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“Free Birth” and the Politics of Childbearing

Black and white photograph of a midwife holding a baby

Last month, a woman using the pseudonym ‘Lisa’ shared on Facebook that her infant daughter had died: ”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.”

Lisa had a post-term pregnancy, lasting forty-two weeks. She experienced complications throughout a six-day labor on her desert property, including an inability to urinate due to her UTI. Attended only by her husband, Lisa did not seek medical support until long after her water broke, and she was concerned by the appearance of an unusual, odorous liquid. After a complicated delivery requiring a vacuum and anesthesiologist, Lisa gave birth to her stillborn child.

Why undertake a six-day labor without seeking medical support? The answer lies with Lisa’s newfound community.  Lisa had joined a 6000-strong Facebook group of women under the aegis of the Free Birth Society. Founded by Emilee Saldaya and Yolande Clark, the Free Birth Society advocates for ‘autonomy’ in giving birth. ‘Autonomy’ in Free Birth parlance appears to be code for ‘isolation’ as much as for individual control.  The website advocates for “wild” birth, as contrasted against “unnecessary interference with this physiological design.”  

Free Birth rejects both obstetrics and midwifery, instead offering coaching packages ranging from $98 USD to $899 with titles such as ”Conscious Conception” and “Radical Birth Keeper.” Membership in the now-defunct Facebook group (to which Lisa belonged) was free. However, strict norms were enforced, which included immediate deletion of comments from users who advised medical assistance when complications arose. This self-regulated online community encouraged Lisa to continue the ‘free-birth’ process throughout the agony of her six days.

The Free Birth Society capitalizes on deep cultural issues around childbirth. The history of medicine does not shine with respect to women’s autonomy. J. Marion Sims, lauded as the father of modern gynecology, performed unanaesthetized operations on nonconsenting slave women. Obstetrics is still fraught when it comes to respecting the autonomy and consent of childbearing individuals. One of the most infamous recent cases was of Caroline Malatesta, whose crowning infant was forced back into her vagina by a nurse for six minutes, resulting in irreparable nerve damage and PTSD. A 2012 study found that the strongest predictor of PTSD from giving birth was conflict with care providers. Often, obstetrics practices can mirror patriarchal paradigms.

In light of these factors, it is easy to see the appeal of a movement that emphasizes women’s control over their own birthing process. Saldaya and Clark offer a vision of birth-positivity, describing it as the “most profound experience of ecstasy, love, power and beauty in our human experience.” Their website seems suffused with joy and even suggests giving birth “naturally” confers esoteric wisdom (Clark speaks of the “deep and hidden truths” of a “secret society”). This emphasis on the subjective experience and knowledge of women who give birth is appealing, as it addresses gaps commonly experienced by obstetric patients. But Free Birth goes further than other critiques, to the extent that it eschews even midwives and doulas who traditionally served as advocates for women-centered birthing paradigms.

Free Birth’s complete rejection of conventional and alternative care providers could be also read in light of an undercurrent of mistrust of experts that runs broader in American culture. On the Free Birth website, there are contradictions reminiscent of other alternative discourses, such as anti-vaccine movement. Multiple references are made to “physiology” and “evidence-based birth” in the abstract, but physiological accounts and citations of specific studies are notably absent.

Saldaya and Clark do not simply encourage women to inform themselves, arm themselves with options, celebrate childbirth, and campaign for better patient-doctor obstetric experiences. Free Birth altogether rejects professional support and knowledge (apart from workshops in ‘Free Birth’) in favor of a sort of mysticism. The claim is that once all interference is removed, the body knows what to do.  

This corporeal yet mystical task of ‘unlearning’ suggests the exploitation of a third cultural trend – the sanctimony of the “mommy wars.” In a world where every reproductive choice a woman makes is weighted by juggling impossibly burdensome roles, Free Birth proposes solo childbirth as one more achievement badge of ‘natural’ motherhood to which women should aspire.

The appeal of the Free Birth Society derives from deep-seated problems around women’s reproductive autonomy. It is understandable why women would be attracted to de-emphasizing the medicalization of childbirth, and to reclaiming its celebration. Unfortunately, as Lisa’s example shows, this desire does not change the fact that childbirth remains a risk in “nature.”

