Episode 70 - Freebirth in the Media with Charlotte King ABC reporter
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Welcome, everybody, to this week's episode of the Great Birth Rebellion. Today, I'm speaking about a topic very close to my heart. We're talking about free birth. And for those of you who've been here for a while, you'll know that my PhD and academic work focuses on the choice to give birth outside the system, and that includes the decision to free birth.
Mel:
[0:46] And I know many, many women who have chosen to free birth. Some have been my clients, some are my friends. so please know that we're coming at this topic with the same intention as we would any other episode of the Great Birth Rebellion to give information and respect to all birth options that are available to women. The choices that women make are their own and they have every right to choose what they feel is best and safest for them so this episode will not be challenging a woman's right to choose their own birth journey and I'm here today with Charlotte King who is a journalist and reporter from the ABC here in Australia. She spent the large part of her year looking into the topic of free birth and what first started out as an exploration into free birth and why women choose it turned into something that Charlotte was not really expecting. So we're basically offering a conversation about that work today but before we start I want to give a bit of background because free birth sometimes gets confused and muddled in the birth world. So just to clarify, a free birth is where a woman intentionally plans to give birth outside of a hospital without the assistance or guidance of a registered healthcare provider. Essentially, a woman chooses to give birth at home or not in a hospital without having a midwife doctor or professional health attendant present at her birth.
Mel:
[2:15] And there's lots of reasons why women do this, which we'll discuss through the podcast.
Mel:
[2:22] Some women hire doulas or what this new term is birth keepers or free birth keepers to attend them as service providers. So just to clarify too that doulas are not clinically trained to be able to give maternity care or medical advice. So they're considered birth supporters rather than having any responsibility or jurisdiction over giving actual clinical care or acting in an emergency. And even for myself as a home birth midwife, I do get calls sometimes from people inquiring like, what's the difference between a home birth midwife and a doula?
Mel:
[2:58] There's a lot of difference. So midwives are registered and regulated, which means that we hold formal training in the form of a university degree. And home birth midwives have to have at least 5,000 hours of clinical work behind them before they can even head out and start attending home birth so midwives highly clinically trained university educated registered and regulated so there's a standard a quality standard that has to be maintained that isn't in place for doulas and other birth workers and honestly doulas are often very very highly educated they spend their entire careers learning about pregnancy birth and postpartum very knowledgeable because of the amount of self-directed learning that they've done and the amount of births that they attend. But they don't have the clinical experience of a midwife or doctor. So they're not a replacement. Sometimes doulas attend free births, but they're not there in a clinical role.
Mel:
[4:00] So because of my research in this area and also here with Charlotte, we do have an understanding of how sensitive this topic can be and we will seek to do our absolute best to cater to these sensitivities as we explore this topic today there will be people listening today who wholeheartedly endorse free birth and there will be others who don't understand it at all so this episode is for us all as women as birth workers and for the public to help expand our view and scope of this topic
Mel:
[4:34] So, having said that, this episode of The Great Birth Rebellion seeks to understand
Mel:
[4:39] the work that Charlotte King and her team have been executing over the last eight months. And this episode is not intended to discourage or encourage free birth practices, but rather to understand what Charlotte and her team have learnt through this investigative process. And what we're presenting today are real stories. They happen to real people. And so we share them with compassion and kindness and without blame. And we extend our sympathies to all families whose birth resulted in either the mother or baby coming to harm or death and it's very hard to know where to start with this i really just want to do this justice and for women who's who choose free birth and also honor the truths and realities of this choice and it can be the absolute height of the human birthing experience to have a free birth but also can have the same consequences as birth in any location
Mel:
[5:34] that a mum or baby might not survive. So with that introduction, I'd like to introduce my guest today, ABC reporter Charlotte King. Welcome Charlotte.
Charlotte:
[5:46] Thank you. Thank you for having me.
Mel:
[5:47] Thanks for being here. So before we start, I'd love to, if you could give us a brief introduction about who you are and the work that you've been doing through your career?
Charlotte:
[5:58] Sure. Well, I've been a journalist with the ABC for about 12 years. And over that time, I've worked as a news journalist in local bureaus, like in Mildura, in Victoria and regional Victoria, where I used to live, Ballarat, Melbourne. But the last couple of years, I have been working in something called ABC Regional Investigations, which is the team of two of us and we generally work with reporters in regional bureau around the country who have a story that's a bit bigger than what they can sort of handle needs a bit more research evidence you know what we call talent which is people to talk to the story on on record and they need help really building that up and developing it so that it's a national story and it gets onto to a national platform like, you know, ABC News on like networked or across the country or on like audio kind of fairs, like the AM, PM, The World Today, those kinds of programs, or even Four Corners and Background Briefing. So we generally work with those reporters in those smaller bureaus to build up their stories. But on this, in this occasion, this story that we did was a little bit different and I ended up being the reporter, which I used to do more of, but not so much anymore. and more, usually I do research. And that happened because, as you know, the ABC did this birth project, which was like an audience call out asking women for their experiences of birth.
