Some women are choosing to have their babies at home without the help of a medical professional, writes Alanah Eriksen.
When Moby came into the world in his parents' living room with the umbilical cord wrapped around his shoulders, his mother, Marnie Hillier, calmly untangled him.
There was no midwife or doctor in the room to guide her through those critical first few seconds and the mum-of-three does not have a medical background. But she didn't panic. Moby still hadn't let out a sound so Hillier turned him over on to his stomach and gently rubbed his back until he cried.
Hillier is among a tiny group of Kiwi mums who have had a freebirth - when women choose to labour and deliver their babies at home without any medical assistance.
Her journey to go it alone started during pregnancy - she decided against getting any recommended follow-up scans after being told Moby was measuring big, she didn't have the routine gestational diabetes test and when it came to checking what position the baby was in, in case he was breech, she learned how to do so herself. When it came to labour, she measured her own dilation, decided when to start pushing, pulled her baby out, cut his umbilical cord and tied the stump, and birthed the placenta on her own.
Hillier had a midwife but the plan was to not let her know she had gone into labour until after Moby had been born in their lounge, with only her husband, Steve, their two young sons and a birth photographer present.
Although it's hard to gauge exactly how many of New Zealand's home births (3.6 per cent of total births) are freebirths, Home Birth Aotearoa says the conversation around them has become "louder" and increased concern about the risks of birthing in hospital amid the pandemic has meant more interest in home births generally. But the practice is not supported by the professional bodies that represent New Zealand's midwives and obstetricians who warn of unexpected emergencies.
Hillier had already had two home births - with a midwife present - with her eldest boys, River, 5, and Mack, 3. She wanted to take the next step and birth "in a primal state whereby the mother surrenders to and fully trusts in the incredible and intricate mechanisms of birth that are a dance between her and her baby".
"I wanted to know, what would birth be like if I completely trusted my body and my baby? What would birth look like if I saw myself as the expert, rather than look to external experts who, yes absolutely have incredible training and experience, but do not have the connection that I do to my body and my baby. I think these days we are so in our heads and so disconnected from our bodies. Since becoming pregnant with my eldest I found I naturally wasn't afraid of birth…"
Hillier, who lives in Waipū in Northland, was aware of the potential backlash she might face so was selective in who she told of her birth plans. "I am a huge believer in a mother keeping her headspace free of other people's opinions when pregnant. I have a handful of friends who either are passionate about physiological birth or who I knew wouldn't project any fears, if they had them, on to me and they were the ones I chose to talk to about it, seek guidance from."
'As hands-off as possible'
At around 12 weeks pregnant she was still planning to have a regular home birth so found a local midwife. But at 20 weeks, she started seriously thinking about birthing unassisted. "I was nervous to talk to my midwife about this as I didn't want her feeling that I didn't value her skills or knowledge... I have tremendous respect and admiration for midwives. However, she was very supportive and the understanding was that I would continue to see her during my pregnancy to ensure that nothing came up that would indicate a risk during birth and that if there was any point during the birth that I decided I would like support then she would only be 10 minutes away."
Hillier, who owns a clothing brand, joined a freebirthing Facebook page which had about 3000 women in it from around the world and read hundreds of freebirth stories about "how they confronted their fears, how they got their mindsets back on track when they experienced things like labour slowing down, or very intense physical sensations".
She chose to have just one scan, at 20 weeks, foregoing the standard early dating scan at about eight weeks and the 12-week early anatomy scan. She was told by the ultrasound technician Moby was measuring large and he recommended further scans to keep an eye on his growth.
But Hillier wasn't concerned as her husband, Steve, is over six feet tall and has long legs that he has passed on to his sons which she believes skews size predictions. River and Mack were born just under nine pounds. "I am all too aware through my interactions with so many mothers on my social media the scaremongering that goes with big babies… but whether or not my baby was big didn't worry me."
She chose not to have the standard diabetes test done between 24 and 28 weeks as she had no indicators that it might be an issue. She only let her midwife check her blood pressure and listen to the baby's heartbeat. "Essentially I wanted as hands-off a pregnancy as possible. I think being told that he was measuring big and the mention of further scans did play into my decision to step away from any further monitoring through the pregnancy and towards my decision to birth unassisted."
Hillier went into labour at 40 weeks but it wasn't until the next day that contractions ramped up. "Once the big boys woke up we had a pretty normal morning, porridge for breakfast, stories, all the usual – just with me pausing for a contraction every five to 10 minutes. I was totally relaxed and can remember laughing at how wonderfully normal a day it was. To be labouring in the midst of my household living their lives."
She checked how dilated she was just once - when she was six centimetres. "I laboured in the pool for a few hours with my 3-year-old son jumping in and out to have a swim or a chat – I even got a lovely back rub from him."
At one point, she started to feel disoriented and second-guessed how far along she was. But after a quick break outside, she immediately felt the need to push and her waters broke. "From that moment I could feel Moby's head and Steve said that a huge grin spread across my face. I felt absolutely amazing, I let out these huge roars with every surge and in a few minutes could feel his little ears coming out. It was such a profound and unforgettable moment, really connecting with the human that had grown inside my body and actually feeling him so viscerally make his way into the world."
