Episode 128 - Birth keepers an investigation with journalist Charlotte King ABC

December 08, 2024

A birth keeper is a vague and obscure term used to describe some unregulated birth workers who attend births. No one except the birth keeper themselves really knows the full scope of what they do or what they are capable of because they prefer to work in secret and away from the gaze of society. In this episode Mel invites journalist Charlotte King to explore the stories of two families who hired birthkeepers and who now, having experienced the care of a birthkeeper, want to alert the public to their experiences. Charlotte makes clear that the families sought her out and asked her to report on and share their stories and her article for the ABC was written in collaboration with the families.

A birth keeper is different from a doula and different from a registered Midwife. This episode seeks to communicate the differences. We thank the families in this story for their bravery and resilience in sharing their experiences and seek to share these with respect to both the families and birth keepers involved.

Charlotte King has been on the great birth rebellion podcast before for episode 70.

Read Charlottes recent article for the ABC here

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Episode Transcript

Episode 128 - Birth keepers an investigation with journalist Charlotte King ABC

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.

Mel:
[0:24] Welcome everybody to this week's episode of the Great Birth Rebellion podcast. Today, I welcome ABC journalist Charlotte King to speak about her recent article released about two weeks ago, November 2024, and it's called, In the Sovereign Birthing World, Unqualified Birth Keepers Are Charging Thousands of Dollars and Putting Lives at Risk. There is a link to the article in the show notes, and it's also linked in the resource folder. If you're on the mailing list, you'll have access to that. And this is a topic that a lot of women and birthing families are unaware of. And we'll be talking about a corner of the birthing world that prefers to exist in private and away from the public gaze. It's unregulated, largely unmonitored. It's an under-researched area. And Charlotte's been uncovering the stories that are unfolding within that community for some time now, over a year, I'd say. And there's a community that's rallying towards and around birth options that include unregulated birth workers. And before we start, I'll summarize some of the terms and the words that we'll be using throughout this episode, because some of it will be new to you.

Mel:
[1:33] In this episode, we do discuss events in which one baby was born in very poor condition and another baby who died in a circumstance that neither Charlotte or I were involved with but Charlotte has spoken to the parents of these babies and the people at the heart of this story and we want to shed light on the events and the people that contributed to this circumstance and just to reiterate the choices that women make are their own and they have every right to choose what feels best for them. This episode will not be challenging women's rights to choose their own birth location or their own birth companions but it will highlight the issues within the maternity care system that are motivating and driving women's decision-making processes and

Mel:
[2:18] And also the impact that birth trauma is having on women's choices and how some birth workers are filling the gaps in care. And we'll be highlighting the unintended consequences of some of these circumstances. So we're talking about unregulated birth workers, and our focus is less on women who choose to hire unregulated birth workers. We're not focusing on the choice to free birth. And actually, if you've been following the podcast for a while, you'll know that Charlotte's been on the podcast episode 70 and we did focus a lot on the choice of free birth. This episode is not so much about that. It's about the world of unregulated birth workers. It's also not focused on the work of doulas and what I really want to highlight here in this episode is that the work of doulas and midwives is significantly different to the work of the type of birth keeper or small subgroup of Birth Keeper that we're going to be talking about today. This small subgroup, it kind of blurs the lines between midwifery work and doula work.

Mel:
[3:21] Charlotte's here and she'll share some findings from her journalistic investigation in this area. And long-term listeners will know that my PhD and academic work focus around the choice to give birth outside the system. So I have an academic interest in this area. Charlotte's interested in this topic from the perspective of a journalist and please know that we are coming at this topic with the same intention as we would pay to any other episode of the Great Birth Rebellion to give information and respect to all birth options available to women and be as unbiased as we can in presenting these things factually and and respectfully. Let's start with some background definitions for people who are new to this terminology. Let's talk about free birth. So a free birth is where a woman intentionally plans to give birth at home without the assistance or guidance of a registered healthcare provider. This can be called a few different things, but free birth seems to be one of the main terms.

Mel:
[4:19] Generally speaking, it's where a woman intentionally chooses not to have a registered midwife, doctor or professional birth attendant present. And if you're curious about why women make these choices, there's more full episodes on the choice of free birth. We did episode 8, 70, which I did with Charlotte and 104. The next term is home birth. Home birth is different to free birth. They both happen in a woman's home or out of a hospital, but a home birth is where a woman gives birth at home, but under the care of a registered healthcare provider, usually a private midwife. The difference is, is that midwives are qualified and registered to give clinical care and antenatal, postnatal and birth care. They're recognized as a suitable profession to be serving women in that way in a home birth. So that's the difference between free birth and home birth. Free birth doesn't have a registered healthcare provider, home birth does. Then we have doulas. So traditionally a doula was a woman offering non-medical support and information to other women and their partners during birth and the postnatal period. They are a support and information bank for women.

Mel:
[5:32] And an important thing to note here is that their role is non-medical, non-clinical. They can work without any formal training whatsoever, although many do pursue training and they hold doula qualifications, but they're unregulated, unregistered and unmonitored birth workers, which means there's no minimum standard for doula work. They're not medical or midwifery professionals. and they're not supposed to use clinical skills or qualified or trained to provide life-saving care or to monitor for complications or the well-being of a baby that's not their role and there are brilliant brilliant doulas who are expertly supporting and nurturing women in a non-clinical role and then there are ones who have minimal training or who overstep their role and oversell their skills and women can't truly know which one they're getting because there's no regulation or way of maintaining a standard.

Mel:
[6:29] But be reassured if you're listening to this as a woman that the vast majority of doulas work within their scope and their role. And there are great organizations such as the Australian Doula College who are training doulas to work expertly within their role. But that training is not medical or midwifery. So doulas have no responsibility to be transparent in their work. There's no process of accountability. And that's what's different to a midwife. So what is a midwife? Because that's going to be important for this discussion as well. In our country and most countries, midwives are registered and the title of midwife is protected. Midwifery is the profession of midwives. Only midwives practice midwifery because it's a unique skill set that is learned and midwives must demonstrate a level of competence and skill before they're allowed to care for women through their pregnancy, birth and postpartum. Midwifery is a unique body of knowledge, skills and professional attitude practiced by midwives within a professional framework of autonomy, partnership, ethics and most importantly, accountability.

