What is 'freebirth'? Stillborn baby prompts debate

The idea behind “freebirthing,” a fringe movement of women who opt to give birth at home or in natural settings with no professional assistance, is a subject that tends to elicit reactions from intrigue to horror — on YouTube, for example, with the hugely popular “Birth in Nature” video (viewed over 76 million times since 2013), and also the short-lived Lifetime series Born in the Wild, which the video reportedly inspired.

But this week, vitriol seems to have taken over. It follows news of a freebirth that ended in tragedy when a baby named Journey Moon was stillborn, with online critics attacking the grieving mother as a “baby killer.”

That mom, who goes by the pseudonym “Lisa” in a Daily Beast article, reportedly chose to labor for several days at her remote desert home in California, with only her husband present; she leaned on the Free Birth Society, a supportive viral community of thousands, and went to the hospital when her situation felt dire. She then posted a final update to the group’s Facebook page: “Journey Moon was born a sleeping angel on Oct. 7 at 8 lbs 13 oz. She passed due to a massive urinary tract infection I had… I’m laying in the hospital writing this and get to go home tomorrow. We will be having Journey cremated.”

The mom was immediately attacked online, telling the Daily Beast, “What should have been a time of grieving and mourning alone with my family was now a time of defending myself from evil people and their horrible words.”

Other critics have focused their ire on the influence of the Free Birth Society — with ob-gyn and author Amy Tuteur going so far as to say that founder Emilee Saldaya “is as ethically responsible for Journey Moon’s death as if she had taken out a gun and shot her.” As a result of the criticisms, Saldaya shut down the group’s private Facebook page and is now speaking out about what she sees as an unjust reaction.

“This is a fight about choice, a woman’s autonomy, and reproductive freedom,” Saldaya tells Yahoo Lifestyle. “You are either pro-choice and support both the legal and human rights of adult bodily autonomy, or you don’t. For anyone to suggest that a woman makes any of these decisions lightly, or is selfish or irresponsible when intentionally choosing what she feels is safest for her and her child, is a blatant misogynist.”

The baby’s death, then, and resulting fiery discourse, has for many been a line in the sand — with those on one side seeing freebirthing as a reckless choice that selfishly flouts the standards of modern medicine, and those on the other seeing it as the powerful epitome of a woman’s right to choose. The argument is strikingly similar in tone to that of this country’s abortion debate, with one question at the center of it all: How freely should a woman be to choose her childbirth experience?

To understand why a woman would choose to give birth without a health professional’s assistance, explains birth-choice advocate and Birth Monopoly founder Cristen Pascucci, it’s important to look at the track record of assisted U.S. births (more than 98 percent of which take place in hospitals) — with their high C-section rate of 32 percent and one in three women reporting they’ve been traumatized by previous birth experiences.

“It is only a tiny, tiny fraction of women who are giving birth with no medical or midwifery care at all, but from what I’ve seen, it’s sort of a bellwether for how well the system is doing in a particular area,” Pascucci tells Yahoo Lifestyle. “Overall, we know that one-third of women describe their births as traumatic, and about one-third of those women fit criteria for [posttraumatic stress disorder] — with the bulk of that trauma due to dehumanizing and uncaring treatment during birth.” Regarding the outrage in response to Journey Moon’s death, Pascucci adds, “It’s really messed up that we blame women for being put in this position rather than recognizing that our system has put them and their babies there.”

Many medical professionals virulently disagree with that perspective, though. The American College of Obstetricians and Gynecologists (ACOG), in its latest (2017) committee opinion on planned home birth, notes that it believes “hospitals and accredited birth centers are the safest settings for birth.” While women are entitled to make informed decisions, ACOG adds, they should be told that the following factors lead to improved home birth outcomes: being an appropriate candidate (meaning low-risk, no multiples, and no prior cesareans); being in the presence of a certified midwife; and access to safe and timely hospital transport.

And while home births are associated with less interventions than hospital births, ACOG notes, risks of home birth include “a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000).”