Charlotte:
[7:23] Um, and that project was done by another couple of journalists, but they had just so much of a response from the public. So many women wanted to write in with their experiences that they just didn't know how to handle the amount of information. So they recruited other people from around the ABC to help. And they had this sort of group, the submissions into different topics. And one of the topics was free birth. And so I offered to take on that job. Free birth was something that I hadn't really looked into before. I found it really fascinating.
Charlotte:
[7:58] And I had done a couple of bigger birth stories already for programs like background briefing. I'd done two that looked specifically at different aspects of birth. One was about the difference in stillbirth rates in regional areas of Australia. And we had two really sad case studies of mothers whose babies had died because of hospital negligence and medical failures in regional hospitals in Australia. And we looked at all the other sort of access problems for women in regional areas in terms of, you know, a lot of hospitals have stopped providing maternity services at all, so they have to travel long distances. There's very few home birth options. And we focused in on this very sad fact that regional babies, babies living in regional areas are still more likely to be stillborn than metropolitan babies. And generally, the mothers who are caught up, I mean, there can be a range of reasons for this, but in the cases that we looked at, it was medical negligence. One of the hospitals apologised off the back of our story.
Charlotte:
[9:10] And the mother had never been given an opportunity to have a proper debrief about it. And it was just shocking the treatment that she had received from that hospital and the medical staff there. It was kind of indescribable, the trauma that she had. So that was that story. And then we had done others, another round racism in the healthcare system directed at Aboriginal and Torres Strait Islander women and the decisions for some of those women to disengage with health services as a result of that. That was a really fascinating story that I did with Carly Williams, who's a Quandamooka woman from southern Queensland.
Charlotte:
[9:48] And that, again, was about hospital failings around the way that they deal with cultural safety. So I've already had an interest in birth, but I hadn't really looked at pre-birth yet. So I really wanted to get stuck into that new topic now.
Mel:
[10:04] Yeah, amazing. And you're right that a birth project just blew out. I can imagine there's so much data there to be talking about birth for years and years and years. And certainly what's been in the news of late are the massive shortfallings that we have in the Australian maternity care system. And a few of the articles you highlighted, and also the current inquiry into birth trauma is really shining a light on the massive shortfalls that we have in the maternity care system. And so I see this kind of story as not dissimilar to the light that gets shined on the current failings in maternity care system. You know, I'm a home birth midwife. Every time a home birth story comes up in the news, I'm like, oh, here we go again. We're all going to talk about how bad home birth is, you know. And then obviously now we've got a renewed sort of media interest in the topic of free birth. So I wanted to ask you about what's the purpose of your work as a journalist? What's the intention of journalism? Because, you know, this free birth story, the chatter online and from the public, you know, they're talking about it as being a witch hunt and kind of really negatively highlighting issues within free birth. But what do you see the purpose of this journalistic investigation to be?
Charlotte:
[11:32] Well, the purpose of it overall, I guess, is to really investigate what is happening and to look at any problems that are there that the public should know about. So that's, I think, the case with a lot of journalism is this idea of what does the public need to know. And so originally when we started looking at FreeBir, we were going off the back of submissions to the birth project. and so we contacted women who had submitted to that with their stories.
Charlotte:
[12:04] Many of them had had a prior experience in hospital that they were really unhappy about and they chose to free birth off the back of that. Some weren't able to access a home birth and so free birth wasn't their first choice but they ended up having a free birth anyway and having a fantastic experience. So we were really interested in that but our purpose as journalists is not to advertise requires anything.
Charlotte:
[12:28] So we wouldn't go out and do a story that just advertises free birth as a fantastic experience, particularly if there is any evidence of risk. So we went into this thinking, we have to be careful about what kind of story we're going to tell. So we don't want to gloss over the risks that are there. But also the main thing we wanted to know was why are women doing this because you know we do have an advanced medical system in australia um why would women want to disengage with that completely it's an interesting area to look at as you know because you did your phd on it um so yeah the point was not to was to look at why women were doing this and what and to kind of diagnose you know for the for the most part it seemed like women who had written in had wanted had preferred a home birth you know they would have liked to have had a home birth with a midwife but they couldn't access one so they had a free birth but then some of them it wasn't it was a bit of a gray area and actually they were really happy not to have had a midwife there and I found that really interesting because I thought um that was not something I was expecting I assumed well of course you would want a midwife wouldn't you because midwives know how to help you have a baby. But then I became aware of this whole other element to free birth, which is really so...
Charlotte:
[13:55] So, so much about reclaiming something that is, you know, absolutely not a medical event that any representation or any representative of the medical community is not welcome there. And that I found interesting, but that was, again, not so much the focus because, you know, like you said, women have a right to birth how and where they choose. So if a woman was going to do that really to the point where she was just with her partner or a sister or whatever, I thought that's not really our place to look into that as journalists. It's very private.