Mel:
[7:41] Midwives are trained through formal means and where there are no formal means established, traditionally midwives were educated through a process of apprenticeship and experience that can qualify them as wise community members and a community midwife in an unregistered sense. And I'll talk to you about traditional birth workers as well. But midwives are expected to be reflective practitioners who take responsibility for their own actions and behaviors. and there's a minimum standard and expectation put on our behaviours and scope of practice. In most countries, the word and title of midwife is protected, which means it's against the law to call yourself or practice midwifery, call yourself a midwife or practice midwifery if you've not met the minimum standards of education and training. If the person that you've hired is not qualified and registered, they're likely to give themselves another name. So some names that are in existence for unprofessional or unregulated birth workers include the term birth keeper, birth worker. I've seen a number of birth keepers or birth workers call themselves mid-witches, which kind of blurs the lines again. And some will add the word sovereign in front of their title or authentic or radical. So there might be a sovereign birth worker, an authentic birth keeper, a radical birth worker,

Mel:
[9:06] And so there's all these combinations and terminology that might show up if you're looking into these care providers. The word sovereign, sometimes they put the word sovereign in front of their name. I can only assume that the sovereign title that they put in front of their name refers to the sovereignty of the woman and the sovereignty of birth that they're caring for rather than calling themselves sovereign because by definition, sovereign means to be an authority or a holder of supreme power certainly from biblical perspectives god refers to himself as sovereign so i assume that when these birth keepers refer to themselves as sovereign they aren't saying that they have an authoritative possessive role in a woman's birth because that seems to be counterintuitive to the thing that they're marketing themselves as but it does seem that birth keepers are setting themselves apart from both doulas and midwives as working differently and with a different sort of category of women. So a doula will often support women who've got a midwife if they're giving birth at home in a home birth or if they're going to hospital.

Mel:
[10:14] Birth keepers seem to gravitate more towards women who are choosing free birth. So I mean the exact definition of what they do or what they propose to do and what skills they actually bring seem to not be well defined and open to misinterpretation and misunderstanding and that's one of the concerns that we'll raise through this podcast is the possibility that women who are seeking birth outside the system might hire a birth keeper or a birth worker and not realizing what they can actually do for them and what their scope is.

Mel:
[10:49] And where the lines are also blurred is that there's also another category of birth worker called a traditional birth worker or a traditional midwife. And a traditional midwife or birth worker is different again, and it's usually a person who's been trained to attend birth in a traditional sense through an apprenticeship under the guidance of a wise midwife type person in the community who is the appointed expert in attending births. Actually, lesser resource countries will often still rely on traditionally trained midwives rather than those who are trained through universities and institutions. It's a way of giving women access to a form of midwifery care. And so traditional midwives or traditional birth workers aren't really common in higher resource countries because we have formal pathways and the term midwife is protected and reserved for only those who have sort of standardized training.

Mel:
[11:45] Here in more Western countries are less likely to encounter people who are trained as traditional midwives or traditional birth workers. But the International Confederation of Midwives states that where the title midwife is not yet protected, other health professionals, including nurses and doctors and traditional birth workers, may be involved in providing this type of care, sexual, reproductive, maternal and newborn health care. But these health professionals are not midwives they do not possess possess the competencies

Mel:
[12:20] Of a midwife and they don't provide midwifery skills but they do provide other aspects of maternal and newborn care so one thing to really remember here is that midwifery is unique it's taught methodically it's protected it's regulated and it has to maintain a minimum level of competency okay that's

Mel:
[12:42] That is all of the definitions out of the way, and we're going to bring them up again as we go through, because I realized that was a lot and out of context. Thanks for sitting through that, Charlotte. All right. I am going to introduce my guest today, ABC reporter Charlotte King. Before we get started, can you talk about your work and your role?

Charlotte:
[13:05] Sure. So I am a reporter with the ABC. I've been at the ABC for 13 years and I currently work in a team called Regional Investigations and it's myself and my counterpart Andy Burns and we work on stories usually with other reporters around the country that take a little bit more time to dig into, need a bit more of an evidence base before they can be reported, hence the investigations element and what separates us from other investigations, reporters at the ABC, is that we focus on stories outside of metropolitan areas. But basically anything that's affecting Australians across the country outside of metropolitan areas is our remit. And we look at all kinds of things from harness racing stories in Tasmania to stories about the chemical pesticide Paraquat, which we did a story about earlier this year, and its links to Parkinson's disease. So this particular area of focus, free birth, is another thing that we've been looking at.

Charlotte:
[14:14] Over the last year or so. And it started off the back of submissions to an ABC audience call out called The Birth Project. There was a handful that dealt with free birth and it was a really new area for us. And I thought it was particularly interesting, really wanted to look into it. And then as we dug deeper, we discovered that there was quite a lot going on that we thought was in the public interest, including some pretty catastrophic outcomes that had occurred in quite a small space of time. That wasn't really being reported and there were concerns from people within these communities that there was, you know, one side that was being advertised online on social media that made free birth look amazing and like the ultimate way to experience birth.

Charlotte:
[15:05] And there were concerns that then when these catastrophes were happening, it wasn't being made so clear. So anyway, that's why we did that first story. Also, just looking at why women were choosing free birth. And a lot of the time, it wasn't their first choice.

Charlotte:
[15:22] And it was revealing that there were major deficiencies in the mainstream hospital system and the choices that women were being given more broadly around how and where they could give birth. So we looked at all of that and they seem to really go hand in hand. The problems with trauma in the mainstream hospital system, which is very prevalent, as we know, a third of women experience hospital trauma, psychological distress and lifelong physical injuries. Sometimes from their experiences in hospital, a lot of women don't find that hospital is a safe place to give birth and they're looking for alternatives and they have a right to look for those alternatives. But in some cases, the alternatives that they're being given, especially for a fee, are worthy of more scrutiny. And that's why we did that story. So this second story came about off the back of that first story because we were contacted by parents who had gone down this path. So I think it's really important to make that point that the families that are in this story, this follow up story, contacted us. So we didn't reach out to them. We didn't go looking for them. They came to us and they wanted to make their stories publicly known because they were concerned about the risk to other mothers and babies. And that's how it started.

