Episode 8 - Giving Birth at Home
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 episode eight of the Great Birth rebellion i have invited one of my amazing friends so this is what i've been doing with guests lately is i've been trying to interview them based on what i know of them and then i'm gonna let you fill in the gaps amazing so yes Aimee Aroha is here with me today and
Mel:
[0:46] you may know her from her instagram presence at rip snorter it's a good totally prepared i.
Aimee:
[0:55] Can't dare to let it go So
Mel:
[0:57] How did it come about? I'm interested.
Aimee:
[0:59] Rip snorter is like have a rip snorter of a day. It's Australian slang, right, which means good or excellent or whatever. And when I started getting, when I started Instagram, I was like, oh, just what's the first thing that pops in my head? Have a rip snorter of a day, rip snorter. And then like 10 years on and I've built a pretty massive community on there. And my career is like very much channeled through there and it's remained. So it's really just holding on strong and I can't bear to let it go. I've got some weird attachment to it.
Mel:
[1:29] Well, you can't change it now because people won't know who you are.
Aimee:
[1:34] Aimee Aroha, who the hell is that?
Mel:
[1:37] Yes. So, Aimee, I met Aimee because I was her midwife for her second baby. And I've invited Aimee because I want to talk about giving birth at home. We did touch on this in Episode 2 of The Great Birth Rebellion, But I wanted to dedicate an episode to birthing at home. Well, partly because I'm a home birth midwife. I had my babies at home. Bea had her babies at home. Aimee had her last two babies at home and first one in hospitals. And Aimee's had a variety of experiences. One baby born in hospital, one baby born at home intended to be accompanied by a midwife, but, you know, her buddy had other ideas. They gave birth before the midwife arrived by about, I think, 10 minutes or so. Yeah. And then a third baby planned to be at home with just her and her family. So Aimee now lives in beautiful Byron Shire. Is that what we call it?
Aimee:
[2:37] Northern Rivers.
Mel:
[2:38] Northern Rivers with her family, three children, and Nick.
Aimee:
[2:44] My beautiful partner, Nick.
Mel:
[2:46] What's his Instagram? Nick.
Aimee:
[2:48] Nick Potts. Nick W. Potts. He's an amazing artist and dad. Correct. Such a good daddy.
Mel:
[2:54] So many muscles too on Instagram.
Aimee:
[2:57] Oh, my God, you saw.
Mel:
[2:59] Is he working on himself?
Aimee:
[3:00] It's literally from carrying babies.
Mel:
[3:03] Holy moly.
Aimee:
[3:04] Literally from carrying babies. A little bit of surfing, but mostly baby carrying.
Mel:
[3:09] And also homesteading because you guys are getting hard into homesteading now, right?
Aimee:
[3:15] Yeah.
Mel:
[3:15] By the way, I think homesteading comes alongside homeschooling because you're homeschooling as well and home birthing. It's just this natural flow, it seems to make sense in... With this lifestyle. You're also, is it transpersonal counselling?
Aimee:
[3:34] Yep, transpersonal, holistic transpersonal counselling and birth mentoring.
Mel:
[3:38] Can you explain what holistic transpersonal counselling is?
Aimee:
[3:43] So holistic, obviously looking at the whole picture, the whole health of a person and transpersonal means to go beyond the ego. So beyond the personal identity and into more unconscious layers of our human experience as well as esoteric so the spiritual aspect of our lives and how we experience our lives so transpersonal goes really hand in hand with art therapy because we use art as a medium and that can be art as you know drawing painting writing music movement to tap into this other aspect of ourselves and learn more about ourselves through that lens Mm-hmm.
Mel:
[4:22] And you're also moving into serving the birthing community. And where do you see your place in that?
Aimee:
[4:30] It's been, it's always rolling, right? Like it's always changing and evolving. I thought I was a doula at first. And then I realized I, when I was showing up in that space, we were doing really, really deep connected work around like the psycho-spiritual, psychosocial aspects of birth. So what was naturally and organically coming through in our prenatal sessions was, you know, this is how I was born and this is the way I feel that that's imprinted me or affecting me in my life. Or these are, you know, some stories that my family have been carrying for many generations that I feel are coming through for me right now that I want to process and break so I don't pass it on to my child. And so then I sort of moved into more like pre and postnatal care from a psychosocial, psychospiritual perspective. So supporting people to look at those cycles that have been present in their families for a long time and helping them or witnessing them in working through it so that they can free themselves from that before they bring their children in. And that doesn't necessarily mean that's gone forever, that cycle, but just becoming aware of it and noticing where that's coming up so that they can parent their children and birth their children in a more liberated way.
Mel:
[5:41] So today, and you know, we chatted earlier because you're putting a course together about liberating birth. And I feel like, and you're doing a lot of work in the space of decolonization in general. But also specifically decolonizing birth. So we're going to use that as a starting point, I think, because I feel like the colonization of society, it's trickled down to birth, obviously, as everything always does because birth is part of life. So could you talk us through what is colonization? Because I think most Australians don't think about colonization. Do you have like a bite-sized explanation?
Aimee:
[6:25] I think I'll probably start with decolonisation. So decolonisation isn't necessarily going back to a pre-colonial society. It's really understanding that the paradigm or the systems that are in place are in place through a colonial lens, right? So they've been established from colonisation. Australia is a very new country in how we understand it. It's an ancient country with an ancient peoples. But very recently in terms of history, it's been colonised. So we understand the systems that were built from that colonization as being sort of the only way. This is the way things are. This is the way things have always been. But of course, that's not true. There are ancient traditional societies all around the world that are experiencing colonization in varying ways who have been here long before the world as we understand it. So I think decolonizing is the process of starting to understand that we see things through a particular lens. I'm talking we collectively, obviously there's so much within that, but that's kind of how colonization, that's how these systems work is by placing
Aimee:
[7:33] one way or one lens above all others. And actually this is the right way and this is how we do things because this is just how it is and what works. We have to be able to have conversations about colonization.
