Freebirth: The Peak Birth Experience?

finding nuance in the conversation around freebirth vs medicalized birth

Oct 06, 2024

Dear reader,

Any expectant mother doing online reconnaissance for birth information in the past seven to ten years has likely encountered the term “freebirth”.

For anyone who may be unfamiliar with the definition, freebirth is a word used to describe a birth which takes place without the birthing mother employing a doula, midwife, doctor, or any other professional or otherwise trained provider to be in attendance at her birth in any capacity. This, for some women, might mean giving birth with a carefully selected group of friends or family. This, for other women, may mean birthing with their partners, or even birthing alone. And, this is not, despite what the last several hundred years of story-telling around the history of birth may have inferred, a new development in human experience.

Women have been birthing in the company of other women and outside of the structures of financial exchange for centuries, if not millennia. And while the coining of the term “freebirth” is relatively recent, stemming from the work of midwife Jeannine Parvati Baker, the concept and practice is not.

What is a fresh development in the span of human experience? Routine obstetric intervention and management, specifically from an organized, centralized group of licensed professionals. What is often taken for granted now has emerged in varying degrees within the past one hundred years, including in-hospital birth with operating rooms down the hall, surgical birth for anywhere from 30% up to 98% of mothers depending on location, and a series of medical assessments and categorizations at every point along the childbearing continuum.

The bloodied history of modern obstetrical birth practice—and the myriad ways its development has influenced and continues to influence modern approaches to birth—is rarely mentioned when a woman is examining her options for care. Nor is it often mentioned that we exist in a present day reality in which we have at hand technologies for birth support which are not all relevant for wellbeing of the mother and her baby, and which fall into the following categories:

Birth interventions which save lives;
Birth interventions which generally provide support for a smoother recovery from complications (usually by replacing more traditional forms of supporting maternal and newborn physiology);
Birth interventions which are at best well-practiced profit-generating placebos and are at worst the direct or indirect source of events which will then cause interventions from the first two categories to become necessary.

It’s that last category, arguably the most frequently experienced and most misrepresented by providers and birthing mothers alike, which is receiving appropriate emphasis in freebirth movements both online and offline. Any significant amount of time spent learning at the feet of physiologic pregnancy and birth provides a visceral experience of the gap between intimate realities of birth-giving and the often ill-applied industrialized technologies of standardized prenatal and birth care.

Birth is inherently an experience of profound transformation, a Before and After written within every cell of the mother’s body and the child’s. But in the presence of care defined by the supervision of industrialized obstetrics or midwifery, practical reverence for the transformation occurring is often missing from the room.

This dissonance between the reality taking place within pregnancy and birth and the way care practitioners behave in the presence of that reality is not a disruption to be taken lightly. Nor, in the context of considering the risks and benefits of how to best support the birth of one’s own child, should it be left out of the factors to include in making a decision. Hiring a midwife or obstetrician whose way of being with birth is misaligned with birth’s realities and who is swift to become involved for the sake of “doing something” is unarguably one of the best ways for a mother and baby whose pregnancy or birth needed NO intervention to end up requiring (after the initial cascade of disruption) one or more life saving interventions, all which come with their own sets of side effects.1

Not only does the probability of such complication-producing interference in what otherwise might have unfolded as spontaneous and uncomplicated birth increase significantly when a professional care provider enters the picture, there is also the authoritarianism towards which the expertise of medicine leans. And it is here, perhaps, that the greatest violation occurs. It is not uncommon for a care provider to assume the place of authority over the woman she is tending, assuming it is her own responsibility to determine what is best for her client. Nor is it uncommon for the provider to take a course of action which does not honor the decisions and insight of the mother, and instead is fundamentally coercive, oriented to achieve “compliance” with a particular protocol or provider-held belief.

For many childbearing women, these patterns within care have become normalized to the point of becoming acceptable, even in instances where such behaviors lead to trauma and diminished long-term wellbeing. But for many other women, these patterns are an unbearable option, not to be tolerated unless life and death is quite literally (and not hypothetically) on the line. For some of these women, alternative midwifery care provides the support they desire. For others, birthing without any professional care at all—freebirth—is the context which allows for the greatest experience of security and autonomy in pregnancy.