Mel:
[16:48] That's a really big point to be highlighting because a lot of people are asking, you know, why? Why would reporters write about this? What's the interest? What's the motivation? Is it just to throw birth keepers under the bus? But you're saying the parents that you spoke to for this article actually came to you and wanted their stories shared. This wasn't something you pursued.

Charlotte:
[17:12] A hundred percent. Yeah, both families contacted us independently. And we worked with them slowly and carefully over many months to tell their story in a way that felt safe for them and navigated, you know, really complex questions around privacy and ethics and legal questions, you know, in order to make that story happen. It's not an easy story to tell, especially when there are, you know, people come from small communities and it's a very, very delicate issue and we wanted to do it right and the main thing for me was for the families in the story to be, for their story to be told with respect and for the story itself to be told with respect, which is incumbent upon us to do as employers for the ABC in WAG.

Mel:
[18:06] There's a lot of mistrust in the birthing world against mainstream media because mainstream media is sometimes seen as kind of revenue earning, kind of clickbait type articles that are designed to just get readers sucked in. My impression is that the ABC and your investigation in particular was quite different and interested in a lot of facts and was carefully and slowly paced. It, you know, it wasn't a hype article. Can you explain what the journalistic process is that ABC reporters undertake?

Charlotte:
[18:42] I haven't worked for commercial media before, but I can tell you that the ABC has editorial standards that we have to adhere to in the way that we report our stories. That includes accuracy for one, is really paramount. And regardless of whether or not that was an editorial standard it's really important to me to be accurate as accurate as possible and our team so we fact check every line of the story before it goes out and have documentary evidence or multiple sources for everything that we're saying or we attribute it to if it's an opinion or claim being made by somebody that we've interviewed we attribute it to them so there are really strict processes that we go through. Also, the legal parameters that we work within, we can only do things and make certain claims with certain evidence behind us. So we can't just put stories out and make any claims that we like without there being a really strong evidence base for those claims. You mentioned revenue before. So the ABC is a government institution. It's independent from government, but it's funded by taxpayers.

Charlotte:
[19:53] And so we don't actually make any money out of the stories that we put out. I don't make any money from it. I get a wage. And the ABC doesn't earn money from the articles that it puts out. So they're put out for a range of reasons under our charter to inform the public and to entertain in some circumstances. But this particular article was deemed very much in the public interest because of the fact that the birth worker in the story in particular is still attending births and charging bees to attend births and the parents that we spoke with were concerned about that given their experience.

Mel:
[20:36] So people reading the article can feel as confident as we can in media that this is a story about things that have actually happened, that it wasn't personally pursued by you as journalists but it was it's reporting on something that is happening and it's the words of the parents who it happened to so that's important for people to know is that this is not a concerted witch hunt as people some people would suggest it's not mainstream media going after certain birth choices and you alluded to the fact that in free birth circles and in you know these areas of the birth world where free birth is happening. Yes, it's often advertised as an incredibly freeing birth option. And for so many women, it is. You know, women talk about how amazing their free birth was, but that when things don't go as intended,

Mel:
[21:31] Sometimes those stories aren't as openly shared because it challenges the free birth narrative and it brings into dispute some of the claims that free birth communities make about the safety and appropriateness of free birth. And so we're bringing that out today, you know, through this article. So I'll start reading and this is word for word. And I want to also highlight that most of the text is actually quotes from the family, which makes sense given what you just explained. And you've changed the names of the parents, and we won't be mentioning the name of the birth keeper, although in the article you do make mention of who this person is, but we won't be doing that today. So when she heard about the birth keeper, Alice was at a dead end. The mother of three, whose name we've changed to protect her identity, had already delivered two young children through the public hospital system.

Mel:
[22:27] Both births had ended in a cesarean and the second affected her in ways she still struggles to articulate. And there's a warning, this story includes details about stillbirth and birth trauma. I couldn't talk about it for about a year and a half, she says. I was traumatized by what happened but didn't really know which way to go to make that better. She began to gravitate towards women in her community and on social media who advocated another way in this world birth could be beautiful outside of a hospital women could birth in their power and undisturbed by medical intervention and this is a quote it did make me feel like birth was over complicated within the medical system and it made me question whether what happened to me was necessary Alice said I felt like the birth was robbed from me

Mel:
[23:19] And when she got pregnant again, her mind was absolute. I thought to undo those past traumas would be to take back my power where I was in control and I had sovereignty over my body, my baby, my pregnancy, and my birth, she says. I was not going to be within, it was not going to be within the hospital system. It was going to be on my own terms. This is the very big first point, that the impact of the current maternity care system on women's future choices for their birth. And what we know through the birth trauma inquiry that's been all through media and from research into the world of birth trauma and obstetric violence is that the current maternity care system is not properly serving women's needs for emotional, psychological and social safety. And some would argue not even for their physical safety. And one third of women are coming out of their births feeling traumatized. Often the language is very strong around obstetric violence and abuse at the hands of their care providers and there's a growing number of women being diagnosed with post-traumatic stress from the birth experiences so there's no doubt that there's a big issue within the Australian maternity care system that's driving women away from these services because they don't serve women's needs and this is certainly the story that that this first woman is explaining is that her previous experiences were disappointing traumatizing and she wanted to find another way.

Charlotte:
[24:47] Yeah. And a key thing that she said, which really stuck with me, was that what she was looking for the most was continuity of care, to have the same provider to take her through her pregnancy and her birth. And she looked for that, both pregnancies, and she couldn't find it. It was just not there. It wasn't available. She would ask for the same midwife. She'd ask for the same doctor. And there was never that option, which we know for the majority of women in Australia is the same they don't have the option the continuity of care and so she actually used the words which isn't um quoted here but she said that she wants she would be her continuity of care and i think that's so sad that the only option for her was to make herself that person that she wanted so desperately to take her through her her pregnancy and her birth and look i'm sure there are free birth advocates out there who say that's not sad it's great you know it's um it's what it's free births all about but it doesn't work for everybody some women want other women to help them through and and she did and she couldn't find it and i think that is that is sad well.

