hope that scenes like that are, if not completely eradicated, rare. On the whole, conditions in clinical obstetrics have improved and women are respected much more than say, 50 years ago.
However, few of the common interventions have a solid evidence base derived from solid research with regards to effectiveness and usefulness. Quite the opposite.
These days, midwives and doctors have accepted that being upright makes birth easier. Despite that, most births in hospitals still take place in positions that make birth more difficult. Many vacuum-assisted and caesarean births could be avoided if the woman were given the chance to turn and the coccyx room to move out of the way to let the baby out.
Instead the birthing woman generally sits or lies on her coccyx (the semirecumbent position at least promises some degree of being upright but on modern delivery beds is easily transformed into the lithotomy position which means being flat on the back with legs in stirrups). Ventouse, a syntocinon drip or the Kristeller maneuver are then used when the woman predictably has difficulty birthing her baby. The Kristeller maneuver was named after the gynaecologist Samuel Kristeller and means to exert pressure on the top of the uterus during a contraction to help with expulsion of the baby.
Originally this maneuver was used to help women who had birthed several babies and therefore lacked muscle tone in their abdominals and had a diastasis recti separation (a gap between the rectus abdominis muscles). It gave the uterus resistance to push against during the expulsive phase of birth.
To use it in between contractions was considered negligent in Kristeller’s times (Rockenschaub 2005). Nowadays, there thankfully aren’t many women with severe diastasis recti separation as it generally develops after many pregnancies.
Despite research showing no benefits from the Kristeller maneuver, it is still being used by some birth professionals to shorten the expulsive phase of birth. (Schulz-Lobmeyr 1995)
To push against the abdominal muscles requires a certain force and it is used without hesitation. Or sometimes it is even used without a contraction, when the abdominal muscles are relaxed, entirely against the original rules. Alfred Rockenschaub, longstanding obstetrician and former head of the Ignaz Semmelweis obstetrics and gynaecology clinic in Vienna, teacher and lecturer bluntly states what he thinks about that:
‘What happens here [during use of the Kristeller maneuver] is more about violence against women than about obstetrics.’ (Rockenschaub 2005)
(Note from the translator: Regarding the Kristeller maneuver there seems to be a different approach in different countries. The Kristeller maneuver is hardly ever used in the UK, except perhaps in dire emergencies and even then it is generally not regarded as acceptable… I have NEVER seen it in nearly 20 years as a midwife.)
If we look at other obstetric interventions one by one, we will find quickly that hardly any are proven to be effective. How much do the much praised and trusted obstetricians and other birth professionals really know? Do all the older women having their first, particularly big babies these days justify the rise in caesarean section rate and many other interventions?
A maternity care system with a caesarean section rate of over 30% can only be described as disastrous or amateurish. Turning it around would mean that over 30% of mothers and/or babies would have died in the olden days. But did that happen?
Not so long ago, in 1993, when the caesarean section rate in Germany was still 16.9%, maternal mortality (which is an important measure to assess quality of maternity care) accounted for 5.5 per 100.000 births. In 2001 this rate remained at 5.5 per 100.000 according to the Statistisches Bundesamt (Statistical Government Department) despite a caesarean section rate of 31.9%.
The rise in caesarean section rate is a global trend of recent years. In countries in which midwives are responsible for normal birth instead of obstetricians (France, Scandinavia) this rate is, in general, more than 10% lower than in countries in which obstetricians lead or attend births. On the whole, this trend does not have a positive impact on maternal mortality, nor on infant mortality.
Assessing maternal mortality, we have to be clear, is not an easy undertaking (due to varying definitions, limitations and difficulty collecting data) and the data we have is likely an underestimation. (Welsch 2010)