Aimee:
[7:45] How these systems are actually really new and are failing a lot of people in society and, of course, in the context of birth, failing women and birthing people.
Mel:
[7:56] I feel like when we talk about the colonisation of society and how to decolonise it and how there's one perspective that gets sold as the right and best way to be, it really rings similar to what's happened to birth in terms of how it's been medicalised. So in the same way as, I guess, society has been westernised through the process of colonisation and this perspective of there being only one right and correct way, birth has also been colonised or medicalised by an industry that wants to sell birth as dangerous and scary. And, yeah, so I see the two as very much connected.
Aimee:
[8:37] Well, the industrialization of birth is like inherently linked to colonization as a whole. It's just another way of at another place that colonization manifests. And I can speak from my lineage. My ancestry is Māori, so I'm on my paternal line from tribes of Tararua and Napui. And we were only recently colonized. And over time, through that process, we went from being a people's that birth was very normal. We were very fertile. We birthed at home in our family systems. We had our traditional birth keepers or healers, tohunga, there with us. And then there was a very concerted push to take birth out of the home and to put it into the institution.
Aimee:
[9:18] So Mali women were, you know, it started out as a push for reasons such as you're not going to be able to register your child. And you have to be able to register your child for that child to be considered legitimate and for you to be able to access resources or financial support, for instance. And so... They would be pushed out of the home and into the hospital. Then they started criminalizing our traditional birth keepers. So it was punishable by law to be tohunga, to be a healer. So our traditional birth keepers were unable to practice and attend birth. So that's another way that through colonization, we were pushed into the hospital system. So over a pretty short period of time, we went from birth being this normal experience that was a family and community experience to being a very sterile, institutionalized medical event that was incredibly traumatizing. So that was where, you know, we were pushed on our backs. We were medicated. All of these things were completely foreign concepts. We'd been birthing, being held up, squatting, you know, being held by our aunties, our mothers, our sisters, being out on the birthing tree. And so colonization has a direct, has had a direct impact on indigenous women and peoples around the world. But of course, everybody, because then that becomes the system. That's the normal system that we believe or are told is like the right way, the safest way, the only way.
Mel:
[10:39] This is a term that, so there's a term that describes this and I feel like I'm the only one that bangs on about it.
Mel:
[10:46] And when I heard this term, when I was doing my PhD, because my PhD was in birth outside the system, there's a term called authoritative knowledge. And this, I feel like this is what describes exactly what's happened with colonization, with industrialization and with medicalization. And we'll define those terms further in a moment. But when you medicalize something, it's to make it, it's to turn it into something medical where it wasn't before. Birth has been made medical. It wasn't before. There was a time where birth was not considered medical. And so this term authoritative knowledge is a term that describes how a particular idea and a particular philosophy becomes the authority. So there's a process by which a certain message or understanding becomes the authoritative message in society. And the idea behind authoritative knowledge is not that it's true. It doesn't have to be true to be authoritative. It just has to be accepted by the majority. It has to, whoever holds the authoritative knowledge also holds power. So it's more of a power thing. So whoever is in power puts forward their perspective on something. So if we think about it as birth, medical people are in charge of birth and they tell everybody that birth is a medical event that's scary and that needs expert supervision and without it, you're all in danger.
Aimee:
[12:14] Mm-hmm.
Mel:
[12:14] And then anybody who opposes the authoritative message gets positioned as stupid, idiotic, irrelevant, fringe dwellers, rebellious, and they're considered outside of society. And so this is what happens to women who make birth choices as well that are outside of the authoritative system in Australia. So the authoritative system is 93% of women have their babies within a hospital institution. About 6% have them in birth centers and there's less than 1% who have their babies at home. And then there's a portion who choose to free birth. So the people who don't go to these birthing institutions are considered to be rebels against the authoritative message of birth.
Aimee:
[13:01] It's exactly, I mean, it's a framework. It's a way to gain power and it's a way to have people, you know, you don't need to be policed anymore or you don't need to be have the system coming to your door like my ancestors experience and having you know removing you from your home or like indigenous people still are here in this on this land it's now a cultural thing it's a cultural upholding of this because to birth at home or to go against the authoritative knowledge is as you said you're a heretic right like you're um you're the odd one out um and so the people around us are upholding that that knowledge, that type of knowledge. And yet it's so deeply entrenched and woven through the fabric of our society. And that's much like, you know, experiences of indigenous peoples around the world through the lens of white supremacy is, well, okay, you can be indigenous, but you still have to be able to fit into this framework. You have to assimilate into the colonized way.
Mel:
[13:55] And anybody who doesn't is considered wrong because the authoritative knowledge and the people in power are considered to be right. But the thing with authoritative knowledge is that it's not necessarily true. It's just the story that everyone believes. And so if you don't believe it, if 95% of the people believe that story, they're like, well, yeah, everybody does it that way. That's what everybody believes. It must be right. It must be the best. Otherwise, why would we be doing it? I mean, it's a form of slow, systematic brainwashing.
Aimee:
[14:28] Literally.
Mel:
[14:29] And then somehow there's a small proportion who kind of look around and go, why are we all going to hospital to give birth? Like why are we all living in this white Western way? Why is that better? And then we start to scratch at the surface. None of the research supports this message that giving birth in the hospital is the best and safest.
Mel:
[14:50] There's no great conclusive evidence that if you're a well-healthy woman with a well-healthy baby that being at hospital is the best, but that's the cultural
Mel:
[14:58] understanding of birth and somehow it's considered to be right. So I want to go there. So, well, this episode, we're going to talk about giving birth at home, which for all intents and purposes really is a decision against the authoritative knowledge of today, of the birthing message that we're sold today. So if we think about what is the authoritative message that we're told, and the authoritative message is that hospital is the best place to have a baby because that's the safest because birth goes wrong and if it does go wrong you want to have the best experts there to save you and your baby from certain death or disability. So that's what everyone thinks about birth is that it's fundamentally dangerous and so just to be safe go to the place where all of the experts are with all the machines and the surgery and hands and knowledge.