Charlotte:
[14:28] What was interesting to me and what I did think was a public issue and still do is when free birth dealers or birth keepers advertise services publicly to attend those births. So that seemed like a pretty different kettle of fish to me and the people I was working with because suddenly there was a transaction going on, there was money involved, you know, which is fair enough. Everyone needs to make a living. But when you have that service that is advertised and you have a promise there for people around what you can provide in a very vulnerable moment, which is birth, particularly for first-time mothers and their babies,
Charlotte:
[15:06] I think it is valid to ask questions about how safe that service is. Um and so we were really interested when we discovered because that was totally new to me that there were people advertising those services to attend free births without specifically without a midwife there and that was their sort of point of difference and i think you know as as i said women have a choice absolutely have a right to choose where and how they birth including choosing a birth keeper or a doula and not a midwife.
Charlotte:
[15:36] Um, but when there is, uh, when there is that service there and it's publicly available and there's a fee attached to it, um, and we're talking about birth and women and babies, I do think it's worth looking at that.
Mel:
[15:50] And so then your initial thought wasn't, let's look into free birth and women who free birth, your interest pretty quickly moved into the industry of free birth. Is that?
Charlotte:
[16:02] Exactly. Yeah. Yeah, so it did start out interested in women who free birth. Why are they doing that? Is there something that the public should know about that we need to fix because women are doing this? But then it became clear that, yeah, that wasn't really the story, what the story seemed to be more about because women, you know, some women were choosing free birth with a free birth doula when they could have accessed a midwife. And so then it was like, okay, there's something else actually happening here. And let's just look at this dynamic generally of women who are choosing to free birth with a doula and why they're doing that because that's bigger than just, oh, I can't access a home birth with a midwife in my area. And it's actually deeper. Like there's more going on and different levels around, you know, distrust of the medical system, distrust of institutions generally post-COVID, you know, radicalisation of these kinds of things, So attitudes online and through social media, there's all kinds of layers to it instead of a woman just saying, I want a home birth, but I can't access a midwife, so I'm going to have a free birth.
Mel:
[17:11] Right. And certainly that was the whole question of why do women free birth was the whole question for my thesis. What motivates women to birth outside the system? So, you know, what you have already described in terms of why do women free birth, there are a small, when I did my research, there are a small proportion of women who just wanted to. They're like, I didn't consider any other birth options. That's just always what I was going to do. And certainly that's completely valid. That's a reason.
Charlotte:
[17:43] 100%.
Mel:
[17:44] And a large proportion did report, probably 80% of the women that I interviewed for my thesis reported that they would have loved to have had a midwife present, but for various reasons, either cost, distance, or they didn't like the midwife who was local or whatever. Obviously, I wrote 100,000 words on this exact topic. You can read it. I'll put it in the show notes. Everybody can read the thesis or articles if you want to, but there was a significant proportion, a bigger proportion that actually would have loved to have had the input of a healthcare provider, but for various reasons, there was barriers. So, well, let's focus on what your activities discovered. So can you tell us about what sort of started to unfurl as you looked deeper and deeper, you know, as you went through the layers of this?
Charlotte:
[18:34] Well, actually, we weren't aware of how popular this dynamic was becoming with hiring a free birth doula or a birth keeper until we actually became aware of our first death, which was with a student doula in attendance.
Charlotte:
[18:56] And I was sort of like, oh, what is a student doula? You know, I didn't realize there was such a thing that women, you know, who are getting trained in these doula courses, in some of these doula courses are then regarded as like a student doula straight after they've finished the course for a period of time until they've done a few births.
Charlotte:
[19:16] Depends on the course as to how it works but in this particular case this that was what was going on and this doula had just finished her course and then attended this free birth um with a first time mother and the birth ended in a stillbirth and the from what we understand it occurred during labor which as you know is very rare in australia um and so we were shocked to hear about that but also that introduced us to the world of not only sort of student doulas but their trainers and these sort of new courses that are really kind of pumping out doulas and there is this industry around it and that was new to me there's actually an industry around this it's not just women quietly free birthing at home in the quiet of their own private space you know with their loved ones around them there's there's actually an industry here and what does that industry involve I've never heard of any of these people or all these courses or these trainers and so we just started getting right into that world and learning who you know the who's who of that world and as as we looked into it more and spoke to more people we learned about more sad outcomes.
Charlotte:
[20:32] And you know some of these were posted about publicly and we spoke with some of the doulas who had been at these births that had ended in deaths and they were open about the fact that a baby had died but they didn't want to talk on record about it. And, yeah, in most instances there was a sense that it was – they wouldn't have done anything differently, basically. So, again, that made me think, well, this seems like –.
Charlotte:
[21:04] You know, a problem because in any context where birth happens, if there's a terrible outcome, usually there's some kind of reflection on what happened and whether we can avoid that happening again. And what seemed to me to be a problem and others that I spoke with, many, many people who had concerns about it, is that there was no reflection on it or there didn't appear to be one and it seemed to be painted as.