Mel:
[25:58] That's the big point isn't it is that she didn't choose free birth because it was her first choice and this was a finding that we found in my PhD, is that the majority of women who I interviewed for my research, and it's highlighted here in this article, felt forced to consider the option of free birth because it presented itself as the best option when they had a look at all the other options available to them. And so it is sad that she had to choose that for herself because it wasn't her first preference. It's not sad if you choose free birth because you genuinely believe that that's the best and safest option and that's exactly what you want. That's amazing that you have the confidence and the autonomy to make that choice. But this woman made those choices under duress and because of a lack of other options. And that's the sad part is that we as a maternity care system failed to serve her in the way that she needed to be served. And you go on to say in the article that Alice wanted a home birth with a private midwife, a registered healthcare practitioner with qualifications to recognize and respond to an emergency. And because of her double cesarean section history, none of the five midwives that she contacted would take her on.

Charlotte:
[27:13] Yeah, I will say that there are midwives that would have taken her on and midwives who have told me that since that they have successfully helped women to birth at home after two C-sections recently. So it does happen, but it really does depend on the midwife and their willingness really to, and their assessment of the situation, a whole range of things. But this was not something that she could find where she was.

Mel:
[27:40] Yeah, and that's an important distinction too is that, you know, she obviously had five midwives who she had access to, which is amazing.

Mel:
[27:48] But that for various reasons, none of them would take her on. One of the things that people might be thinking is, well, the midwives in this story had some responsibility over the fact that this woman wanted a private midwife and didn't take her on. But I just want to say that part of the skill of midwifery and our requirement as midwives is that we don't work out of our personal scope. We don't work outside of our skill set. We don't kind of wing it and see how we go. That's not our strategy and so whenever we're choosing which clients to take on and which clients not to we're also doing a lot of personal reflection about our own skill set and our own capabilities what's going on for us in our lives already does somebody have a lot going on at home is their current caseload already full of quite complex clients that they know are going to take a lot more of their time often midwives will not choose to take on clients who they don't feel completely and 100% confident that they're the best practitioners for. And so there's absolutely no blame put on the midwives here for not being able to serve this woman's needs because part of that was the midwives recognizing their own limitations and being clear with their ability to care for her, which is not something that happened with the next birth worker that this woman sought out and then because she couldn't have access to them she went the next step she didn't

Charlotte:
[29:14] Have any other options um as in terms of as far as she was concerned and so because she really wanted somebody there she says to recognize to recognize red flags as she put it um if they appeared um that was really important to her to have somebody not just for emotional support she did reach out to another birth worker a doula who did attend free birth but the doula made it really clear i am only there for emotional support i know nothing about you know the stages of labour in terms of managing it from a clinical perspective or knowing what's what. She said, provide the emotional support that is what doers do best. And so for Alice, she thought, well, that's not going to work for me because I need more than that. I need somebody who's somewhere in between that and a midwife because the midwives won't take me. And so then she found this other birth worker who said, yeah, I've got 20 years experience attending births. She got the impression that she had a skill set in terms of knowing what to look for in a birth that was going well and knowing when things might need a bit of extra medical assistance. And so that's all she wanted from this person. She just wanted her, she was going to labour at home with the support of her family and this birth worker, but she really wanted the birth worker there to be able to say, this isn't this is not quite right and you're going to need some extra help.

Mel:
[30:42] And this is the also the difference between women who choose free birth intentionally and women who are forced to make this decision is that this woman made no mistake about the fact that she wanted a clinician to be able to tell her if things were safe or not safe to continue at home whereas a lot of women who free birth acknowledge that they're taking that responsibility on themselves and that they would use their own knowledge, intuitive knowledge, knowledge that they've gathered through their pregnancy to... To fully take on the responsibility of making those kinds of decisions. So if they feel like things are going well, they would stay home. If they feel like they're not going well, they would go to hospital.

Mel:
[31:26] And the fact that Alice chose not to hire the doula who was really clear about her scope, and that is the scope of the doula, is to provide non-clinical support in so many ways, either educational, physical support, and so many other practical ways. But for the doula to acknowledge that I have no other role in your birth space I cannot tell you if your labor's going well or not going well that's not my role again that's a demonstration of a doula acknowledging and recognizing their scope and it's clear that Alice wasn't after a doula she really wanted somebody with midwifery skills and failing all the other options the The article goes on to say that Alice heard about a woman who'd had experience with off-grid births and who came highly recommended. This birth keeper, she supported free births where women plan to birth without a midwife or a doctor present.

Charlotte:
[32:28] And the woman who had highly recommended this birth worker was a friend of Alice's and she had... Had by you know all accounts a free birth with this birth worker sitting in the room and doing nothing and so she everything had gone fine everything was great um so she said you know she's great i had a great birth she was there but that that woman was fortunate to have a very straightforward physiological birth at home didn't need any any any assistance so that's yeah part of, the situation was that Alice was getting that high that recommendation from this woman who had a very uncomplicated birth although her pregnancy had been really straightforward her birth was not straightforward and.

Mel:
[33:13] That is a truth about birth is that most of the time it actually does function quite well without the input of a health care provider and our role is just to be able to help women identify when things are abnormal or when they're not and when everything's going beautifully well, we need to do relatively little actual clinical work. You know, I'm a private home birth midwife and I don't, every single birth, I don't have to engage a lot of my clinical midwifery skills. So absolutely free birth and most births could go very well. The reason that people have qualified healthcare providers at their births is to be able to recognize complications and offer clinical interventions that might help prevent catastrophic events. Then it goes on to say, and you highlight as well,

Mel:
[34:02] That birth workers like this birth worker aren't medically trained and go by a few different names including free birth doulas or birth keepers and many provide strictly emotional support but Alice wanted something more she says I wanted to give it my best go at having this beautiful redemptive birth but I didn't want it to be at the cost of my baby she says I laid it all out on the table two previous cesarean sections I can't get a midwife to cover me and I think my words were actually am I a lost cause and she said the birth keeper said not a lost cause darling and so Alice says I felt like she I was almost saved can you tell us a bit more about that conversation and that the birth keeper put herself up as a suitable option in this woman's case Peace.

