Some weeks before I gave birth to our sixth child at home, a discussion I had never seen in Norwegian Media popped up: How, where, and with whom should Norwegian women give birth?
In Norway homebirths are rare and expensive. We talk about 139 planned homebirths in 2023- which is actually an increase, costing 29000 - 35000 Norwegian kroner for a midwife's assistance. Unplanned births outside birth institutions are more common. 171 women gave birth under transportation, explained by the ongoing closure of birth institutions. 3 of 4 birth institutions have closed since 1967, a decrease from 182 birth institutions to the 48 we have today. In addition to this many birth clinics are closed during summer time. The closing of smaller clinics is described as a necessary measure to ensure high quality in maternity care: There are not enough births for midwives working there to maintain their skills. A long distance will naturally create distress and worry for parents. While 171 human females found themselves giving birth in their car, ambulance, helicopter, ambulance-boat or taxi in 2023, female cows were protected by the Norwegian law who stated that they are not allowed to be transported during birth. Midwife associations and other birth professionals have for many years highlighted the discrepancy between theory and praxis regarding women's positions, welfare and rights regarding birth, its severe consequences, and demanded concrete changes.
Now we see that mothers are seeking together to handle traumatic birth experiences, feelings of distrust and disappointment, and to strengthen their intuition concerning pregnancy, birth and motherhood. A Norwegian newspaper reported from such a gathering. Some of the women had given birth unassisted by professionals, and others were preparing for the same. What followed this reportage were midwives and obstetricians' warnings: “Romanticization of freebirth is potentially life dangerous” and “Several pregnant women refuse check-up routines. Midwives warn.” Birth professionals have experienced births with tragic ends. Even at hospitals communicated to parents as the safest place to be for birth, with the most fancy equipments, babies die. Parents bring their stories to the news hoping that will help to prevent the same from happening to others. I can't imagine how hard it must be for parents to loose a child due to what is afterwards defined as 'system failure.' Maybe the mother time and time again tried to be heard about what her strong intuition told her, or she got pushed into procedures which caused a chain of events that led to a baby without heartbeat. Despite this being some women's reality, these midwives chose ridicule while trying to get mothers 'on the right track': “Birth influencers without medical background whitewash the message about birth, and pack it in incense, green tea and sense of freedom.” The woman in charge of the women's circle answered so brilliantly:
‘It’s nice that you as professionals acknowledge that increasingly strict national guidelines and a feeling of “assembly line” can lead to bad birth experiences and lack of trust towards the system. But do you see that the way you communicate can be perceived as condescending, and perhaps reinforces the development you flag as scary?”
- Maria (my translation)
"Things can happen at home as well. Babies die at hospitals and babies die outside hospitals. (...) If that's part of my life history I would rather that to happen at home with me alone and my family, than at a hospital. When you give birth to a life, you also give birth to a death. Society has totally lost the acceptance of death.
- Kristin (my translation)
"If you turn it around, I found it irresponsible not to listen to myself and my body's signals during birth, but rather to listen to what someone outside of myself had to tell me. That's not taking responibility, it's giving away responsibility. The most important thing is that women give birth where she feels safest. Wether it is in hospital or at home - there are several people in the circle who agree on that."
- Helene (My translation)
I understand the freebirth awakening as a growing awareness, a renaissance for the mother's intuition. We see healthy women with uncomplicated pregnancies taking charge of their births by embracing it as the natural process it is, first and foremost. I heard during a one hour conventional online birth course by a midwive that when we finally entered the hospital, we '..could hand over the responsibility.' The freebirth awakening is about more women wanting to keep the responsibility for their births. Women who make sure that they have firm knowledge, and that they are well prepared for several scenarios. The critique these women face reveals an underlying distrust. Thinking about- and expecting the worst of a woman close to giving birth is not how to create trust, neither is it a productive way to make a birthing woman seeing this individual's presence as a positive contribution. Professionals' belittling of 'non-cooperative' mothers creates distance, walls, avoidance. The critics have to see the whole picture from the mothers' standpoint: They as birth professionals are here for us to give birth to our babies. They come out from our bodies. We are not in their presence to make their day at work smooth, or to sooth their fear of what may happen to us. So what is a more productive way to make sure 'all women' choose to give birth with the attendance of professionals?