Mel:
[15:49] So that's the authoritative message. So then women choose to give birth at home in that context. So when you choose to give birth at home, the first thing that people say is, oh my gosh, aren't you scared? Or wow, you're brave for making these decisions because it's against the authoritative knowledge and people can't even comprehend how you could possibly be safe by giving birth at home. So I'm wondering if you could tell us about your decision to give birth at home with a midwife for the second birth.
Aimee:
[16:21] Yeah. So when I, I mean, I was 24, 25 when I had my eldest daughter. And for me, I never had any fear around birth. I always just thought birth was this thing that we did and it was totally fine and normal. And why wouldn't I be able to give birth? But I also didn't consider that there could be any other way than just doing it in the hospital because that's what everybody did. And I had my birth experience. I labored for 15 hours basically by myself at home. And when my partner at the time came home and we labored together for a while. I didn't want to go to hospital. I actually, at one point, and I believe that I was really nearing or in transition, ran up the stairs to the bedroom and was on all fours and he had to call the midwife and I didn't want to go. And that was a very primal thing. I ended up going. At the time, felt that I had a really easeful, perfect birth experience. I was only in hospital for 20 minutes. I didn't even go into the birth suite. I was in an examination room, I'm still wearing my dress and birthed my baby without a tear,
Aimee:
[17:23] without any drugs. So for me, that was a brilliant experience. It wasn't until many years later and sort of expanding myself as a woman and how I lived and viewed the world that I looked back.
Aimee:
[17:36] And realized that there were things that happened that didn't need to happen and that my body was actually holding like a level of, hey, I don't want to use trauma because I think that's too extreme for what I was experiencing, but definitely holding a memory. So for me, that was having a non-consensual vaginal exam during a contraction where I was saying no. Afterwards, I was given a catheter for no reason other than they gave me Sinto to bring the placenta out. So learning more, becoming more of who I am, looking back with a different lens, noticing things differently. So when it came time to birth seven, it was six years on and I had drastically changed my life. I was living off grid up in the Blue Mountains and, you know, I've always been pretty anti-establishment. I tend not to, you know, engage western medicine like unless I really have to or really feel that that's the right thing to do um so why would I birth my baby in in a hospital it was essentially not even a conversation with my partner it was just obviously we're going to birth this baby at home this is how we live why would we birth any different and yes it was actually a really at that time a really easy decision to come to and then of course we reached out to you and connected with you and the rest is history so they say. But for us, it was a really clear decision.
Mel:
[19:02] Yes. And so there's that decision to give birth at home. And I'll probably, let's use this opportunity to sort of talk to women about how birth at home works. Can happen here in Australia because it's very different all around the world. There's some countries who embed home birth into their current birthing systems and actually midwives who work in hospitals and in the healthcare system can attend women at home. That happens in the UK. I'm pretty sure that happens in New Zealand as well.
Mel:
[19:31] Yeah, you can have your baby at home with a publicly employed midwife. Here in Australia, there are some home birth programs. I think There's about 14 or 16 in the whole country. And I believe that they will expand those over time, but that's a bit tricky. But again, in Australia, if you want to have a publicly funded home birth, you would have to be close to a public hospital that has a home birth program. You have to fit their criteria for getting in. So the criteria is quite strict in the sense that you can't have any risk factors in your pregnancy or for your baby that might introduce some complexity into your pregnancy then if you can't get into the public home birth programs the next option is to hire a private midwife to be your personal midwife and some private midwives can come with you wherever you choose to go so in Queensland they've got a pretty sweet deal a lot of the midwives can get access to hospitals and have visiting rights where you could hire a private midwife and basically say, I want to go to this hospital or I want to have my baby at home. And those midwives can follow women to where they want to give birth. It's a pretty sweet spot in Queensland from what I understand, but the rest of the country doesn't have that amazing situation.
Mel:
[20:49] Here in New South Wales, there's one hospital where midwives can have visiting rights if women want to hire a private midwife to go in hospital. Otherwise, if you hire a private midwife, You can give birth at home with that midwife as a care provider or you can go to hospital but the midwives are not allowed to work as midwives in a hospital. It's illegally against our registration to provide midwifery care in a hospital if you don't have visiting rights. And then the catch with private midwives, obviously, like any private practitioner, is there's not a lot of public funding attached to it. So women have to pay out of pocket to hire this person to care for them.
Mel:
[21:30] Medicare does cover a portion of the fee if women want to hire a private midwife to be with them for birth. And the reason why women choose private midwives over a public system is firstly, there's not a lot of public home birth programs available. Secondly, a lot of these women get risked out of public home birth programs. So if you have any kind of risk factor that doesn't fit in with what they're allowed to do, you just can't stay on the program or you can't go on the program. So then women come to private midwives who have fewer restrictions. We do have to work to the Australian College of Midwives guidelines but there's wiggle room in there because women still have the right to decline certain things and we have to do a lot of paperwork for these women who end up making decisions that are at what we call outside the guidelines and so midwives on the whole private midwives are really happy to do all this paperwork and give women education about their unique complexities so that they can make decisions about what they want to do. So it's not that we can't look after these women. We can. So that's kind of how you access a home birth in Australia. And then there's a portion of women who don't want any of that. None of the hospital system, no private midwives, no public home birth programs. They just want to have their babies at home without a care provider. We'll talk about that too. But the thing I forgot to mention is, sorry, I'm doing a lot of talking here.
Aimee:
[22:55] Love it. It's like I'm in a workshop. Keep going.
Mel:
[22:59] Um, so this, the message that's sold about home birth is, whoa, that must be dangerous because birth is dangerous and that's why we all go to hospital. So why the hell would you stay at home?
Aimee:
[23:11] Yeah.