There are many well-considered reasons for choosing to birth entirely apart from a formal care provider. I have heard many a remark from fellow birthworkers about the foolishness of freebirth, and frankly I don’t share that opinion. For some women, freebirth may be the only available way to bypass birth settings or care providers who lack capacity to meet the mother where she is. For other women, it may be the most ideal way to birth, aligning with the mother’s clearest desires and needs for herself and her baby. However, despite my confidence in women’s ability to birth outside of conventional care settings if they so choose, I have become increasingly uneasy with the messaging which I’ve seen emerging within the online freebirth movement.

Before I heard the word “freebirth”, the concept of birthing without a trained assistant was already deeply familiar to me. I’d grown up hearing about my grandmother’s decision to plan an unassisted home birth, and about home births with no midwife present within my extended family due to swift labors. I knew women and stories of women who regularly birthed without any professional attendant. And once I began attending births, I developed relationships with seasoned mothers who came in for prenatal care and, after birthing alone multiple times following lightning-fast labors, simply planned for unassisted birth and called the midwife the next morning for a home visit. From my earliest memories around birth, talk of the choice to birth alone had no slogan flown overhead and no label attached.

It was only in the past handful of years that I really started tracking online conversations around freebirthing, or saw the experience of birthing without a midwife present be labeled and marketed as a particular type of birthing experience. Most frequently, I began noticing that women who birthed without a midwife were described as having birthed in sovereignty, as opposed to birthing within the system.

Often, the language engaged around these birth experiences reflected beliefs around truly physiological birth requiring the absence of any kind of professionally-trained support. As in, freebirth=sovereign birth. Freebirth=physiologic birth. Midwife-attended home births or hospital births were often cast as being inherently non-physiologic, power-diminishing birth.

Now, there is a level of recognition present in this kind of categorical association. It is incredibly rare for a true uninterrupted birth and immediate postpartum to unfold within a hospital context. It is also relatively rare to find an openly practicing midwife who is not deeply influenced in her work by industrialized medicine and the colonization of the body—particularly the female body. However, despite already being aware of these realities, seeing birth dissected and branded in this particular way really threw me for a loop.

At this point I had supported hundreds of women in birth, primarily at home. Unlike many of the women communicating about birth online, the clientele with whom I worked were (and still often are) rural-dwelling, lower-income farming families, primarily within Amish communities. To this day, many of the women who invite me into their birth space are more concerned with the matter-of-fact practical details around birth (will the children be asleep, will we need to bring a brother to do the milking or do you think my husband will have time to step out to do it) than they are concerned with birth as a transcendent or self-actualizing experience.

They want to be supported and offered more information in their use of herbs, supplements, and nutrition. They want to birth at home, and mostly choose to move to a hospital setting only in the instance of a life-threatening emergency. Breastfeeding is the norm; spontaneous natural birth is the norm; and most often prenatal visits are shorter than an hour because checking in with a midwife is both a desirable part of pregnancy and also a relationship that must submit to the time requirements of busy harvest, planting, or schooling seasons. (I have had clients come with a checklist of questions to quickly review, after which they ask if I can take their vitals, do a urine screen, and then measure and listen to their babies all within ten minutes, because a driver is waiting and the mother I am seeing has two stops to make before getting home to make dinner.)

If judged within the framing provided by more popular social media accounts, these women might be assumed to be having incredibly disrupted births (per some freebirth influencers) or incredibly dangerous births (per some advocates for medicalized birth). But they weren’t. And they still aren’t.

Never in the context of the clients with whom I worked did I see in-person reflection of the drama I saw taking place around birth choices online. There was the occasional client who dealt with challenging familial attitudes around her birth decisions, but ultimately, even for the mothers who came for prenatal care and then opted for hospital birth for whatever reason, birth was just…well, birth. Not a point to prove, not a performance to execute, not an ideology. Not drama, not competition, not something to be publicly shared and critiqued. Just birth. The portal through which mother and baby moved in simultaneous transformation from participating in a biological identity of two-in-one to becoming one-in-two: the motherbaby dyad, contextualized and held within the broader web of family relationship.