Charlotte:
[21:31] Oh, well, it would have happened in any context and it was just a tragedy and it was better that it happened in this way because it was at least in a comfortable home setting rather than hospital. So, yeah, we just thought that that's not always the case and the evidence that we had was that from people that were directly involved in some way in these
Charlotte:
[21:57] cases was that they actually were avoidable. And so we wanted to make that clear that some of these deaths that are occurring do appear to be avoidable because I think that women have a right to know that when they are choosing to have a planned free birth with a supporter or a birth worker who doesn't have clinical skills to know how to recognise as an emergency and as much as these supporters can say that they provide information to these mothers that they don't have that clinical skill I think it's an interesting dynamic and from others I've spoken to you lean on the people around you you trust them when you're in labour.
Charlotte:
[22:41] And you know some women will free birth and they know exactly what they're doing they trust their intuition it all works out great but it doesn't always happen like that and I think that women do need to know what what's actually possible yeah so i will say that we didn't start out looking for death um like we absolutely didn't we looked we started out one wondering with an open mind why women were choosing free birth and wanting to learn more about this world and and i was quite shocked when we discovered the first the first death um the others just kind of unfolded so as we were doing our research um we found out about the first one which was in queensland with the student door and then another one became relatively public because the coroner announced an investigation that was in Toowoomba and then we found out about the case study that formed sort of the basis for our story which was on the Sunshine Coast and again confirmed it with the coroner but it hasn't hadn't really been made public. In total there were seven baby deaths that be confirmed between, yeah, since 2022 and between 2022 and now.
Charlotte:
[23:57] Um, and then we also found out about two catastrophic brain injuries involving babies. You know, a lot of the time this discussion is around life and death and not the in-between. And absolutely there are preventable injuries in hospital and that does happen. Um, and there are usually, you know, legal cases around that when that does happen, if it's medical negligence. But, um, we thought it was important to mention that there had also been brain injuries involved with free births and two that we could confirm because that's a lifelong effect on that baby but it's not really talked about very.
Mel:
[24:35] Much and what we know too is that free birth stats aren't collected so there's no actual formal data collection process about the outcomes or even the number of free births that are happening here in Australia so it's really hard to know if that seven is actually proportionate to the outcomes that would happen anywhere with a midwife at home or in hospital, or whether or not this is a disproportionate number of poor outcomes?
Charlotte:
[25:03] Well, that's an interesting question, definitely. But we didn't sort of just go headlong into this without considering that. And we actually spoke with perinatal mortality experts about the figures that we'd found and there are other deaths that have been looked at in other parts of the country that we know about by these experts and it's a similar kind of number in the same time period and they said that it is actually very high. And the reason that they say that is because, yes, we don't know the full number of free births that are taking place but a lot of these deaths happen at 10. And in and around labour, which is, you know, you know more about this than me, but that's pretty rare in Australia.
Mel:
[25:55] Very rare to have. It's incredibly rare to have a baby die at full term during labour. So perinatal data about the deaths of babies from 28 weeks to 28 days postpartum, that's 28 weeks of pregnancy all the way through the rest of the pregnancy during the labour and birth and 28 days postpartum. It's somewhere between seven and nine per thousand.
Charlotte:
[26:23] Well, we actually looked specifically into avoidable stillbirths for this other background briefing and looked at hospital births involving avoidable stillbirths. So I am definitely interested in avoidable stillbirths in any setting, including hospitals, and I've done work on that it's it's it's very rare after 28 weeks because yeah we have one of the lowest rates in the world and it's less than three per thousand so.
Mel:
[26:49] That was was that seven just in in a particular catchment area
Charlotte:
[26:54] Yeah so it was going to look at just southeast queensland because we wanted to keep it focused because you know it's we're also storytellers so it needs to be you know, a story about a particular part of the world. But when the twins died, we needed to include that in the story because people knew about it and it was already public. There were seven all up, and that was northern New South Wales and southeast Queensland. So it is a related geographic area. Like there's a lot of crossover between communities and the lifestyle of some of these areas. But that doesn't include anywhere else in the country where we do know that there have been other deaths. So, look, I mean, it's not really about, I don't think, comparing the numbers in that hard and fast way because we just don't have the data on it. But what we can say is that they happened, that they happened at term and that they either happened just before, during or after labour, which is, it's a big deal and it doesn't happen often in Australia. And I think, you know, there is this conversation, obviously, online around women making it clear that and free birth advocates making it clear that death is a part of life and death is a part of birth and that they don't shy away from that. So I think that we do need to be transparent about those outcomes.
Mel:
[28:20] And to be clear too, and this is what many free birth advocates and women and doulas are yelling at the podcast at the moment, is that death in birth can happen anywhere, at home with a private midwife, in hospital, with all the possible medical care that's available, and that an inherent risk in giving birth is that you or your baby might not survive. What I guess we're kind of talking about today is that is it possible that with a growing free birth movement that there are deaths that wouldn't have occurred in different circumstances and then women will argue that avoidable deaths have happened in hospitals through negligence, through over-intervention.
Mel:
[29:08] So all of that's absolutely true. That would be right.
Charlotte:
[29:13] I mean, yes, there are avoidable deaths happening in hospital.
Mel:
[29:16] Absolutely.