Mel:
[23:11] Well, we have a stack of research. That's why. And that's why I've been a home birth midwife for 15 years because I can see that it is actually safe most of the time. I'm going to get mail about that now because people like some babies do die. Some babies do get injured. Yes, absolutely true. Some babies do die and some babies do get injured in birth. And that happens everywhere. That happens at home. That happens attended, unattended. That happens at hospital. It happens in birth centers. It happens in developing countries, Western countries. There's always a risk in birth that you or your baby won't survive. That is an inherent risk that we can't. No matter how hard we try, of all the interventions we can give, of all the monitoring we can do, there's a small, very small proportion of babies who are injured and mothers who are injured.
Mel:
[24:07] Or don't survive the birth process. It's really unfortunate and wouldn't it be amazing if it happened to nobody? But the reality that we have to know is that it does happen and it can happen wherever we are. And I'm really sorry if it's happened to you, somebody who's listening. It's the thing that practitioners would desperately love to solve and we haven't worked out how to save every single baby and woman. And so women are forced to decide, well, where's the safest and best place to be in this process of birth? And that's different for everybody depending on what your understanding of safety is. So hospitals really prioritize physical safety. We want to keep you all alive. And then what happens is that they forget about emotional safety, cultural safety, social safety, psychosocial safety. And then, you know, we've got stats now where one-third of women feel traumatized by their birth birth, even though they're alive and even though their baby's alive. You know, trauma doesn't come from sick babies or babies who have died. Yes, that's traumatic. But the trauma we're talking about for one-third of women is emotional trauma.
Mel:
[25:16] And so women have to start making decisions, okay, what's the safest? So physically, physical safety, if we just look at that, if you're a woman who's healthy and well and your baby's healthy and well, you're physically, your baby is physically safe anywhere you choose, home, birth center, hospital. The difference is, is that these three settings will give you the same outcomes, but with varying differences in interventions.
Aimee:
[25:42] Mm-hmm.
Mel:
[25:43] So the hospital will keep you as physically safe as your home birth midwife will or your midwife in the birth centre. You'll be just, your baby will be just as safe, but you'll have to have a lot more intervention in hospital to achieve that same level of safety that you'll get in less intervention settings like birth centres and at home.
Aimee:
[26:01] And also, you know, how safe, like even physically, right? So what is their definition of safety when a baby is then, you know, experiencing instrumental birth or, you know, being wounded through that. And just because it's something that isn't life-threatening doesn't mean that it's not traumatizing or that they felt unsafe. The injuries that I support people through are really intense. I think the system perhaps wouldn't consider them to be intense.
Mel:
[26:29] And that's the issue is that there's some really hard objective thoughts about what is physical safety. So they look at mortality, which is death. Then they look at morbidity, which is like how many babies were admitted to special care units and neonatal intensive care and what were their APGAR scores when they were born. Like all these really objective, hard, obvious signs of well-being. So they also would consider a woman safe if she'd had an episiotomy and then the baby came out with a vacuum and then they both went home 24 hours later. That's success in the eyes of the hospital. We kept them both alive. With minimal trauma, I'm doing like speech marks here.
Aimee:
[27:11] I don't accept their understanding of what it means to be safe.
Mel:
[27:15] So the authoritative message about safety is different to what women actually experience. Yes. And so when the authoritative message is, oh, but you're alive and your baby is alive, why would you be traumatized?
Mel:
[27:29] But we kept you safe, again, speech marks by their own definition. We kept you safe. So they've got their own criteria for what safety means. What we know from research actually is that women's perspective on safety does not resemble the authoritative message about what it means to be safe in childbirth. I want to say here too, like if you felt safe in hospital, that's amazing. And if you felt like that was the best and safest place for you, then that's where you should be to have your babies. You've got to be where you feel is best and safest. If you experienced hospital birth and you didn't feel like it's best and safest, it's totally fine to take your perspective as the authority. And if other people are saying to you, you were kept safe and you are fine, that's their truth. That's not your truth. And so women will go and give birth where they feel is best and safest. And statistically speaking, if you just look at hard numbers from research, so we've got recent research here in Australia. It was done in 2019 and it looked at maternal and baby outcomes by planned place of birth in Australia. So there was 1,250,000 births in study and they looked at hospital births, birth centers and at home. And these were all women who were well and healthy and their babies were well and healthy. So women without complexities in their pregnancy.
Mel:
[28:55] And what this study found was that compared with planned hospital birth.
Mel:
[28:59] The odds of normal labor and birth were over twice as high if you plan to have your baby in a birth center at nearly six times as high at a planned home birth.
Mel:
[29:09] Six times better chances of having a normal labor and birth at home. And there were no statistically significant differences in the proportion of stillbirths, early or late neonatal deaths or neonatal deaths like baby deaths in the three places so what they're saying is is if you give birth at home there's a very good chance that your baby is going to be as alive you know statistically and babies who were born in hospital but you've got six times more chance of a normal birth at home and that was out they had over 8,000 I'm looking at it 8,212 home births is what they could look at so what they did conclude though with 8,000 births, 8,200 births. You can't detect the more rare incidences that might happen one in every 10,000 or one in every 20,000. That mimics international research as well, is that a low-risk woman, it doesn't matter where you go, you and your baby are likely to experience a level of physical safety that's, for the definition of safety that we get from the hospital. What we get, although from home birth, is this amazing quality of experience that you act that women and, you know, the research talks about it as maternal satisfaction.
Mel:
[30:30] These are the words that we use. Like if you want to find out how acceptable a birthplace was to a woman, the research would talk about maternal satisfaction.
Mel:
[30:42] You know, if it quite does it justice. Yes, I was satisfied.
Aimee:
[30:46] Full smile. Yeah, it's so, I mean, enough said. And it's like sort of driving out the wall because I know that we need stats, we need numbers, people need numbers to really get a clear picture. But also like it's established, it's well established that home birth for low-risk people is largely the safest option and that babies are safe in that environment mostly. And so I wish we'd just believe it.
Mel:
[31:13] I know. So I keep saying to people, can we stop researching if home birth is safe, please?
Aimee:
[31:19] Like it's established. We know.