If an unexpected or undesired turn of events occurred, like a transport to the hospital or a NICU stay for a baby with respiratory challenges, it was contended with and accepted as part and parcel to the work of being human and bringing children into the world, to be borne as any other trial within context of life ordained and ordered by God and experienced by all creatures alike. And without hesitation the community would rally to support the family for however long the duration of need.

There are multiple reasons for this dynamic, not the least of which is a homogenous subculture coupled with reduced exposure to norms outside of that subculture. Within Amish communities there are certain baseline realities taken for granted, including the need for balance between the body’s natural signals and medical resourcing, the understanding of birth as a process equally spontaneous to the human woman and the nonhuman mammal, and the exclusive authority of God over matters of life and death.

These elements, among others, form the foundation for what can only be described as a matter-of-fact approach to life, and—in keeping with the understanding of birth being a reflection of how we live—a pretty matter-of-fact approach to birth. Yes, these women hire midwives for extra support, including having someone with emergency skills and practiced calm present in the rare event of a emergency. This is viewed neither as a lack of trust in God nor a lack of trust in birth. Instead, this way of moving through pregnancy and birth is viewed as an extra layer of support in a time when the desire for support is keenly felt. It is viewed as a means of accessing information and engaging extra hands in advance of birth, including for provision of emergency services if needed. It also is viewed as the cultivation of a relationship of concentrated, intentional availability between someone who practices devotion to physiological birth and an expectant mother, her unborn babe, and her husband.

Coming from this particular context, having witnessed what felt (and still feels) to me like mothers interfacing in a drama-free, physicality-honoring way with choices around and within birth, what I saw popping up in the digital sphere tipped me into a bit of a tailspin. So much so, in fact, that I started questioning my entire framing and understanding of birth. It took several years of deep soul-searching (and the birthing of my own child) to really begin to sense my own inner anchoring amidst the somewhat tangled threads of various birth ideologies.

In most instances, conversations I have with clients around birth involve some level of detangling from what essentially comes down to profit-based propaganda around the role of clinical services in birth. When I read birth stories, I often am acutely aware of the points in which there was some level of (likely unconscious) misrepresentation of facts offered to the mother by the the practitioner. But in the effort to reverse the widespread damage done by the coercive and ignorant medicalization of women’s bodies and women’s childbearing, the pendulum of sentiment is swinging wildly in the other direction. The overcorrection is understandable—even necessary. There is a seat at the table for caricature in the work of bringing new (or re-newed) ideas to collective consciousness.

Yet I also see the potential for this orientation towards blanket statements around birth choices to become as coercive and foolish as the medical system that so many birthing mothers and care providers are seeking to exit. And I question if a collective shift is really going to happen in the absence of attentive, disciplined nuance, a nuance rooted in loyalty to the broader webs of life instead of ideological commitment. Nuance that is largely missing in statements and beliefs like the following:

Sovereign birth is synonymous with freebirth.
You don’t need to know anything to birth your baby. Just rely on your instincts.
You are the creator of your birth experience.

Each of these statements highlights a certain aspect of what is real in the world today. Industrialized medicine, especially within obstetric and newborn care, is based on historical patterns of abuse, coercion, status-signaling, profit-increase, and ignorance. Most mothers and practitioners alike have been born and conditioned into a belief system around birth which ignores the physiology of human birth and connection, and forgetting that while engaging with industrialized medical services is to increase the chances of being subjected to the worst abuses of that system. However, when statements like these are made, nuance is usually left out. It’s that nuance I want to explore now.

1. Sovereign birth is synonymous with freebirth.

The word sovereign is conceptually linked to rulership and the orientation of power within relationship. To be sovereign is to hold “power over”, to rule; a sovereign experience is one which is supreme, superior, or potent in the highest degree. A sovereign birth, then, is a superior birth, a birth potent to its full potential.