Do women deserve better maternal care around the world? Indubitably, both in the developed world, and especially in developing countries, where for some women, ‘natural’ childbirth is perforce and not an Instagrammable lifestyle. But women also deserve better than Saldaya and Clark’s “secret society.”  While identifying some serious issues, Saldaya and Clark have accepted and reinforced the marginalization which leads women to a radical dichotomy.  A meaningful childbirth and a healthy, living mother and child should not be treated as mutually exclusive outcomes.

Women deserve social transformation that harnesses scientific knowledge, political voice, individual autonomy, subjective experience, and ethics. Instead of alienating women from crucial maternal health support, we need concerted efforts between pregnant individuals, medical care providers, midwives, and society at large to improve knowledge of and adherence to maternity care that respects women’s autonomy.

Male Contraceptives Might Allow For a Shift In Responsibility

Photograph of three different brands of birth control

Women carry the entire burden of childbearing for biological reasons, and the majority of child rearing for social reasons. Before contraceptives, a woman’s sexual freedom was inhibited by the potential for unplanned pregnancy. Despite the invention of contraceptives, men have not and will never have to worry about bearing the physical burden of unplanned pregnancy. For centuries, women were expected to raise children as their career. The first birth control pill was invented in 1950, but the effects of societal pressure on women to raise their children have remained statistically evident. It was not until recent years that women began to choose professional careers over child-raising careers. The invention of contraceptives has allowed women to gain power over their bodies and the choice to have children or not, but is it possible for men to share in more of the responsibility of childbearing? And if so, should they?

According to a Guttmacher Institute study, “60% of all women of reproductive age are currently using a contraceptive method.” Of this number, about 63% of women are using non permanent or hormonal methods such as a birth control pill, a patch, an implant, an injectable, a vaginal ring, or an intrauterine device. Another 22% of women using contraceptives choose sterilization as a means to control pregnancy. Men are contributing to preventing pregnancy by getting vasectomies, and are responsible for 7% of the 60% of pregnancy prevention.

Although the percentage of men and women in the workforce has approached equal over the past century, it is still composed of 53% men and 47% women, and projections say it never will be completely equal. The invention of birth control for women has not resulted in equal gender representation in the workforce, and did not end the societal expectation and pressures placed upon women to raise children in place of having a career.

Although accidental pregnancies affect both partners, women are the ones who will bear the physical burden. In order for women to have the same sexual freedom as men, they have no choice but to use contraceptive measures. However, birth control does not come without both physical and financial costs. Each form of contraception has its own benefits and detriments, all of which impact only women.The birth control pill, the most common form of contraception, has a common list of side effects that women may experience. Common among these are nausea, breast tenderness, headaches and migraines, weight gain, mood changes, missed periods, and decreased libido. In addition, birth control is not free for all. Only those who have insurance that covers birth control have access to it at no charge. There is no doubt that birth control pills, among other forms of contraception, are a burden on whomever chooses to use them.

In 2000, 450 men were surveyed from Edinburgh, Cape Town, Shanghai, and Hong Kong. Depending on the group surveyed, 44-83% said they would take a male birth control pill. There have been several male contraceptives developed and tested, yet none have reached the market. In 2016, a study was done on 320 men to test a male hormonal birth control shot. The subjects, ages 18-45, all had normal sperm cell counts, and were injected with synthetic testosterone and a derivative of the female hormones progesterone and estrogen. The drug was designed to stop their production of testosterone and sperm. The experiment found the contraceptive to be effective for approximately 96% of users. Common side effects participants experienced were acne, increased libido, pain at the injection site, and muscle pain. The study ended early because of several cases of more serious side effects of depression and irregular heartbeat. However, in these cases, the correlation between the injection and the side effects has been debated for various reasons. This study is one example of multiple; yet, in 2018, male birth control has yet to be introduced to the general public. Although a male birth control pill is in testing stages, it seems there has not been enough demand from the public to result in its creation before now.

Biologically, women have more to be concerned with in the case of an unplanned pregnancy than men. Does this mean that women should have more responsibility to prevent unwanted pregnancies than men? Men cannot be forced to take a birth control pill, but perhaps society should exert more pressure on them to take greater responsibility in preventing unwanted pregnancies. Should a mother’s responsibility to her child be greater than the father’s because of her biology? Or should men and women should share the responsibility of preventing pregnancy more equally?

This is the problem: there is a large demographic of individuals that wish to avoid pregnancy. This is a solution: contraception. Should women have the responsibility for the majority of the solution? A University of Washington Medical Center endocrinologist summarized the issue when he said:  “It’s hard to solve a problem when you essentially exclude half the world’s population from doing anything about it.”