Mel:
[31:22] Exactly. What we need now is to ask the question is, is hospital safe? And how dangerous, you know, because that's all, you know, when you look at home birth research, it's like the studies are like, is home birth safe? I'm like, okay, stop asking that question. Next question we need to ask is, is hospital birth safe? because that is not an evidence-based approach to helping birthing women is an animal hospital. There's no evidence that that actually is better for everybody.
Aimee:
[31:53] It's like the cultural piece, right? Because we know the numbers are there. We know the research is there. And so why isn't it landing on a cultural level? Like when is the cultural shift going to happen? and it is in you know pockets but on a larger scale and I think that like comes down to the colonization right of the mind that we were talking about before a little bit and that there has to be a level of personal work that goes into unraveling why we are holding on to this thing that's like largely failing us low-risk people because it's our own cultural messaging that's holding so strong to that ideology
Mel:
[32:34] Totally and that's what the great birth rebellion is about amen sister why we are here is that we're literally rebelling against the authoritative message against about birth and saying calling it out and saying we actually have all been thoroughly lied to and brainwashed about what
Mel:
[32:53] birth is and what birth needs. And so the Great Birth Rebellion is about just waking people up to realize that there's quite possibly a much better way than what we're currently doing. And small pockets of people are realizing that and making decisions that are aligned to their own intuition, their own understanding of what's best and safest for them. And also what the research evidence is actually saying to us as a society about what seems to be best for women and babies that but that's that's against the authoritative knowledge of the day and so it's going to be a battle because if we want to completely decolonize and and demedicalize birth we actually have to take on the authority.
Mel:
[33:40] And the people who hold authoritative knowledge and that's as pervasive in society as like the patriarchy is, where now women embody the patriarchy and start attacking each other. And it's the same in birth. It's like women turn around and go, well, you can't have a home birth. That's dangerous. And you're going to hurt your baby. And that's crazy. And so now we, like you said, start upholding the authoritative knowledge ourselves. And it just spreads without being questioned. So we're here to question the authoritative knowledge.
Aimee:
[34:14] Yes, we are.
Mel:
[34:15] Yes.
Aimee:
[34:18] Because it's also individualistic, right, to put the onus on the individual and that, okay, well, we just need to individually divest from the system. What was the number? 98% of people are birthing in the system.
Mel:
[34:31] You know, there's that small proportion who have private midwives or who free birth that would be not connected to a public maternity system. And that's less than one. Yeah, less than 1%.
Aimee:
[34:42] Yeah. So like 99% of people are birthing in the system. and a lot of those people are birthing within the system because they need to. Actually, they still deserve the best care that they can get. I don't think we're going to see it in my lifetime.
Mel:
[34:55] No, we won't see it. There are women who benefit from being in a system that can offer them every intervention possible because it is a proportion of the population who need and must have medical intervention in order to be alive themselves and in order for their babies to be alive. So in no way would I suggest if you have conditions that definitely need management, medical management. Like that's the beauty of technology and skill and expertise is that even with really complex physical situations, we can still survive and thrive. So I am not anti-hospital and I'm not anti-institution. I'm just anti-using them for everything and everyone.
Aimee:
[35:37] Yes.
Mel:
[35:38] And I think they would work so much better if they were just used for the people that really need them. Yeah. And we were talking the other day, going into hospital and hiring a doctor to look after you if you're well is like hiring a pediatrician to babysit your child. Like it's over the top. It's an unnecessary level of skill to have in a perfectly normal situation. I was making a point and I don't remember what it was.
Aimee:
[36:04] This is good anyway.
Mel:
[36:05] Okay. I feel like I'm just hijacking this whole podcast. Like hey Aimee come and listen to me talk for two hours I'm.
Aimee:
[36:16] Here for it
Mel:
[36:17] Well we might move to free birth and I also am keen to talk about free birth and home birth culture because it's really unique in itself a free birth is basically choosing not to engage a health care provider for your birth to just go ahead and have your baby without supervision of a societal expert in birth so some women might have a doula there or friends or a wise woman their partners the rest of their families nobody who has is kind of a registered health care provider to provide medical care if needed yes is that your understanding of free birth as well yeah.
Aimee:
[36:55] And I know there's like all different groups and definitions and see things different ways. You know, some people will consider that it's only a free birth if you don't have anyone there, you know, not a birth keeper or anyone. But for me, my understanding is just birthing at home without a medical attendant.
Mel:
[37:10] And what do you see? Because you're probably more entrenched in the free birth culture than I am at this point. I did my PhD. I finished it in 2015. So I look at it from a very academic perspective. You know, I asked people what motivated their choices to have a free birth. And we certainly know that some women come at it from deep-seated trauma from first birth. Some fundamentally do believe that any interruption in the birth space increases risk for them and their baby and they want to reduce the risk of their birth. So they see the exclusion of extra people in the space as a way to keep safe. There are women who just believe in their own authoritative knowledge and just go, well, birth's usually pretty safe. Then there's a pretty big proportion of women who would have preferred to have a home birth with a midwife, but couldn't access it. But it wasn't their first choice. So when I look at it from like an academic perspective, that's what I see. And then I also see a, I guess I'm going to be careful with the words here because I don't want to upset people, but I want to open up the conversation.
Aimee:
[38:16] Just open it up.
Mel:
[38:17] Just open it up. No, great.
Aimee:
[38:20] That's everybody just, you know, we walk tentatively and, and, and acknowledge nuance and everybody to, you know, is responsible for their own feelings and if you're noticing yourself getting activated or triggered just Check in with your body. Take a few deep breaths. We acknowledge nuance. We acknowledge the complexity.
Mel:
[38:37] All right. This is now a safe space because Aimee's so good up to be so. So I noticed that because it's probably a more extreme decision to be free birthing amongst this, you know, when we look at authoritative knowledge and the choice to free birth and the newness of free birth. Because historically, women were supported by wise women and by women in their society who knew about birth. So midwives are mentioned throughout history. Wise women and medicine women were mentioned throughout history as being present at birth. So the newness of free birth is one thing, just like the newness of hospital birth is a thing. But there's an extreme wing of free birth that kind of becomes culty. Like it creates a following and it becomes less about birth and more.