Charlotte:
[29:17] It doesn't mean that there aren't avoidable deaths happening in free birth. And look, if people know all that and they still want to go ahead and do it, then, you know. Totally. It's absolutely their choice. But I haven't seen investigating this a huge amount of transparency about those outcomes in the discussion around free birth. There is a lot of positive messaging around free birth and a lot of the experiences are positive. and they appear to be exhilarating and empowering. And I'm very happy for those women to have had those experiences because they sound fantastic. But just because you have had that fantastic experience doesn't mean that every woman will. And some of the women have literally said pre-birth is for every woman. But I don't think that that is a very responsible message to be sending about birth and what are the risks. And sometimes that doesn't happen in hospitals. Sometimes you might have an obstetrician who is telling you something that is really not evidence-based, not in your best interests. And the same goes, you know, they might have a particular agenda that you should be wary of. And I think anybody that does have a particular agenda in birth, you should be wary of because... Every woman's different and every birth is different.
Mel:
[30:38] You know, and I actually have written in a whole researcher paper about the concept of risk and safety and how actually the concept of risk and safety is fluid and it's actually in the eye of the beholder. So the woman gets to decide where the safety and what level of risk and safety she's willing to accept. And certainly the women who are choosing free birth look at their birth options and they see I mean every birth option has risks and benefits so there are massive risks and benefits to giving birth in hospital there are risks and benefits to giving birth at home and there are risk and benefits to having a free birth and I I feel as though the majority of women and birth workers and midwives would accept that, that yeah,
Mel:
[31:26] Every single birth option has risks and benefits and that, and you could list all the benefits to free birth. You can list all the risks. You can list all the benefits and risks of hospital birth, but to deny them, I think is the irresponsible thing. To deny that there could possibly be a risk is the irresponsible part. And the majority of women who free birth, this is what we found in my research. Again, if this doesn't speak true to you, then that's your own story. But the majority of women knew that there was a possibility that their baby might not survive, but what they would be exposed to in hospital, that was more overwhelming possibility that their baby might not survive in a free birth. So women's previous experiences were a massive problem. element.
Charlotte:
[32:22] And that should be the focus, right? There'll be some women, obviously, that say, I don't need a reason to free birth. It's always going to be the best option no matter what. And that's fantastic for them. But it's not always the case for women. And if you are free birthing to avoid a hospital system that is so terrifying and traumatizing to you that you will do anything to avoid it, that is a problem we need to address. We need to look at our hospitals and we need to look at how we approach birth
Charlotte:
[32:45] generally in Australia. I mean, it was so interesting to me to talk to doctors and obstitutions during this story, which we didn't actually include in the story in the end because we didn't think it was really necessary.
Charlotte:
[32:58] But the...
Charlotte:
[33:00] Their point was that most of the time it will go fine in a free birth. And I'm thinking, well, why don't you say that publicly? Or why don't you act in that way when you approach birth in a medical setting? You know, why don't we do more of that? Like where women just take charge in a room, in a setting where they can have access to medical people if needed. But, you know, if they can be the one that's leading the, you know, leading the process. So there is a lot to, you know, the medical system has a lot to answer for in the fact that they acknowledge that home birth now, finally, they've acknowledged home birth is safe with a midwife in attendance. And they'll also say that, yes, birth is a physiological process and a lot of the time free birth will be fine. But instead we've got these just vast extremes, you know, which is like the way that Hannah Darlan described it as a massive chasm between two imperfect worlds. I think that kind of sums it up and obviously there will be people who disagree with me and say free birth is a perfect world it's not there's nothing imperfect about it but I don't think you can ignore the the outcomes that we have found I think that they are tragedies you know that's not the reason we went into this but it was hard to ignore and that's just our little investigation there are there are bound to be more that we don't know about and if they're avoidable that's a problem because avoidable deaths aren't a good thing and.
Mel:
[34:29] And I think the majority of doulas and birth workers would be doing the right thing and actually just providing birth support as they say they should and within the bounds of their work as doulas but there will always be and this happens with home birth midwives too I've been around for 16 years doing home birth and I've seen And home birth midwives come and go, some of who we look at and go, ooh, I really question this kind of, this type of the way that you're working. And thankfully, there's a regulation process that often will pull people into line and make sure that they're working clinically safely and prevent, hopefully, avoidable incidences from happening as much as possible. Um, there's, there's no regulation of, of doulas and so, um, Although the majority would be doing the right thing and be completely fine and safe to be doing the work they're doing, we've got to acknowledge that in all industries with midwives, doctors and with doulas, there'll be a small proportion who aren't. I'm actually curious to know what you discovered about the culture that's growing around free birth and workers who are working within the free birth.
Charlotte:
[35:49] Yeah. Well, I agree with you that a lot of doulas do a fantastic job. And, you know, we interviewed Renee Adair from the Australian Doula College, who obviously is opposed to doulas attending pre-births and has a code of conduct around it. And she's also opposed to regulation. So she doesn't want any regulation for doulas because that changes, in her mind, what doulas are in the fact that they're not part of the medical system, that's part of how they define themselves. She doesn't want them to be regulated and neither do a lot of doors, I imagine, want that. But her argument was then that if we want to stay unregulated, we need to stay in our lane and not cross over into what she regards as sort of lay midwifery, you know, dabbling in a bit of, oh, I can check the heart rate or, you know, she told me about, you know that she had heard of doors bringing syntosin into births you know those are pretty, that is massively um jumping outside of your scope as what in terms of what you've been trained for and if you go in the argument from many people i spoke with was if you're going to do that then there's going to be some consequences it's only fair.