Research shows that for healthy women with normal pregnancies, homebirth is safer than (or just as safe as) hospital birth. This fact is a central argument for midwife-activists like the author of the book “Barselbrølet” and the founder of “Birthrights Norway” who want to see homebirths as part of Public Maternity care. Imagine homebirth with a midwife being accessible for women who want it, if they escape the high-risk pregnancy factors. Amongst the women facing restrictions are women over 37, like myself. The midwife behind Birthrights Norway explains this age limit as a systemic hindrance from taking women’s wishes and needs seriously. Her text is so brilliant that I have to translate a part of it:
Women are increasingly talking about disrespectful treatment when they are about to give birth to their child in the hospital. They experience what is defined as obstetric violence. We therefore need guidelines that make health personnel who do not comply with the law more accountable.
The law states that women have the right to caring treatment, the right to information adapted to every single one, and professionally updated at all times. Informed consent. The right to say no. The right to say yes. The right to refrain from information. The right to change one's mind. The right to care and security.
Research will always be assessed differently. The view of what is best practice will always be up for debate. People will always have different acceptance of risk and different understandings of what is safe. That is why our rights as patients are important. AND our rights as human beings.
- Cathrine (My translation)
She received what I read as a cold and disciplining academic reply from six midwifes, doctors, and professors; three of them with PhD, criticizing her for misusing the term 'obstetric violence.' They mean that '..readers will get the wrong impression that violence is used in the Maternal Care in Norway." Therefore the term obstetric violence '..shouldn't be used in a scholarly discussion about health risk for mothers and children. Such a disagreement should as other scholarly discussions be discussed on the basis of objective facts and statistics' (my translation). Of course the midwife who finds herself on the barricades for choosing to listen closely to what mothers are saying, and therefore prirotizing the dignity and autonomy of every birthing woman before the institutionalized illusion that different forms of violence doesn't exist at Norwegian birth clinics as well, gave an amazing reply This is my translation of two parts:
"I believe that the concept of obstetric violence and its consequences are more undercommunicated than misused. Those who have experienced being treated badly and who struggle with varying degrees of ailments afterwards find it difficult to get recognition for their experiences. Both the experiences themselves and the lack of recognition afterwards can very likely lead to poorer mental health. Women who share their stories also tell of years of therapy, diagnoses such as PTSD, severe depression and anxiety after childbirth."
"I will not stop referring to women's descriptions of what they have experienced related to their birth. I will not stop supporting women and acknowledging their experiences. I will not undermine their description that contains the word "violence" by calling it something else. In my opinion, we have everything to gain by acknowledging women's use of words when they talk about their experiences. Recognition leads to trust, which we desperately need to correct that which is not right within maternity care."
- Cathrine
Maternity care and women's health in general are suffering from disinterest, decreasing budgets and business models that value medical intervention and surgery over natural births. It's so utterly sad that this hinders what could have been with all the knowledge and traditions allready incorporated. The more I read and reflect, the more I realize how blessed I have been for having five good birth experiences at two different hospitals. I had caring midwives who showed respect for my wish for a natural, unmedicated birth. They encouraged the natural process of birth to unfold by itself. They somehow managed to keep hidden from us the exhausting system they work under, with a chronic lack of midwives and long shifts. I stayed two nights at the hospital before going home, despite my inner wish to just stay home for both birth and the post-birth bubble. There is no place like home. It wasn't before I moved abroad and eventually found myself pregnant again that homebirth became an option I considered for real. I hadn't heard about the concept of freebirth before I got a book with the same name recommended by a sister in our neighbour city, written by the German doctor Sarah Schmid. A highly relevant book for all pregnant women, regardless of where they plan to give birth. Her book is commented by the retired midwife, author and researcher dr Sara Wickham.
I pray to Allah that He protects all women from all forms of obstretric violence, that He gives us and our daughters all the knowledge we need to feel prepared, relaxed and full of joy and excitement for the birth of our babies, and that He brings our society back on track by incorporating the home as a natural place to give birth for the healthy women who want, with assistance by individuals of their choice.