Charlotte:
[34:56] The account that I have is from Alice. I will say that we did reach out to the birth worker more than a week before we published the story. She didn't get back to us. So we sent written questions to her Instagram, email, Facebook, but she didn't get back to us on those either. So it's difficult to know what her account is because she didn't choose to engage with us. But the account from Alice is that she was really clear about her history, the C-sections.

Charlotte:
[35:26] And the fact that she wanted to birth at home, couldn't get a midwife, and that she said that she said multiple times to this birth worker, are you able to spot red flags? I need to know that you're able to spot red flags. And she clearly said, yes, yes, I'm able to spot red flags. And it's not just Alice that has that account because she had a family meeting like a sorry birth meeting with members of her family before the birth with the birth worker and her mother also said are you able to spot red flags she said she just had one question that was the only question she had the mother and the birth worker said yes and so I've got that firsthand from the mother and from Alice that that conversation was had but also the things that she was doing do go beyond what doors say is their role so she physically assessed the position of the baby before labor a couple of days before labor and told alice that everything was normal alice's.

Charlotte:
[36:29] Um account is that at that stage the baby was in the position that it was in when she went into labor which ended up being oblique or diagonal so we didn't get into that part in this story because that's only time for so much but that's that point that physical assessment and the the checking of where the baby's position is i would not expect somebody with who's purely providing emotional support to tell you where the baby is and where the baby's head is, because that seems like a clinical, well, that is a clinical thing to do. And then obviously, as we go into the labour, she continued to make those clinical assessments without any clinical foundation of knowledge.

Mel:
[37:10] And the big issue here is that, I mean, the position, and as we read through the article, we'll come to know it, the position that the baby was ultimately in would be a fairly obvious and easy palpation for a midwife. That if we could feel the head in the position that the woman described it having been in, somebody with skilled midwifery hands would have immediately diagnosed that this baby is not in an ideal position for birth. And actually there's things that we can do about that. And potentially a midwife or a trained clinician could have said, hey, your baby's here, here is a number of options that we could offer you to help move and adjust that baby in preparation for birth. And if we'd made that finding in the days prior, we would have known that as the labor began and potentially checked again and again.

Charlotte:
[38:04] I guess the point is, though, that she didn't have that option. So Alice didn't have a midwife. And what I do sympathise with in this situation is that it's very easy for us to say, well, a midwife would have figured that out. But she didn't have a midwife. She couldn't process a midwife. And there are other women in this position who cannot access a midwife and do not think the hospital is safe. So this is where we are. And this is why I think the story is important. Not because we want to put out a story and call out particular behaviour. I do think it's worth amplifying the concerns of these parents about their experience. But the overall point is to say that women are choosing this because they see it as an option. And that is an issue that we need to look at because it wasn't her first choice. Why couldn't she get her first choice? And that's what we need to look at as broadly as a society. That's the main point. Yeah.

Mel:
[39:05] And we'll discover later too that this woman put her faith and trust in this clinician to be able to tell her when there might be an issue. There's a lot of responsibility being put on the birth keeper by the woman because the woman originally wanted to move that clinical responsibility onto a registered healthcare provider. She wanted the responsibility of that clinical work to be on somebody else, not herself. And so she put that onto the birth keeper. And the other grave concern here is that the birth keeper took that on.

Charlotte:
[39:40] Well, exactly. She didn't say, no, I can't, I don't know what I'm doing. I don't have any real training with this. Don't ask me because I can't tell you. She said, yeah, I can, I can check. And, you know, at no point did she say I have medical training, but the things that she was doing, according to Alice, were clinical. So she, it's confusing for her because she thinks, well, yes, you don't have medical training, but you do have some skills, don't you? Because you've told me you do and you're saying this so that's reassuring to me that everything's okay and you know multiple times through the labor there were moments where Alice didn't feel like things were progressing as they should and you know everybody has different labor nobody can really know how it's going to go and some labors take days I understand all that but this felt off to her and she she said that she was getting these very thick fast contractions and then it was pulling back to nothing for hours at a time and it felt confusing to her because she wasn't her understanding of what quote unquote should happen uh during labor and she you know she has a right to to look to reassurance from somebody who might know a little more and when she did she was told everything's fine because of a b and c and yeah and that was indirect information so.

Mel:
[40:57] She wasn't given the opportunity to to explore other options because she was told it was fine and in the article you say that when Alice questioned the birth keeper if she would be able to spot red flags the answer was yes this reassured Alice that she was at least in the hands of the next best person that if there was a complication that this birth keeper would recognize it and that Alice could use that information to make decisions so the birth keeper agreed to support Alice through her pregnancy and birth. And in the article, you say it was at the cost of $5,555. So just for some context, This is slightly cheaper than what a fully qualified registered midwife would charge for a birth.

Charlotte:
[41:43] It is and it isn't because you do get, you actually get some back when you go through.

Mel:
[41:47] Well, yeah, this is what I'm, you know, for me personally, my fee would be about that much out of pocket after the woman gets their rebate for Medicare.

Charlotte:
[41:56] So the midwives would charge less. And, yeah, somebody did contact me after the article and say that their partner actually, you would end up $4,500 out of pocket after of the rebate. So it's actually more expensive than their partner would be.

Mel:
[42:09] So this presents not dissimilar pricing to what the woman was willing to pay for a private midwife and the birthkeeper accepted that and obviously must have presented that as the fee. And it says here in the article that in written communication, this woman that referred to herself as a birthkeeper, but face to face, Alice says she used a different term. She called herself a sovereign midwife multiple times, so presented herself as a midwife outside of the system.