Aimee:
[39:29] Yeah, well, it becomes dogmatic. And that there is like this hierarchical, this hierarchy of birth and what it means to truly have a powerful birth and what it means to be a powerful woman. And free birth has really become, you know, in some arms of the culture, that that's like the holy grail, right? Like, well, I birthed my baby by myself. I was fully in my power. And that's true, like for so many people that that's how they felt. But then there's others who maybe, you know, through this like dogmatic understanding might actually betray themselves and their needs by trying to aspire to this hierarchy rather than tuning into, you know, what is it that I want? Maybe I actually really need somebody in my space to witness me in my power. Maybe I really need someone in my space to make me a cup of tea afterwards, you know, and tuck me into bed and take down the pool and do those things. Because as you said, ancestrally, we didn't birth alone. I'm sure there were instances and there have been cultures where maybe a woman went off and birthed by herself, but largely we would be in community,
Aimee:
[40:30] in family and with an attendant.
Aimee:
[40:32] So yeah, I think dogma has no place in birth. Birth is like the antithesis of that. Birth is wild. Birth is unpredictable. It's like at its core, like a rebel, you know, you think it's going one way, it goes another. We can't control it. And so I think when people start putting parameters around such a free and wild thing as birth in any capacity, whether that's like institutional, the institutional parameters or, you know, dogmatic free birth parameters. We do it in injustice and we do each other and ourselves in injustice.
Mel:
[41:01] Free birth can be held up and glorified, like you said, as the pinnacle of birth. And then everything else starts to be looked down upon as less and not as good. And like, well, if you needed someone in your space, then maybe there's more work that you need to do in yourself.
Aimee:
[41:18] That's literally, I've actually seen that pretty much exact quote somewhere. I can't even remember how it was worded, but something about if she needs someone to support her through her pregnancy or the emotional stuff that comes up for her pregnancy, then she hasn't done enough or she doesn't know herself well enough or some crap like that. And it's really counter to what we're wired as humans to need and to want through such a massive initiation into parenthood where naturally things are coming up for us and we're stepping across the threshold into mothering. And like we really are wired to be witnessed through that in some capacity.
Mel:
[41:56] Society's become individualistic yes sense that we're expected to have the capacity to do everything for ourselves and be self-sufficient no that doesn't work in so many areas of life and a woman's brain actually there's parts of it that physically turn off during birth and that's a requirement for the birth hormones to actually flow is part of your brain has to stop working to make way for this primitive brain that takes over the process of birth. And if you interrupt that process, the process of birth is interrupted. So we intentionally don't ask a lot of questions to a laboring woman because her mind has literally turned off the capacity to make complex decisions intentionally because it's put all its energy into this physiological process of birth and in that hormonal cascade be uninterrupted. It's bringing women out of the physiological laboring process and and I think that's the role of a wise person in the birth space is for the woman to use her autonomy to say I want the freedom to completely concentrate on giving birth in a space where I feel safe and so I'm hand picking these people to take a level of responsibility over something at my birth so.
Mel:
[43:18] For women who choose to have a home birth midwife there, they're saying, I would like to completely focus on birthing and you are in this space to let me know if things, if there's something going wrong and then to do something about it for me. And the woman's giving away that responsibility to the midwife, to someone that she trusts and someone that she's chosen. And so, you know, when women talk about free birth as being the ultimate autonomy, I mean, it is because you literally are the decision maker and whoever is in the space is there for you, which is ideal. That's what it's supposed to be. But everyone in that space still has a level of responsibility that the woman's given to them. And I don't think that's a bad thing. I think that is a full expression of autonomy, is being able to make the decisions about who will care for you and where you'll be and what everyone's responsibility is, is to actually be dictating that in your.
Aimee:
[44:16] Birth space and asking for help or knowing that you are curating a team around you is is being autonomous like self-appointing yourself as the person at the center of these people and giving these people responsibilities within your space you can be autonomous it's not giving away your power because you ask for help and there's a really big it's really important that when considering free birth you know we really feel into the level of responsibility that we want to take on in that situation. Exactly what you said, if I'm losing too much blood, if, you know, baby's coming out feet first, bum first, whatever, like what am I going to do in that situation? If there's a cord, the cord comes out, like what's my plan? Am I going to be able to navigate that situation at home on my own? Do I want to? Because you might acknowledge, yeah, I'm able to, but do I want to or do I want to be guided through that and have support through that and am I okay with the risk that comes with that and knowing that there's no one else in that space
Aimee:
[45:17] Other than me that is responsible for whatever unfolds or whatever choice I make within that space. And that's a big decision. And some people make that decision. That was my choice. I felt good about that. I felt capable of doing that. I wanted to do that. I understood that when I was choosing to free birth Ember, that babies do die. And it is a horrible, horrible tragedy. I wish it didn't happen, but it does sometimes.
Aimee:
[45:47] And would I be able to live with myself if my baby was born still, or if something happened and I was unable to save my baby? And I said, yes, I would be able to live with myself with the choices that I made, because I believe that at the time it was the safest choice for me to birth at home with people I love and trust deeply. And that's a really weird, you know, my partner and I had to sit down and talk about that. Like, what are we willing to do that? And are we willing to stand by our choice if it didn't go the way that we, you know, so hope that it goes? And compounding that, we did a hell of a lot of research around neonatal resuscitation, around we had plans, you know, what if there's a cord prolapse? Okay, this is what I have to do. And this is your responsibility within that. So people that free birth often are, you know, incredibly educated around the physiology of birth and around birth emergencies. It's not something that should be or is taken lightly. But then when we see this, so then when we see this like pervasive, you know, this like new kind of colonizing that comes out when we start seeing an industry being made out of something, because now free birth is an industry, which is like lunacy, right?
Mel:
[46:55] Well, we're trapping free birth, yes.
