Going it alone : the "free birthers"

Laura Shanley : Bornfree

I have only ever seen one post-partum haemorrhage.

I was a medical student at the time. I was observing a normal delivery in a "low-risk" fit young women in her late twenties. Second baby. First baby born two years previously with no problems. The baby was born without difficulty, without an episiotomy, without even much of a tear. The midwife was waiting for the delivery of the placenta which was not coming. She was doing gentle controlled cord traction. There was a sudden gush of blood. The mother said, “Oh dear, I feel strange” and asked her husband to take the baby. I glanced down at the “business end” to see a sudden torrential flow of blood. There were two midwives present. Both were excellent. I was dispatched to get the registrar, who was next door. I returned with him to find that the mother had lost consciousness. This was a London teaching hospital. Within a matter of minutes there were two experienced obstetric registrars and an anaesthetic senior register in attendance. I was once again dispatched to get the emergency supplies of blood. I have no idea how many units of blood were transfused. By the time the patient was in theatres the consultant had arrived. I stood at the back. I can remember seeing the sweat on the consultant’s surgical cap. It was the first time I had seen a surgeon, and a good surgeon at that, seriously stressed.

The mother survived and walked out of hospital in good health. I have not the slightest doubt that if this had been a home delivery, the mother would have died. I fear that in a “modern” understaffed maternity unit where there are not enough midwives, never mind enough doctors, that the mother would probably die.

It made a lasting impression on me. I have never seen the like of it since. But from that moment onwards I was resolute in my determination not to have any truck with home deliveries.

Today, I am quoted in the Guardian in an article entitled "Going it Alone":

The controversial NHS doctor who writes an award-winning blog under the pseudonym "Dr Crippen" has proposed that at some future point women will be sued by their (damaged) offspring for having had a home birth (let alone an unattended one).

I suspect it will happen. And why should it not? Does a mother not owe a duty of care to her baby? Should a mother not take reasonable care to protect the baby when she gives birth? And if she does not take reasonable care – and the standard should be objective not subjective – why should a baby who has sustained avoidable brain damage due to the mother's negligence not take action against his mother? This is well within Lord Atkin's neighbour principle:

You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour. Who, then, in law, is my neighbour? The answer seems to be — persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions that are called in question. (Donoghue v Stevenson)

Going it Alone states:

“…the government is planning to introduce new - and prohibitively expensive - insurance requirements for independent midwives who currently provide private backup to women who have found it difficult to arrange an attended home birth on the NHS."

This is, with respect to the author, misleading. The government is not racking up insurance premiums, it is merely insisting – and rightly so – that midwives attending home deliveries should be properly insured. Midwives working within the NHS who attend and supervise home deliveries are properly insured. They are properly trained too.

There are however some midwives who do not approve of NHS obstetric care and chose to work “independently.” There is no insurance company in the country that will insure them. This is a business decision, not an emotional one. Independent midwives are a liability. They do not understand that giving birth is the most dangerous thing that most woman will do during their life.

Not only do the Independent Midwives not understand the danger, they think they are infallible. Annie Francis, spokeswoman for the Independent Midwives’ Association said:

“Most clients understand you can’t insure against things going wrong during childbirth, only against negligence, and negligence is not really an issue for us”

Negligence is “not really an issue for us.” Breathtaking! Read here what happened to an independent midwife who did get into trouble.

Going it Alone is not just about home births conducted by midwives, independent or otherwise. It is about a new fashion that is gaining popularity in the USA. The fashion for “freebirth”. No doctors. No midwives. Do it yourself.

Although rare in the UK, there is a growing online community of freebirthers or "UC-ers" (unassisted childbirthers) in the US who are celebrating "the primacy of autonomous birth". Laura Shanley, 49, from Boulder, Colorado, author of Unassisted Childbirth (Greenwood Press) and veteran of five unassisted births, believes that "women are the true experts of birth. Birth is sexual and spiritual, magical and miraculous", she says, "but not when it's managed, controlled and manipulated by the medical establishment." Her website motto? "If you want the job done right, do it yourself."

Dr Crippen believes that a baby sustaining injury during a deliberate “freebirth” should indeed have a legal remedy against his mother. And I would go further. If a baby were to die of an avoidable cause due to and during a “freebirth”, the mother should be prosecuted for manslaughter.

The baby does not have a choice and must be protected.


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Guardian article "Going it Alone"