Charlotte:
[37:08] If you didn't do that and you just stayed in your lane, provided that emotional support, then, you know, there's no argument for them to be regulated. But I think there is just such a big grey area at the moment with doulas and doulas who I've spoken to who've told me about, you know, even free birth doulas who I've spoken to who aren't happy with other free birth doulas going much further than they would. So there's just this enormous grey area. It's totally down to personal choices, basically, and individuals and the way that they're choosing to operate and I think when you're dealing with something like birth where the stakes are pretty high that's alarming um that it's just down to individuals and and what they decide to do and the way to yeah one way to combat that I think is education for mothers but there's just so much distrust out there at the moment um in terms of medical institutions that, and you've got, you know, a world of influences and Instagram and I think it's hard to know where to get your trusted information from.
Mel:
[38:15] Well, can you talk just a little bit about, because you have an article on this, a bit of an explainer about the background to this whole investigation.
Charlotte:
[38:27] Yeah, so this, you know, often you just put out an article and nobody can read the backstory behind it. But we thought with this story, because of how sensitive it is, it was a good opportunity to just put in a little bit more detail about the investigation itself. So we do have a story that's attached to the other story, which sort of just goes into that background investigation that myself and Andy Burns, who also worked on the story with me, what we went through when we were looking into this and that we did go in with an open mind. And, you know, generally with the work that we do, we are pretty comprehensive with the research that we do. So, and we like to be, you know, it was never meant to be a finger-pointing exercise. Like it was, we'd like to look at a problem in a way that can maybe point at a solution or is just about, you know, public information. So, you know, public interest kind of story rather than let's blame somebody for this. So we do have that piece up online if anyone wants to read about what our sort of thought process was around this. You know, there are obviously privacy issues involved in telling these stories. And the previous story that I did on preventable stillbirths in hospital, the two main women that we interviewed were the mothers. And so normally that's obviously...
Charlotte:
[39:51] The way that you want to do it because the mother's at the centre of the story but it was more complex in this in this case and and all the people that I've spoken with who deal with free birth and especially in cases where things go wrong it is it's just a very difficult.
Charlotte:
[40:08] It's just such a quagmire and so yeah we would have liked to have um had the mother involved in this story but she didn't want to be involved and we did make the decision that because the story was already been had already been made public online her doula had posted about it in quite a lot of detail and images were posted etc and because it was before the coroner that we de-identified the mother and the door that we could still tell that story because there was a wider public interest and she wasn't this wasn't the only baby to have died but that is all a very difficult thing to grapple with as a journalist and we did go through a really extensive process there and so we have written about that in that explainer piece um uh if anyone wants to read about it you know in the course of this and we talked about this in the story in the course of this investigation there was a lot of pushback from some of the sort of online free birth community and just really around us interrogating the issue of free birth and the industry around it, there didn't seem to be a lot. It was very negative. That process of investigation itself was seen as negative and we were described as part of the system because we were in the media.
Mel:
[41:26] Why do you think there was that response? When people start probing into free birth, why do you think the community pulls away from that?
Charlotte:
[41:34] I asked Hannah Darlan this question because it's a good question. And she said that with communities like this, I think a lot of the time, well, this is not her words, but she said that they can close ranks when there's outside sort of probing or interrogation. They're quite insular communities. They can be confirmation bias. So you don't generally have robust sort of discussions on these pages. It's people agreeing with each other so I had a great free birth it's amazing I had a great free birth too isn't it fantastic you know and then if anybody says oh what about you know you know I've seen pages where a woman says I've been to.
Charlotte:
[42:17] Preeclampsia and what what about me and they say well it sounds like you're being pathologized so there's you can do whatever you want and there's no one coming in there going hold on maybe you should get a second opinion on that you know preeclampsia can be pretty serious there yeah there's just this very circular conversation so I don't think in that particular community there's a lot of willingness to have a robust conversation which takes criticism and you know is up for a debate it's sort of up for debate it's and I was I was I was told in no uncertain terms unless you support free birth or unless you've had one you can't do the story about free birth and that is not really um how we operate as journalists we don't do stories because we're supporting them or because we're directly involved in them.
Mel:
[43:09] I mean, that's the same when I did my PhD on free birth. If you presented something that was clearly an opinion piece or just bolstering up something that you wanted to bolster, it would not have been considered a rigorous project or thesis. It's just, well, you can't just present the information that you want presented. You actually have to present the full range of things. You know, this women who free birth and people who are involved in free birth, they're a traditionally ostracized group. They've been traditionally judged, called names, misunderstood, reported to family services. Some have had their babies removed from them. You know, they've been blamed. You know, the women that I interviewed for my PhD talked to me about, you know, what people said to them about their choices and, And so it makes sense that they would flee from public view because historically they've been absolutely publicly vilified. And so I think the immediate response is that this is a witch hunt. How dare they try and put free birth in the spotlight?