Aimee:
[46:57] When we see industry sprouting from something, then we see like those parameters that we were talking about before coming around it, we see heroes that arise. And so I think it's just really important that people are, you know, it's very centred within, um, us and our and what we are capable of and not what we're trying to achieve per se you know it's like birth is an achievement of course in all of its manifestations
Mel:
[47:20] But no I get what you're saying you know and with the power stuff that we were talking about you know when women are like no you know I gave birth in my power I'm with my authority it's an expression of power to curate a birth that you want in a place that you want with the people that you want and I wrote about this in my thesis too how the choice to free birth is motivated by the same decision-making process as women who choose to have elective caesareans without a reason and women who talk about choosing a caesarean section without a medical reason talk about how in control they felt to know that they could dictate every little aspect of their birthing process there's so much choice within that decision to have an elective cesarean section that felt so powerful for them. And that's the same motivating factors as women who choose to have a free birth. It's like, I can choose so much. I can choose who's going to be there, who's not going to be there. You know, all this stuff, the own timing, the location, you know, but each of them has inherent risks. One is major surgery. And if a woman understands the risks of that, and then in free birth, in all birth, you know, there's always Is the potential for something to go wrong? And in a free birth, do you feel like, yeah, like you said, willing to take that risk? And some women see, like, I would like to take the risk of birth at home.
Mel:
[48:44] And I'm going to mitigate that risk by doing certain things. And so women who free birth mitigate by doing certain things, like how you did neonatal resuscitation courses and all these things. And some people see having a midwife in the space as mitigating risk. People ask me like, oh, my gosh. Or they'll say to my clients, what are you going to do if something goes wrong? And the women say, well, what happens if something goes wrong? And I'm like, well, that's why I'm here. I'm not here if something goes right. because literally whatever my hands do, if something goes right, whatever my hands do, I want anybody's hands could do. Anyone can stop a baby from landing on the floor. Everybody can push your baby in your direction in a birth pool so you can pick it up. I'm there for women if I'm needed, not if things go right because if things go right, it was going to go right whether I was there or not. And so, yeah, I think when we think about power in the birth space, It's not about if you free birth, home birth, go to hospital, elect to have a cesarean section. It's about how much power you had over the decision-making processes. And that's powerful birth.
Aimee:
[49:52] A parent who chooses an elected cesarean for whatever their personal reasons may be, she and I are comrades. We have more in common than we have in different. Because we've copped shit from society. We both copped shit from authoritative knowledge. We're both like divesting from this idea that we have to perform some certain way in order to be the good girl that births our babies the way people want us to. And I think we really need to celebrate that and to invite the differences to the table so that we can really learn how to center women and people who birth babies. That's just what it is. That's what we need to be centered in the experience. It's really not hard.
Mel:
[50:35] So it's a rebellious act to select people and execute and pursue the thing that you believe is best and safest for you in birth. And to me, that is liberated birth, is being free to make the decisions that you feel are best and safest and pursue them. But there's so many barriers to that as well, like for women who...
Aimee:
[50:55] Yeah, free. And I think a lot of, you know, in my community and people and friends that have free birth, it's so much more than the birth of our baby. The birth of our baby is so much, right? Like it's the best, the absolute golden, you know, piece to it. But then like we're actually also centered within that and our experience matters. It's a revolution often that we can't shy away from. Like when we birth in our power, and I'm speaking from my perspective as someone who free births and would free birth again, but of course I'm sure there's people that chose an elective cesarean or had other kinds of birth experiences that can resonate. Like when we are in our power through that experience, a veil is lifted and
Aimee:
[51:37] it impacts so many other areas of our life. As you said before, this continuity between like home birth and homesteading and homeschooling, it's like, if I can do this, if I can birth my baby after all of the lies and all of the conditioning and all of the oppression that we have experienced for so many years, what else can I do?
Aimee:
[51:57] What else have I been lied to about? and it's it can set us free and so you know just what you were talking about before with what could go wrong it's always people coming to me what could go wrong what could go wrong but what could go right what if it could go right what if you could have you know the most beautiful powerful expansive experience of your life and be forever changed and the foundation that's you know set beneath you and your family is one that is staunch and strong and powerful that is unshakable and unfuckwithable dangerous dangerous person to the status quo right yes like what else have I been told that I can't do that actually I can what else have I been told that you know especially around our bodies and then like wow my body can actually do this incredibly profound amazing crazy psychedelic thing yeah and I can do it feeling powerful. It's really, I mean, like talk about liberation.
Mel:
[52:54] And the thing that keeps us entrapped in following what the authoritative knowledge says about birth is that they tell us it's super painful, that we're going to need pain relief. And then they tell us it's super dangerous. And then, so then we believe that. But then when women do it, you know, women who give birth at home so often, they're like, that didn't even hurt that much and I'm like yeah it doesn't it actually doesn't hurt that much like yeah it's a big sensation it takes work and energy and like a mental investment in doing it but we can absolutely do birth without pain relief because it's not as bad as they say it is and that's what entraps a lot of women they're like well I want to be somewhere where there's pain relief because, childbirth is the most painful thing you'll ever do and.
Aimee:
[53:42] I think pain is different when you are depending on your environment. So if you're in a room that is not conducive to the optimal unfolding of physiological birth, the pain is going to be experienced differently. That's if you're at home with your beloveds, you know, in a place that you feel really safe and comfortable. Pain is experienced differently in birth when we are going against our mammalian needs, which is to be in a quiet, warm, intimate setting with people that we trust. Is it birth that was so painful, or was it the obstetrics and the environment and the everything that happened in the institution.
Mel:
[54:22] And that's what dulls down our capacity to manage labor. Yes. When we don't have what we need, we often don't have what we need in an institution. The needs of birthing women haven't been met. And so then women experience more intense pain and then they promise to take that pain away by giving pain relief. But as having done it myself and been witnessing women doing it for 14 years women who birth at home very rarely talk about pain very very rarely.
Aimee:
[54:52] Yeah they
Mel:
[54:53] Always say most of the time again oh my gosh i can't wait to do that again that was amazing how incredible i am so happy jiggling and laughing in absolute bliss and joy after pushing a baby out of our.