It stands to reason, then, that freebirth is most frequently an experience of sovereign birth, since freebirth is often not chosen as a default but as a calculated choice centering maternal authority over her own body and the birth of her child. This includes centering maternal authority in who attends the birth, in how various elements of support are provided, and how she and her unborn (and then newborn) infant are treated. Freebirth can be a beautiful and meaningful choice for mothers whose deepest desire for their birth is to either birth with their partners or husbands, or be tended by intimately chosen friends and mentors.

However, what feels liberating and power-centering for one mother in birth-giving will not necessarily align with what another mother may value or desire. And while freebirth CAN and often IS sovereign birth in the most accurate sense of the word, for those women who choose it, the sovereignty isn’t in the absence of a trained attendant. Rather, the sovereignty is rooted in the exercising of maternal authority over and responsibility for her own body and experience and that of her baby’s. For another woman, what might be defined as a truly sovereign birth will not be freebirth at all. Many women, if not most, will not feel supported or secure without respectful presence and reverent care involving a rooted knowledge of physiologic birth.

This lack of security and support is present both within hospital/obstetrician and midwife attended births—since, despite popular belief, rooted knowledge in birth is not actually the result of professional licensure and training.

It is present when anyone at a birth, whether a care provider or a relative or a friend, is occupying the role of “managing” the birth instead of supporting the mother, either directly or indirectly overriding her expressed or indicated wishes and actions.

It is ALSO present when a mother who desires to be supported in birth by someone familiar with birth and postpartum integration finds herself without that support during any point in the birth journey.

This is a reality often bypassed within the digital freebirth space—especially with the conflation of “physiological birth”, “sovereign birth”, and “unassisted birth”. The emphasis on birthing without the presence of a midwife (or other support provider) who has a devoted relationship with the birth process shifts the focus AWAY from the effective power of choice within context of modern realities on the part of the mother and TOWARDS the specific decision made.

Freebirth—do birth right. Or, as one teacher and influencer in the online freebirth sphere wrote, “Why would you hire a midwife if you trusted your body?”2

2. You don’t need to know anything to birth your baby. Just rely on your instincts.

I have heard this said in person and seen this written or posted on social media more times than I can count, particularly in the context of encouraging women towards freebirth. Much as I appreciate the simplicity of the sentiment, it feels fundamentally misaligned with current reality. Yes, every body holds innate wisdom on a cellular and systemic level, wisdom which I believe bypasses any technology constructed by human consciousness. Yes, this is a message worthy to be told loud and long. Yes, this is a message which is frequently ignored and suppressed within our modern view of birth.

However, individual human experience, including within birth, happens within the broader context of reality in real time. And the broader context of reality involves loss on an ancestral level of inherited knowledge around embodiment and childbearing. Most women, at least those part of mainstream culture within the United States, have not witnessed the birth of a child, or even the birth of an animal. Most women have not witnessed other women breastfeeding, or shared in the grief and healing around another woman’s pregnancy loss, or ever taken a meal to a postpartum friend. Layered within the absence of embodied understanding is the reality that be human is to experience conscious thought so deeply interwoven into our physicality that we can barely divide thought from physiological response. In light of this, many people (mothers and practitioners alike) are accessing forms of embodied interpretation of the world which inhibit healthy physiology throughout life—especially in birth.

Pregnancy and birth are incredible opportunities for observation and learning about ourselves and about the fabric of culture into which we are woven, on a level that bypasses conscious thought. It is not possible to disguise or manipulate what a birth communicates about reality as it is, both within and without the body. As birth and physiology worker Adelaide Meadow insightfully observes, “Birth works how bodies work.” And bodies work how bodies live. And bodies live how the mind instructs, in accordance with what knowledge is carried.

There are many ways of passing knowledge between generations. A mother-to-be who has witnessed her aunts nursing their babies, who has sat in on discussions about postpartum experiences and stories of naturally occurring labor, who has cared for newborns and infants, who has become acquainted with the rhythms of her own cycle, is in a very different place going into pregnancy and birth than the mother-to-be who has never observed the care of an infant and who medicates sensation through her menstrual cycle. The reality of the thing is that we cannot spend our entire lives fully disembodied and then expect pregnancy and birth to reflect a different story.