Mel:
[44:16] Somebody said, oh, you know, this whole story is just thrown a grenade into the free birth world and creating divisions. But what I think it's done, I don't think it's a grenade. I think it shed light on things that are happening that perhaps the free birth community would rather not talk about and that there is a division between various healthcare workers and, you know, a division of philosophies. But, yeah, I think there was a big reluctance because there was concern about what topics of free birth would be brought up. And you know I saw it on on social media you know women and birth workers and people saying don't talk to the journalists you know it's a it's a witch hunt so
Charlotte:
[45:04] This is already public this is the problem that I have with that is that that the entire movement is public it's for there for everyone to see so um the idea that you can't answer questions about it from a journalist who who who genuinely wants to know is, it just seems... It's not consistent with the very public face that we're seeing at the moment. You can't just have a public face. Well, you can, but I think that it's better if we can have a conversation that's reasonable about that just acknowledges that, yeah, sometimes some really horrific things are actually happening. But you know what? The hospital system is also pretty stuffed at the moment. And the fact that women are choosing to just go alone or go alone with a doula and sometimes do it out of fear of the hospital, that is a big problem and we should not have a system in Australia like that
Charlotte:
[46:07] that is the mainstream system and that's the system that we've got at the moment. So that's the biggest issue, I think. But we couldn't ignore at the same time this industry that's popped up where some pretty serious things are happening.
Mel:
[46:23] And it's not to say that, you know, the women who genuinely think, you know what, I actually want to have a free birth for my very own reasons and that's what I'm doing, I don't think those are the women we're talking about.
Charlotte:
[46:33] Absolutely not the women we're talking about.
Mel:
[46:35] No. I wouldn't want to.
Charlotte:
[46:38] That's a private matter, like I said. And it's a grey area because you could argue, well, this is still a private matter. But it's not a private matter. I don't think when you have people getting paid to attend those births and they're ending in deaths or permanent injuries, then it becomes of public interest because.
Mel:
[46:57] It's like a public
Charlotte:
[46:58] Hazard, like.
Mel:
[46:59] Yeah, I think the other thing that's of public interest is the women who would have wanted a different, who would have wanted not to free birth, but felt forced, almost forced to free birth because it represents, often women free birth because it represents the best option available to them. It doesn't necessarily represent their first choice. And people who this was their first choice will say, well, that wasn't the reason that I chose it. Well that's you the other 80 percent of women are choosing free birth because it was the best and safest option that they had available to them and certainly the women I spoke to in my from my thesis said I would many of them 80 percent of them would have preferred to have a private midwife but for various reasons couldn't access one and so free birth became the best and safest option when they all their other options. So I think that's the real issue is that the Australian maternity care system is not providing women with all the possible options that should be available to them if they want them. So we're not poo-pooing free birth. If you absolutely want to have a free birth, if all the other options just seem substandard in comparison, then that's your choice. But I think what does need to be fixed is the circumstance where women want maternity care, but can't access it, and so free birth becomes the next best option.
Charlotte:
[48:26] And also the confusion between a doula and a midwife, which I've heard from many people, is there. And I don't think that is helpful to be confusing women in that sense, and they need to know what they're getting and what they're paying for.
Mel:
[48:44] Did you come across doulas who were actually providing clinical care or giving education that maybe steered women away from seeking medical care?
Charlotte:
[48:56] Um, it's difficult to go into that because it wasn't in the story. Um, but, um, but there are certainly investigations that we know about that are taking place at a national level into that question of doulas providing medical advice or clinical advice when they don't have the qualification to do so. Um, but it's definitely, um, yeah, I think that there is an increasingly gray area that free birth doors and birth keepers are operating in, particularly when they're the middle man or the middle woman between a healthcare provider and the mother, which is what's happening quite a bit.
Mel:
[49:39] And if you're listening today, I would really encourage you, so below this podcast in the show notes is a podcast episode that Charlotte produced all about this story that we're talking about. I actually think it was really factual and unbiased and just presented the reality of some of the stories that are just emerging about free birth outcomes. And it would be amazing. I mean, it's entirely possible that free birth is just as safe as all the other birth options. We just don't know. And so there's this question about is free birth dangerous or safe? Is hospital birth dangerous or safe and is home birth dangerous or safe the only difference is that we have data to be able to make comments about hospital birth and home birth and so anybody kind of pushing free birth as you know external to the woman the women can make any choice they want because women can decide what represents safety and risk but when you have an outside person
Mel:
[50:46] Suggesting that free birth is safe or that free birth is dangerous we can only go by what kind of data we're able to collect and unfortunately there's a data black hole around free birth so nobody can say with absolute certainty that free birth is dangerous or that free birth is safe or that the outcomes would have been different based on a different birthplace so I think also be cautious if anybody's saying yep absolutely everyone should free birth it's the same caution as somebody saying yeah absolutely everyone should home birth or everyone should hospital birth no one way of caring for a woman is the same for any woman and
Charlotte:
[51:30] Um uh I guess you know at the end of the day we're just telling a story and we're doing our best to do that in a fair way um and to tell people what we've uncovered, what we've discovered.