It was from this perspective that some doctors shared their concerns about freebirthing on Twitter this week.

“Instagram glorifies home unassisted deliveries and this leads women to make dangerous choices,” began a long and impassioned Twitter thread about the situation on Monday from Jennifer Gunter, a San Francisco-based gynecologist known for frequently taking folks to task for what she says are “snake oil” claims (especially when they are peddled by Gwyneth Paltrow’s wellness brand GOOP).

Gunter, who stopped her obstetrics practice after one of her own triplets was stillborn years ago, shared her feelings about being part of a medical system that is often shunned by home birthers but then hastily called in for help at the last minute, only to be blamed for problems in the end.

“No one ever talks about how traumatic it is for the OB team to receive these patients [from home births]. We often have minutes to intervene, and so the rush to prevent catastrophe is interpreted as ‘you only want to cut me open,’” she shared, adding:

Gunter noted, “Imagine doing your best to salvage a baby from a home delivery gone wrong. And failing. And being told you ruined the birth experience.”

That thread led some to call out the difference between midwife-assisted and unassisted home births, with some saying they supported a woman’s right to choose her childbirth experience, as long as she wasn’t going it totally alone.

Other doctors weighed in as well.

Still others, such as psychologist and grief counselor Joanne Cacciatore, have expressed simple compassion for Journey Moon’s 29-year-old mother.

Women’s reasons for wanting a freebirth vary wildly — from aiming to prevent unwanted medical interventions, to avoiding (or healing from) incidents of obstetric violence, or simply living in an area where no home-birth midwives practice.

“Freebirth is choosing to navigate your pregnancy and childbirth with no medical management. Women choose this path because it is the only way to ensure the chance of having an undisturbed, normal, physiological birth — which is inarguably optimal for the vast majority of mothers and babies,” Saldaya tells Yahoo Lifestyle.

The difference between freebirths and midwife-assisted home births is that the latter occur in the presence of highly trained midwives, typically certified professional midwives (CPMs) or certified nurse midwives (CNMs), who follow different paths to accreditation. Both operate according to the Midwifery Model of Care, which looks at birth as a normal physiological event rather than a medical one.

While there have been no known studies on freebirth outcomes, there have been many that compare the outcomes of hospital and planned home births, including a landmark 2014 look at 17,000 home births — the largest ever — which found that among low-risk women, planned home births resulted in low rates of interventions and extremely healthy outcomes, including excellent birth weights, a low 5.2 percent C-section rate, high rates of breastfeeding, and a 10.9 percent rate of hospital transfer for babies, mainly for nonemergency reasons.

Another such study, of 80,000 births, found that for planned out-of-hospital births, 3.9 out of 1,000 cases resulted in a baby’s death during the birth process or within four weeks afterward; that’s compared with 1.8 deaths out of 1,000 in planned hospital births. On the other hand, out-of-hospital births were far less likely to involve C-sections — 5.3 percent compared with 24.7 percent in a hospital — which are high-risk surgeries.

ACOG believes the jury is still out on these comparisons, though, as, “to date, there have been no adequate randomized clinical trials of planned home birth. … Consequently, most information on planned home births comes from observational studies, [which are often] limited by methodological problems.”

But Saldaya says that’s all besides the point.

“An average of 24,000 stillbirths occur in the USA annually. But when a woman shares her story of her loss outside the hospital, this happens? This isn’t about stillbirths,” she says. “Free Birth Society stands for women’s complete and total reproductive autonomy at every stage, including birth. Every decision involves risk, and our position is that it is women themselves, and women only, who are the arbiters of their own risk. Reproductive autonomy does not and cannot exist without the freedom to make any and all choices around birth.”

Read more from Yahoo Lifestyle:

• Tarana Burke’s #MeToo Campaign Proves Black Women Have Been Discussing Sexual Assault For A Long Time

• Illegal midwives and border babies: The determined fight for home birth in Alabama

• March for Our Lives and gay activism: ‘They’re definitely linked for me,’ says Emma Gonzalez

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