Aimee:
[55:07] Vaginas yes and sometimes not even pushing and
Mel:
[55:10] Sometimes not even pushing sometimes having them ejected from our bodies like.
Aimee:
[55:14] You did well like you know it's it's just so interesting this idea of like pushing a baby out of course sometimes we have to push a baby out but the amount of times I work with people where they say I barely I felt like a pushing or bearing down sensation and it was almost like my body just guided me and it just happened and my baby came out you know Zevin just flew out I had fetal ejection reflex ember i had to um bear down quite a bit but then ember just flew out yeah you know it's a bit slower than zevin but just my body did it and so even this concept of like having to push the baby out and work so hard to get the baby out um it isn't always the case it isn't necessarily the norm when we're in an optimal environment yes
Mel:
[55:59] Oh okay so we've spoken about giving birth at home and how it's an It's an anti-authoritative move to do that in this society.
Aimee:
[56:11] This is an opportunity. Pregnancy and the whole childbearing continuum is an opportunity to liberate our minds and to liberate our families from an indoctrination into this system that none of us really consented to actively,
Aimee:
[56:24] but we consent to it through our continued acceptance of it. And so what can we do as we travel along this continuum to set ourselves free from these things that may not be of benefit to us. And that can't come through. Of course, we require teachers and mentors and guides, and we can learn from people and research and so on and so forth. But at the end of the day, how can I liberate myself enough so that I know I'm, you know, I'm the boss. I'm the boss of my decision-making process. Like I'm willing to put myself in that position. Not everybody wants to do that and that's fine too, but there is an opportunity there across this landscape to reclaim ourselves in a very real way so that whatever we want to do comes from a place of our truth. Whether that's electing to have a caesarean, whether that's choosing to have a free birth, whether that's going out into the river and birthing your baby, or I saw a woman the other day birthing in the middle of the ocean. Like, how about your sister?
Mel:
[57:21] I think that's the take-home message about birthplace. Make a conscious, responsible decision about what's best for you and your baby and pursue that. Because it might be best to have a cesarean section. It might be best to go to hospital. It's quite possibly best to have your baby at home with a midwife, but rather than focusing on free birth, home birth, hospital birth, cesarean birth, is just pare it back and go, what is the best for me and my baby? What's important to me and my baby? Now, I get it. And that is powerful autonomous birth.
Aimee:
[57:57] Yeah. Boom.
Mel:
[57:59] The great birth rebellion. I reckon we've got it. Do you reckon we've got it? Is there a take-home message? Is there anything you feel like, gosh, I just haven't said this yet and I need to say it?
Aimee:
[58:11] So final thoughts.
Mel:
[58:13] Yes, take-home message.
Aimee:
[58:14] What I really hope that we can cultivate as a society is asking more of what could go right in a situation. Asking what could go wrong is a vital part of our preparation for birth right like what okay what risks am I comfortable with taking you know what am I what are my risk factors and how will I navigate those but I hope with at least equal measure we are asking ourselves and each other what what could go right what would it look like for you to really go right what would it look like for and what is meaningful to me and what would make me feel like I was really centered in that experience. And I'm a powerful person who's capable of parenting my child and feeling, you know, really powerful and stable within that. Because ultimately, you know, birth is setting us up. Birth is the doorway into the next chapter of our parenting journey and lives. And we want people walking away from those experiences, feeling really competent, capable, powerful, and staunch. So I just, I really hope that we can get to a place where that is as much of a valid and asked question as what could go wrong or what if something went wrong?
Mel:
[59:32] Yes. And that is a rebellious question because the truth is, is most of the time things will go right.
Aimee:
[59:39] Yes.
Mel:
[59:40] And we are only sold the message of birth being catastrophic and wrong because they want to keep us frightened and entrapped to a system of birth system that's been established they want to maintain. Yeah, but we're the rebels and now we have this highly successful podcast that will hopefully, start the rebellion the great birth rebellion yes please oh my gosh thank you so much and where can they find you what's your website where can their website is.
Aimee:
[1:00:12] The stoned chrysalis.com and that really has all my offerings and um i am on instagram as at rip snorter
Mel:
[1:00:21] And i'm going to put all this information we have a mailing list Aimee so if there's any resources that you want me to put in there anybody who's on the mailing list and if you want to get on the mailing list you go to melanethemidwife.com and on the home page there you scroll down and you can get on the podcast mailing list because every week I send out an email with all the resources and you can click the buttons there and it'll take you to folders and folders and folders of research from every single episode and all the resources so you're wondering what was that thing she said who was that person she was talking about? What was that website? What was that Instagram handle? It all comes through on the email every week when the new podcast episode lands on a Monday.
Mel:
[1:01:05] Amazing. And if I think about what offerings I can bring to the table around birthplace, obviously my entire career is centered around serving women who are choosing to give birth with a private midwife whether that be at home or in hospital and if you this is something too if you're a midwife listening to this episode and thinking oh my gosh I actually need to decolonize and demedicalize my own personal career as a midwife that is also absolutely completely possible to do here in Australia I know it feels like there's a stack of barriers but one thing I've been running and I'm about to run it again I'm about to open up enrollment in the next, you know, if you're listening to this, when it just lands, you haven't missed out. But at the end of October, I open up.
Mel:
[1:01:57] The launch yourself into private practice midwifery mentorship and I open up enrollments for only one week and then you can get in there and I personally mentor you for an entire year there's a whole online course there's monthly zooms there's unlimited email access to me where I mentor you to move from working in an institution as a medicalized midwife or physiological midwife working in institutions because they exist as well but if you want to leave that zone and start working for yourself as a private midwife you can launch yourself into private practice midwifery under this mentorship and 76 midwives have already done this over the last two years through this mentorship so this thing works so I'm thinking about how midwives can move out of that space and when midwives go there it opens up access for women as well yes thank you so much for being here so.
Aimee:
[1:02:54] Good thanks for having me
Mel:
[1:02:55] Magic okay the end the end 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 @the GreatBirthRebellion. All the details are in the show notes.
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