Charlotte:
[42:41] This term is relatively new to me, but I'm sure some of your listeners would know, the Free Birth Society in the US, and they talk about this. There's a post quite recently talking about sovereign midwifery and what it means. And the way that they describe it is midwifery that's free from any state, institutional, governmental involvement. Midwifery that's focused solely on supporting and nurturing and honouring the mother and her baby and recognising the mother and the baby as the sole authority over the birth experience. That's the closest that I've sort of come to a definition of what sovereign midwifery is, but it's sort of similar, in a similar vein, I think, to other sovereign movements which have sort of emerged since COVID-19. Which is around, you know, separating yourself from the state, severing off that tie of any state or institutional involvement in your life. And so that is my understanding of what that term means. We didn't just get that from Alice. We have other sources who have told us that that is how this birth worker refers to herself, not in written form, but face to face.

Mel:
[43:52] And I guess there is a slight difference too in the American use of the word midwife in a sense that here in Australia, it's illegal to call yourself or behave as a midwife if you're not registered as a midwife. So even unregistered midwives, we could no longer use the title midwife even though we have a midwifery qualification because it's a protected term by law. Even more serious is if you propose yourself as having those skills to women who are then assumed that you have those skills. And a real issue is that when you're a registered midwife, there's sort of checks and balances to make sure that yes, you've been through the appropriate training. Yes, you have the appropriate minimum competencies as a midwife. So women have a really clear expectation of what they can expect from you and what your skill set is.

Mel:
[44:45] And the issue with unregulated birth work or unregulated work as this so-called midwife is that women can have no reassurance of what training or skill that person has. And so that's the difference between being registered and regulated and unregistered and unregulated is that there's some real pride from birth keepers who are outside of the system about the fact that they are free from gays and that they can't be controlled and that they can do whatever they want under the guise of serving women. And that's certainly the catchphrase is, you know, you can't control us. We are free from government control and regulation.

Charlotte:
[45:36] Yeah, in which case I think it's really important to make it known that you don't, there's no confusion, that you're not a midwife.

Mel:
[45:44] Yes, and that was one of the motivations from the families is to say we want to highlight that these people aren't midwives. They propose to have some midwifery skill and have some clinical reasoning that might mimic midwifery, but it's not midwifery. It seems like the family, Alice and her family, they knew that, but they tried to position this birthkeeper as somebody who could fill that role, and it's obvious that she couldn't.

Charlotte:
[46:14] Well, it's obvious now to the family, yes, because of what happened.

Mel:
[46:20] In the article, it says Alice's pregnancy was a breeze, and she went into labour at full term, but as night turned into day, something wasn't right. So Alice, during her labor, recognized herself that something was unusual. And then she looked to the birth worker, the birth keeper, to give her some answers about what was unusual. She asked the birth keeper, is the baby, so I guess one of the lines that really caught me was, yes.

Mel:
[46:55] Alice says, I would have taken myself to hospital at that point, but because I was reassured by her birth keeper that she continued at home. And this is a significant difference to women who free birth. And one of my questions that I ponder in my head is, would this woman have actually had a different outcome and have been kept physically safer in a free birth without a birth keeper because she would have rested more in on her own intuition and her own decision-making rather than transferring that to somebody else. And she says that she would have taken herself to hospital, but she didn't because the birth worker reassured her that everything was okay because the birth worker, the birth keeper, did an internal vaginal examination and told Alice that the head was there and that everything was going fine.

Charlotte:
[47:51] Well, there were actually multiple points through the labour where she reassured her and at one point she told her, the baby's only stressed if you're stressed. And this is when the labour wasn't progressing in the way that she expected it to. And that line, you know, a couple of parents that I've spoken to, that really bothers them because it just puts this, it puts the onus back onto the mother basically for having, it's her fault that she's having a complicated birth because she's just not relaxed enough. She's not in her own, she's not in the right head space. And, you know, there might be people that argue that, but I would suggest that there would be others that would say there's actually literally nothing that she can do to get her baby to change, she could do in her mind to get her baby to change from being in a diagonal position where its shoulder is stuck and to get into a position where it can come out and be birthed naturally. There's literally nothing she can do. So to say that, you know, in that situation, not that the birth worker knew, understood that that was the position of the baby, but it just, it shows a blatant ignorance of the situation and to put that on the mother, I think is very unfair because it blames women for their birth outcome because they just weren't in the right headspace.

Mel:
[49:11] Right. And that's something that the article makes a point of is that the birth keeper kind of suggested the baby's only stuck if your mind is stuck and actually also misdiagnosed what she thought was the head applied to the cervix was actually the baby's shoulder presenting. And that's a very complex presentation. The baby would not have come out vaginally. And as we discover later in the story that Alice eventually does feel like things are not right. And she does acknowledge her own intuition, which she knew, which by the story that she told you is that she knew that, she knew what she was feeling but seemed hopeful that the birth keeper had information.

Charlotte:
[49:54] She did it herself because the birth keeper told her, well, it's only going to be stressed if you're stressed. So she kept saying, I've got to relax, I've got to relax. But it's me, it's all me, I've got to relax. And that's not true and it's not fair and it just delayed her actually being seen by professionals who could assist her and her baby. And in the end she did listen to herself and she sort of had this moment where she just said, this idea she just realized that actually if it was the baby's head i'd be feeling more pressure and i'm not feeling that pressure so and she just said it was sort of this light bulb moment and then that's when they went in you know none of this she blames on the birth worker she doesn't blame the birth worker for the fact that she ended up with an emergency delivery and the baby was in you know not in a great place at all when it was born and uh needed a lot of help it thankfully is fine now after um after that life-saving treatment and delivery but she still doesn't blame she says you know that would have happened anyway but what i do blame her for is taking me down this path where i was being reassured falsely and it it put my life at risk and and her babies because it's not just the baby's life that's risk in this situation her life was at risk her own life was at risk it's not just baby's lives that are being put at risk when these kind of this kind of false advice is given it's mother's lives yeah.

Mel:
[51:23] And she says that at the end she says that um the birth worker repeatedly exaggerated her skill set and provided a false sense of security that put her life and the woman's life in danger and Alice says I believe she's fraudulent in the service that she provides and that's a quote from Alice did Alice reflect on that time of her own her own intuitive thoughts versus balancing those against the advice or assessment of the birth keeper.