Yes, women can carry enormous downloads from their lineage. Yes, women possess vast amounts of power within their bodies and psyches. And yes, women can be completely and utterly lost when it comes to carrying, birthing, and raising their babies. These things are not mutually exclusive.

I think we do women a huge disfavor to say “Oh, there’s nothing to it. Your body knows what to do and anyone who says otherwise is stripping you of your power and engaging in egoism or birth saviorism.”

The reality is that, in absence of transmitted wisdom from generation to generation, in absence of strong mother-daughter/aunt-niece/grandmother-granddaughter/healer-apprentice relationships, we NEED education. We NEED guidance and support and resourcing. We are not simply going to wake up one morning and intuit into right relationship with life and its laws while absent guidance and presence from those who are actively carrying the wisdom and insights necessary to do so. And this is a reality to be faced by every woman entering into birth, regardless of whether she is choosing freebirth, medically managed birth, or any birth context between those two points. Birth is deeply influenced by the world of thought and perception, yes. But it is also a peak experience of physically expressed reality. And meeting the body where she is does, for almost every woman entering into pregnancy and birth, require some amount of preparation in terms of knowledge.

3. You are the creator of your birth experience.

A mother’s decisions—both in the specific context of a pregnancy and in the sum total of her life leading up to birth—play an influential role in her experience of birth. They also directly influence the challenges or ease she might encounter. In the context of a culture which has posited women as the victims of their own bleeding, childbearing bodies, such a re-centering of responsibility is vital.

Once again, though, in swinging to the opposite pole, the nuance of real life ends up being misplaced somewhere along the way. In the path to restoring understanding of the power and responsibility women have within birth, after generations of power being stripped from the hands of women and given over to systems which benefited from managing and commodifying women, it can be easy to forget each human’s place as an embodied creatures, rooted and sustained within nature’s intricate and intercommunicating matrix.

It is easy to bypass the truth that humans, like any other creatures, exist in subjection to natural law. We are as obedient to our physicality as our physicality is obedient to us. Which means that inhabiting responsibility for one’s birth is only part of the story woven through experience. Which means that we carry great power, but power within context of flesh and blood and bone, memory and perception, environment and heritage.

We cannot exist as individuals within a vacuum, but only as individuals born within complex webs of intergenerational, interpersonal, interspecies engagement. And birth itself is one of the deepest—if not the deepest—real-time expressions of relationship. It is influenced by maternal lineage and by what is carried and expressed through specific genetic lines. It is influenced by region and the elements present and absent within the land. It is influenced by the community surrounding the mother, the resources available, the food by which she is nourished, and the overculture in which she is saturated. Every individual, along with her experiences, is NEVER an island. What unfolds within the context of giving birth is no exception; it is not and cannot be the sole responsibility of the mother giving birth.

Some of the most painful experiences within the birth realm, freebirth or otherwise, have roots in women taking this sense of personal responsibility to the ultimate extreme. I have watched women hold the conviction that, whatever happened, they must have chosen and orchestrated exactly what unfolded. I have watched unanticipated complications or “twists” in a birth plan result in psychological whiplash extending far beyond the life-altering anguish of grief and loss. It’s one thing to trace patterns of decision and acknowledge where choice affected outcome, and to allow oneself to be transformed by that new understanding. It’s another thing entirely to construct a version of reality which centers the weight of an experience, whether painful or ecstatic, entirely in the power of an individual human.

In other words, “the proof of desire is in the having”3 is a belief which only works until it doesn’t, until what is most desired is brought face to face with what actually happens. And birth, serving as it does as an amplifier and communicator of all which is most present within each woman’s current reality, is responsive to far more than the deepest desires of the mother’s heart.

In emphasisizing the reclamation of birth from a system that imposes its own machine-oriented will over the biological design of birth, the swing towards an almost obsessive orchestration of the ideal—or optimal—birth experience has its cost. There is most certainly a place for this devotion to orchestration. Especially in a context where so many women enter childbearing without a cohesive set of stories around birth, a strong alternative message sharing that women actually are capable and equipped to give birth without professional support has significant value.