Charlotte:
[51:44] It doesn't mean that we're judging anybody for making these choices. I've made it pretty clear in the story that women do have the right to give birth where and how they choose. And I have deep compassion and sympathy for women who choose all kinds of contexts to birth because it's very personal. But, yeah, our focus was on this industry mainly that's popping up around this and the influence that that industry and those advocates have. On a woman at a vulnerable time, and particularly when that woman has experienced previous hospital trauma and the like. And I'm sure that women are very capable of making their own choices and making good decisions. But if you're in this space, I think you need to be careful about the messaging that you're putting out there. And, you know, having the odd disclaimer wouldn't go astray.
Mel:
[52:38] Is it possible, and this is something I've wondered and haven't really voiced or aired publicly so here we go is it possible that there is a grooming process going on within the free birth movement to encourage women over to free birth
Charlotte:
[52:55] Rather than women.
Mel:
[52:56] Making that decision freely is there
Charlotte:
[53:00] That's not really a question for me because I'm not deep in it and I don't know how these people think and why they're making the decisions that they're making but I will say that I listen to a lot of podcasts around this and it does start to affect you. There's so little doubt coming across in any of these podcasts. It is said with so much certainty that free birth is the answer that you start to, you know, believe it. And it is great that there are so many women that are getting, you know, that are having this experience, especially women who've had horrible trauma in hospital that they're you know they have the right to an undisturbed birth absolutely and um you know good good on them for for getting that but yeah i think um it's just so personal and and i think if you're getting this messaging look there's a you know.
Charlotte:
[53:58] Like in any context, there's a possibility for being coerced into that. And I have spoken to women who have dealt with women who've had free births with very strong-willed birth keepers. And they've reported that, you know, some of these sort of free birth women have spoken in a similar way about their fears, using the same kind of language, like around, you know, it's just my conditioning, the way that I'm, like, wanting a hospital. It's just my conditioning. I just need to, you know, get past that conditioning. And that kind of thing is a little bit concerning, I think, if it's not coming. It starts to feel like it's not coming from them so much. the the people the the birth worker that's that's influencing them and i think that is something to be wary of and you.
Mel:
[54:56] Made comments you know when we chat on the phone many times about this story is that even you having your own internal crisis like your own internal truth was being
Charlotte:
[55:04] Challenged well it wasn't so much that my internal truth was being challenged but i was surprised to see the outcome like the positive outcomes as well you know and and that's why we put that in the story because women have had twins and ended up fine and the twins are fine. And I went into it thinking, oh, they must all die. Of course they're going to die. You know, they don't have a midwife there. They don't have a doctor and they have it. So, but then in other circumstances, they have. I just, I find it pretty amazing. And I think that the hospital system definitely can learn from the fact that women are having breech babies in free births that are fine. And that is something that we should all think about. But, you know, in the way that we approach things like Breach and another... Other kinds of pregnancies that the hospital doesn't, you know, freaks out about. But at the same time, there's reasons that they freak out about those things because there are things that we have learned through science and through the medical system about those kinds of pregnancies. So yeah, I just think that there's a very big chasm between these worlds and it would just be fantastic if we could have a bit of middle ground where, you know, women were respected to have of undisturbed births but had, you know, medical knowledge on hand when needed.
Mel:
[56:22] Yeah. And the truth is is that most births will likely go fine with wherever you are, with whoever you've got. But there's a percentage of time where the birth needs assistance. And, you know, with breach, for example, the thought is is that 70% of breaches, breached births will occur unassisted, spontaneously, without anybody there. Great, 70%. The 30% of time where some knowledge is required on what we should be doing in this situation is where the health professional that's present at the birth can be of assistance. So there's no doubt that most free births will be fine. And that's not what's in contention here. So this is a discussion about the times when it's not and where the line is between the role of external people outside of the woman and the role that they're playing within the free birth world. And is this becoming problematic or not?
Charlotte:
[57:26] Yeah, absolutely. Yeah. Yeah.
Mel:
[57:29] Thanks so much for being here, Charlotte. I reckon we could talk about this topic forever and there's so many little avenues we could go down, but I feel like we've really covered the crux of what your story was about. For those of you who are still with us on this topic, if you're on the mailing list for the Great Birth Rebellion podcast, there is a full page of resources available where you can read all the articles that Charlotte's read and been talking about. The podcast episode that we've been talking about, my personal publications about free birth, academic articles, my PhD. If you want to go deeper into some of the topics that we've been talking about, please know that every woman has a right to choose where and with whom she will have her baby. And we've just added our voice to this discussion on free birth today. So thanks again for being here, Charlotte. And that has been this week's episode of The Great Birth Rebellion. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com and to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @theGreatBirthRebellion. All the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
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