Between a Rock and a Hard Place: Considering “Freebirth” During Covid-19

Abstract

Background: The global coronavirus (Covid-19) pandemic concerns all people, but has a specific effect on those who are expecting a baby during this time. The advice in the UK changed rapidly, with 14 different sets of national guidance issued within 1 month. Individual NHS Trusts released various guidance relating to the withdrawal of homebirth services, the closure of birth centers, restrictions on the number of birth partners (if any) allowed during labor, and whether any visitors were allowed to attend after birth. With the landscape of maternity care changing so rapidly, research was carried out to provide real-time data to capture the lived experiences of expectant families.Methods: A mixed methods online survey was carried out over 2 weeks between 10th and 24th April 2020. The survey was open to those in the third trimester of pregnancy, those who had given birth since the beginning of the “lockdown” period in the UK, and the partners of pregnant women and people who were in these circumstances. The survey asked questions about how respondents' holistic antenatal experiences had been affected, whether their plans for birth had changed, and the effect of these changes on respondents' emotional wellbeing. Of the 1,700 responses received, 72 mentioned that they had seriously considered “freebirthing” (giving birth without a healthcare professional present).Findings: An analysis of the respondents' reasons for considering freebirth was conducted, finding that reasons for considering freebirth were complex and multifaceted. Lesbian, bisexual, pansexual, and queer women were more likely to have considered freebirth than heterosexual people (p < 0.001).Conclusions: Considering giving birth without a healthcare professional present is unusual in the Global North and represents an emerging field of study. The literature examining the reasons that people consider freebirth shows a variety of underlying motivations. A global pandemic represents a new factor in such considerations. The findings from this research can help inform maternity service planning in future crises.

Companionship for women using English maternity services during COVID-19: National and organisational perspectives

“…In the latter case, in some Trusts, ensuring that labour had progressed sufficiently was perceived by some stakeholders to be associated with coercive and invasive practices, such as regular vaginal examinations when women may otherwise not have needed or wanted such examinations. General uncertainty over organisational companionship permissions may also be reflected in anecdotal rises in women choosing to freebirth (20,21), and the issuing of associated RCM guidance to ensure appropriate professional responses (22). Trust policies that restricted companionship until labour was established (or until birth was imminent) seemed to be built on an assumption that companionship was only really needed when labour was very intense, and/or when the birth was imminent so that the birth companion (as the co-parent) could be 'permitted' to witness to the birth of their baby.…”

Giving birth in a Pandemic: Women’s Birth Experiences in England during COVID-19

“…Due to the suspension of NHS-supported home birth services, the RCM reported a surge in expectant women removing themselves from NHS antenatal care and a spike in private midwifery services, with increased numbers of expectant parents avoiding routine and obstetric care in hospitals (Davis, 2020). One study showed that between April and July 2020, one in 20 expectant women were considering giving birth without a doctor or midwife present ('freebirth') in the UK, 3% higher than recorded in 2019 (Greenfield et al, 2021). This qualitative study attributed the increased demand for 'freebirths' to wanting to avoid hospitals, fewer choices in terms of birth preferences (e.g., having a birthing partner present), and practical problems (e.g., inability to use public transport) (Greenfield et al, 2021;.…”

“…One study showed that between April and July 2020, one in 20 expectant women were considering giving birth without a doctor or midwife present ('freebirth') in the UK, 3% higher than recorded in 2019 (Greenfield et al, 2021). This qualitative study attributed the increased demand for 'freebirths' to wanting to avoid hospitals, fewer choices in terms of birth preferences (e.g., having a birthing partner present), and practical problems (e.g., inability to use public transport) (Greenfield et al, 2021;.…”

“…Throughout the pandemic, pregnancy and childbirth have been associated with anxiety and uncertainty for many pregnant women and their partners due in part to the changing landscape of the healthcare system and increased demands on healthcare providers. This has resulted in a number of best practices endorsed by the World Health Organising (WHO) being side-lined as evidenced by reports of women giving birth alone (San Francisco: Human Rights in Childbirth, 2020; Walsh et al, 2020), restrictions being imposed on birthing options (e.g., no water births) (Greenfield et al, 2021; Nelson & Romanis, 2020)), and separation from their baby shortly after birth (San Francisco: Human Rights in Childbirth, 2020).…”

A Qualitative Analysis of Feelings and Experiences Associated With Perinatal Distress During the Covid-19 Pandemic

“…And although a small number of qualitative studies of perinatal mental wellbeing have been published globally during the pandemic, it is di cult to draw comparisons across countries given that government responses to COVID-19 have varied greatly. To our knowledge, the qualitative research conducted in the UK has, so far, focused on very speci c aspects of perinatal experiences (e.g., [37,42]). The current study qualitatively explores broad descriptions of personal experiences of perinatal distress during the rst UK lockdown.…”