But I do believe that embodied, sovereign birth is not automatically disrupted if a midwife shows up with gloved hands, if someone other than the mother receives the baby as he emerges, if blood pressures are taken, if a vaginal exam is requested, if a Doppler is used to listen to the unborn baby’s heart tones.4 The real barrier to birth holding its rightful space within our continuum of experience is living within the fabric of a cultural place and time in which women are largely unconscious of their capacity and responsibility to make authoritative choices surrounding pregnancy and birth.

Ultimately, on both a practical and a philosophical level, I found mooring amidst conflicting birth ideologies in this: It is the privilege and responsibility of the mother to develop profound clarity around what she needs and desires for herself and for her baby within pregnancy and as she gives birth, with respect to her unique intersection of place, time, psychobiological heritage, spiritual and philosophical worldview, and available resources.

Such an understanding includes and honors women who choose to freebirth. This includes and honors women who choose medicated births. What this does not do is establish an external list of factors for “how to have a sovereign birth” or “how to birth in power”.

When we begin to dissect every element of birth as a series of components to be properly aligned for the “right” sort of birth, we risk replicating exactly the sort of thinking exhibited by industrialized medicine: fixation on parts to the exclusion of the whole woman and the whole baby in the process of birth giving.

To assert that hiring a “professional” midwife is a choice that automatically involves becoming a cog in the industrial medical system, creating an energetic contract that subverts maternal authority…

To say that hiring a licensed provider means a mother definitively will not experience an undisturbed birth, and that the provider does not work for the mother but for the state…

To imply that a woman who chooses not to birth her baby into her own hands but into the hands of the baby’s father or a midwife or a friend is ruining or diminishing her own experience of birth…

These are costly statements to make. Because, out of the broad range of mothers desiring and valuing undisturbed births, the majority will desire the presence of someone who lives in conscious attendance to the birth portal and who is able to offer clear, calm reflection and support. Not because those mothers are terrified of the “what ifs”, or because they don’t trust God (however God meets with their understanding) or the resilience and wisdom of their bodies, or because they don’t want to take full responsibility for their experiences, but because human beings experience life in connection. In relationship. And birth is no exception.

Not every woman making powerful choices in birth is going to choose freebirth. Not every woman birthing in sovereignty is going to choose to birth her baby into her own hands, or bypass formal prenatal care, or only hire someone who has no connection into the medical system. Not every woman who chooses with clarity and insight is going to orient around achieving a particular type of birth experience. And not every woman birthing in full authority is going to choose to birth at home.

I think we need to have bold and genuine conversations about how medicalized birth contexts are saturated with fear, coercion, and the segmenting of the human body and experience. I think we need to be honest about how interfacing with modern healthcare has negative effects on birth that need to be weighed with clear-eyed wisdom against the value gained. I think it is naive to forget that many modern procedures which are taken for granted in modern birth have a bloody history with the grubby handprints of power-seizing and mammon-lust all over it.

But ultimately, the conversation isn’t about where women birth, or who attends or doesn’t attend the birth. The real conversation needs to center around about women understanding and connecting to the depth of their power and responsibility in fertility and childbearing. It needs to center around mothers comprehending the breadth of their biologically ordained role in nurturing life. It needs to involve re-weaving of the mother and her child into a web of interconnection through every part of the birth experience, however it unfolds.

To me the emphasis on freebirth as sovereign birth feels like a misdirection, an entanglement in bandying over superficial details of systems while leaving the root of the matter unexplored. Because what IS a truly sovereign birth? Is it not a birth in which the authority of the mother giving birth is honored by all in presence? Is it not a birth in which the decisions made are made from a place of personal agency and interconnection rather than from a place of fear and coercion? Is it not a birth in which the wisdom of the body, anchored in place and time, is honored rather than ignored?

With love,
Jan

P.S. I have not found the uninterrupted time to record the audio for this piece. It will be added once complete, hopefully later today or tomorrow!

As always, I enjoy hearing your thoughts. You are invited to share your perspective on this nuanced topic in the comments, or drop me a line in response to this email!

The Mother Letters

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