Charlotte:
[51:55] Oh, a lot. She's done an enormous amount of reviction because she does take responsibility for the outcome because she says it was my choice. But she still has a right, I think, to voice concerns about the path that she was taken down in that process. Yes, it was her choice. Yes, it was her responsibility. But if you have an agreement with someone who is working with you through your labour and through your pregnancy, labour and birth, they have a responsibility I think as well to be clear about their knowledge and their skill set and if they're going beyond it it's probably worth reflecting on that after the fact when you get it wrong and, Alice according to Alice that just hasn't happened and she wasn't really up for that which again is part of why we thought there was a need to tell the story.

Mel:
[52:45] And this is part of the challenge of regulation versus unregulated birth work, clinical birth work, is because midwives have a responsibility to be reflective practitioners. There's lots of checks and balances. And certainly you mentioned later in the article that there's another family who shared their story. As we continue in this podcast episode, we are going to move to the story of Patrick and his partner. And due to time constraints Charlotte and I couldn't fully explore this story but I want to honor the fact that this this family has offered up their story and asked Charlotte if she would please share it on their behalf. So in order to honor the sharing of this story I'm going to read it as it is in the article which will also help make the following parts of the podcast make a lot more sense.

Mel:
[53:37] Now the article says, for Patrick and his partner, the public health system was too restrictive and home birth with a registered midwife was expensive. They heard about someone in between, a birth worker who wasn't registered but appeared to have all of the experience and training of a standard midwife, albeit acquired through alternative means. The birth worker was in the same network as Alice's birth worker and agreed to provide antenatal birth support and postnatal care. Patrick says, my understanding was, is that we would have someone who was skilled in experience, even though they may not be registered. It was Patrick's first baby, and he wanted to make sure everyone would be safe. He says, there were two main things that my partner felt supported to have a healthy natural birth, and if things go wrong, that we had things covered. The person they had in mind was asked whether she would be able to identify warning signs that may require a transfer to hospital. Patrick told the birth worker, I don't know what I don't know and so I need to know that you know these things. The birth worker reassured them that yes, she knew what to look for and that there would be time to get to the hospital if needed. Patrick said the birth worker used a Doppler to check the baby's heartbeat and assess the baby's position as head down in the final weeks of pregnancy. Everything appeared to be normal. When his partner went into labor, things moved fast and then at some point she suddenly had a large show of meconium, Patrick says.

Mel:
[55:06] Meconium is the first poo of a newborn baby and if passed while the baby is still in the uterus, it can be an indication of distress.

Mel:
[55:14] Patrick says his partner became concerned because she assumed this would mean a hospital transfer but the birth worker was not so sure. She sought advice over text from her colleague who was Alice's birth worker.

Mel:
[55:27] Who encouraged them to continue at home. The birth worker then used a Doppler to check the heartbeat and Patrick says she told us the baby's heartbeat was fine. Patrick's partner forged on and was having strong, fast contractions. Getting in the car and driving to hospital seemed out of the question. The baby was coming soon. Patrick's partner was on her hands and knees on the floor of the living room when the baby began presenting. And then at some point, I realised that it was his bum, he says. Breach births are uncommon but can be managed in a hospital or at home if the practitioner is trained in how to respond. Patrick says, I didn't know it then, but I think you've got seven minutes to get them out because the umbilical cord gets pressed against the skull, Patrick says. Things have to happen fast for the baby to either not get brain damaged or die. Patrick says that the birth worker decided to scoop the baby's legs out. Eventually, the arms and the legs came out and the body came out, but his head was stuck. An ambulance was called and an emergency midwife got on the line. They were talking my partner through changing position. When that position was changed, right away, that's when he eventually came out, Patrick recalls, and he wasn't breathing. The birth worker tried to resuscitate the baby and soon after the ambulance arrived, they came in and they made their efforts to resuscitate, Patrick says. This older guy, I remember him pretty much just shaking his head as soon as he saw.

Mel:
[56:52] The paramedic tried to administer adrenaline, but the baby boy was unable to be revived. Patrick says what followed was grief, devastation, disbelief and pure horror. My partner was just wailing. The paramedics had also called the police. When the officers arrived, Patrick said that the birth worker left, went out into the back room and disappeared. Before the birth, Patrick says he and his partner had discussed with the birth worker what they would do in the event of a hospital transfer. And they'd spoken about the fact that the birth worker was operating outside of regulations. And Patrick says there was an understanding that if we did have to transfer, we would just say she's a friend. We wouldn't say she's our midwife or our birth worker.

Mel:
[57:40] And that was to protect her, he says. At no point in any of these conversations had I imagined a dead baby. Patrick's baby boy was deemed a stillborn and the coroner made a decision not to investigate. He and his partner were able to spend a few days grieving with their son's body at home before he was buried. In the weeks and months afterwards, Patrick says they were left grappling with what had happened and how and whether things could or should have gone differently. They reached out to medical experts and birth professionals for advice about what took place and whether the death could have been avoided. The understanding we got consistently was that Patrick said that all indications are that I could have had my son if I'd had the right support in place at the time. Patrick says hospital trauma is part of what is pushing women towards birthing outside the system, but that those presenting themselves as birth professionals need to know their limits. He believes the pendulum has swung too far. This person who had every good intention to support us to have a healthy baby boy was ill-equipped for the job when things went wrong, Patrick says. She wasn't aware of her shortcomings,

Mel:
[58:47] That, to me, is a dangerous combination. He's concerned that for some in the free birth community, there's not only a lack of knowledge, but also a strong resistance to calling for external help. There are multiple babies dying, and it doesn't need to happen. That's the story shared by Patrick's family. For Patrick's family, their baby did not survive their free birth under the care of a birth keeper.

Mel:
[59:12] Alice's baby was born by cesarean section. And if you read the article, you'll hear Alice's account of what condition the baby was born in as a result of the positioning. And Alice's baby has recovered and report to be doing well. That's not always the case, though.