Moby was born after three to four pushes at 6.34pm, weighing a healthy eight pound four ounces.
"My favourite part was pushing… Feeling his little soft ears. Wow, I will never forget that moment and have many many times since felt the tops of his ears in wonder."
But, seeing that he was entangled in his cord, her job was not done. "I didn't at all panic as I knew that this was very normal and that he was still getting oxygen via the cord. I slowly unwound the cord and brought him up to my chest. After a few seconds when he hadn't let out a sound I rested his chest on my palm and gently rubbed his back. Again, I wasn't concerned and knew that it was normal for some babies to take a minute to adjust to this big new world. It took a few more seconds and he gave a wonderful big cry. Right at this moment my 3-year-old son charged into the room and jumped into the pool. My 5-year-old also arrived but just peeked from the periphery."
The couple let Hillier's midwife know that Moby had arrived safely. She came to their house about an hour after he was born but he was sleeping so his newborn checks didn't happen until the next visit.
About two hours after the birth she cut Moby's cord. "I just lay him on the couch between my legs and cut the cord and tied it off myself with a muka pito tie, a woven flax tie."
Hillier still hadn't birthed the placenta but didn't stress as she was feeling well and didn't have bleeding. "Again through my research and the Freebirth Facebook page I'd heard from many mothers whose placentas had taken a few hours to release and that this in itself doesn't indicate anything risky."
It finally released when she went to the bathroom and the family froze it and have plans to plant it under a special tree.
'Labour can be unpredictable'
Although she was intent on having a freebirth, Hillier had a back-up plan should she need it. "If there was ever a point where I felt that something wasn't going right, or there was an indication that the baby was in distress - reduced movements, bleeding - the plan was to get in touch with my midwife and go from there."
The New Zealand College of Midwives' stance on freebirth is pretty clear. "Labour and birth can be unpredictable, and the college does not recommend birthing without the attendance of a health practitioner who has been specifically trained in recognising and responding to obstetric emergencies," says college midwifery adviser Jacqui Anderson.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists' opinion is similar. "The safest place to give birth is a hospital or birthing unit, where highly trained midwives and doctors can care for women, and facilities are available if they or their baby become unwell," says vice-president Dr John Tait. "RANZCOG strongly recommends that women do not plan to have unassisted births because of the significant risks for both mother and baby."
Tait adds, "Women who are considering a home birth should receive accurate and evidence-based information about the benefits and risks to enable informed decision-making, and be assessed by a midwife or doctor for risk factors that may impact on the choice of birth approach. A decision to give birth at home must be taken in the knowledge that there are fewer resources available for the management of sudden, unexpected complications and that these complications may affect any pregnancy or birth – even those without any known obstetric risk factors."
Home Birth Aotearoa, which has a contract with the Ministry of Health to encourage more women to birth at home, says women are feeling more empowered in birth.
"The conversation around freebirth has become louder as more women recognise that they should have rights in birth, they are aware of their right to informed consent and that is also the right to informed refusal," a spokeswoman says.
But for some women, freebirthing has been a last resort due to a maternity system under "increasing unrelieved pressure". "Equitable access to midwifery partnerships is challenging for some women. It is likely that this stems from an undervalued midwifery workforce that is not funded to meet the demands of the maternity service. This results in disillusioned and disheartened birth givers who are unable to have their care needs met and in many instances are struggling to even find an LMC [lead maternity carer]."
During the March/April 2020 lockdown, the group saw a significant increase to its local home birth social media pages, as well as a surge in inquiries for pool hire. "There was an increased concern among whānau about the possible risks of birthing in hospital, which seemed to equate to more interest in home births."
The group doesn't have a collective stance on freebirthing, saying members' views differ, although the spokeswoman encourages women to do their research, analyse the risks and consider a home birth using a midwife.
A survey of women across the Tasman about their experience of maternity care during the peak of Covid-19 showed 26 per cent reconsidered where they wanted to give birth and who provided their care. Of those, most home birthed but about 3 per cent chose to freebirth, which the authors in the Australian College of Midwives study called "concerning".
Some said they viewed it as a better option to birthing in hospital in light of the pandemic. "While there has been some discussion relating to this growing trend over the last decade, the numbers of women seeking this option have remained relatively low," the authors of the survey wrote. "However, our results reflect an increase in response to the pandemic and we suspect that the number is likely to be higher based on women suggesting that there had been a lot of discussion in pregnancy and birth forums about women intending to freebirth. It is clear that women will seek freebirth where they feel their self-determination and autonomy are threatened."
One woman told the study: "I can feel my mental health slipping with all of the uncertainty… I'd prefer to stay in my isolation and freebirth so that I can have the support of my mother-in-law."
Hillier wouldn't change a thing about the birth of her third son, who is now a thriving 5-month-old.
"With every one of my births, I've learned more about myself and I think the lesson with this birth was again that trust in the process. During that time I was confused and thought things should've been more intense or harder, I realise I was just needing to trust that this birth, like the baby that was being born, was just more peaceful than my last births."