Charlotte:
[59:29] No, and Patrick and his partner had a different experience and their baby died after a breach delivery. It's difficult to know exactly when the baby died, but it was deemed a stillbirth. That it's interesting because actually they don't talk about going into that birth thinking that it was a free birth so that wasn't actually their terminology they wanted a home birth but the birth worker that they had they understood her to have some midwifery training or skills even though it was an alternative to your mainstream system so both of them not neither of them thought that they were having a free birth. They thought they were having a birth outside the system with a birth worker who had midwifery skills and who definitely, they thought, had the skills to recognise, a situation that needed more help and more intervention when it was time to go to hospital.

Mel:
[1:00:28] Yes. So I guess what women need to be hearing here is that when you choose an unregulated birth worker who claims to have clinical skills, there's no way of knowing what those skills are and if they are capable or not of assisting you so you are having a free birth because there's no registered healthcare provider there who's capable of dealing with complications

Charlotte:
[1:00:55] And they just said that they did not they they put a lot of faith in this birth worker and the father that I spoke with Patrick his sense was that the birth worker didn't know her limits that she didn't recognize where her skill set started and finished and that was the biggest problem because he thought that she had an inflated sense of her skills and when when this baby was breached and when the way that it was born um it became really clear that she she didn't have those skills you.

Mel:
[1:01:30] Mentioned in the article

Charlotte:
[1:01:31] That i mean one thing What I will say is that I, you know, there has been some discussion online after the stories come out and, you know, there are always going to be positive and negative responses to a story like this. But I did contact the father again to ask, to tell him about doing this podcast. And I said, you know, is there anything that you want me to say or any point that you want me to make? And he said just the same message, really, that came through with the article. And he said that having someone in the room taking a role and assuming a level of expertise, even if they say, I'm just sharing an opinion, it's your choice what you do with it, will inevitably influence choices that parents make. And so they better be really sure what they're saying is the right thing to say. And that's that whole thing of, you know, this whole phrase that there's no enemy worse than bad advice. If you're giving someone advice in a very vulnerable moment, and it is a vulnerable moment when you are giving birth for both mother and baby, you really want to know that what you're giving is the correct advice. Or at least that it's framed in a way that this is where you're coming from. Because, you know, there's no such thing as perfect advice. You know, even from midwives, obstetricians, they can give the wrong advice as well, obviously. But I think the key thing is to know what you don't know and when you're going beyond what you know.

Mel:
[1:02:57] Yeah, it's a real overstepping of the scope and assuming that there's midwifery skill that will just present itself as the need arises. And also there's a difference midwives and obstetricians and registered healthcare providers are required to take responsibility for the type of information and the type of care that they're giving. Whereas I think the difference here is that the birth workers haven't, by accounts in these stories, haven't taken responsibility for their role in this scenario. And that's potentially added, I'm assuming, to the motivation of these families to come forward because these birth workers are continuing to do what they've been doing and have chosen not to take responsibility over the outcomes. And that's certainly, when you free birth, parents do acknowledge that they're taking responsibility for whatever the outcome's here because they've chosen to free birth. But I think here the birth workers position themselves as somebody in the birth space that had an element of power and decision-making capability and therefore some responsibility over the choices that were made. But they're choosing not to take that responsibility and absolving themselves of any role. And that demonstrates a lack of reflective practice.

Charlotte:
[1:04:20] Well, and that's not always going to be the case. I mean, obviously there are other women out there, other human beings out there who may have dealt with this very differently and been very reflective after a catastrophic outcome and, you know, really rethought their role. But in these particular circumstances with both the families that we spoke with, that just hadn't happened. I do think that there is a public interest in the current climate where women are choosing these alternatives to know that sometimes they're getting, they might not know what they're getting. And, you know, women are choosing this path, are often very educated and very clear on what they are getting. But it can be difficult to know exactly what you're getting.

Mel:
[1:05:08] And one question that I get asked a lot is how many more, you know, we talk about the most undesirable outcome and the worst outcome as being a baby has died. And in the article you mentioned that between 2022 and 2024 in this particular small region,

Mel:
[1:05:25] That there's been reports of seven babies who have died in the context of free birth and that Alice's, this particular birth keeper, Alice's birth keeper, was the attendant at three of those births where the baby, it actually resulted in the baby dying. I'm curious to know if there's going to be any repercussions for this because for me as a private midwife, I've been a private midwife for 16 years and so far in my midwifery journey none of my clients have experienced a baby that hasn't survived their birth and it's actually quite a rare circumstance. So the fact that three of these have occurred in a two-year period with one single practitioner is actually alarming. It would be alarming even for a highly trained clinician to experience three babies in a two-year period not surviving. So I just want to highlight it's not as though this issue's been highlighted for no reason. Babies have died and it seems to be a high percentage compared to the number that we would normally expect in hospital or under the care of a clinician. Are there going to be, from what you know, any repercussions for these birth keepers in the sense that they're positioning themselves as having midwifery skills and at least in private talking about being midwives?

Charlotte:
[1:06:52] Well, I will say that we're not making any specific allegations in relation to this birth worker being responsible for these baby deaths. We are merely stating the fact that she was employed as the birth keeper for these women who lost these babies so the circumstances around the births and the deaths are being investigated by the new south wales coroner we're not actually sure if the coroner has knowledge of the fact that this woman was the birth keeper we know for a fact that she was through evidence that we have that's documentary evidence or um multiple sources have given us their accounts.

Charlotte:
[1:07:38] First-hand accounts of that. So we just wanted to point out that she was employed as the birth keeper. And like you said, it is unusual to experience infant deaths late in pregnancy at all in Australia or after birth. Some of these deaths were neonatal. So it's just unusual and we don't know what the circumstances exactly were around those deaths. They are being investigated. But it's not public knowledge. It wasn't public knowledge before that this same person was associated with these deaths. I think that's important to make clear in a context where this birth keeper is still attending births. Women and the public should know that and they should know that about other practitioners as well. If an obstetrician is involved in, has been associated with baby deaths, higher number than usual, I think it would be important for the people who are seeing that obstetrician to know that. And so that is why we named her in the story.

Mel:
[1:08:42] We could go through this story in so much detail and pick out all the issues but there will be and have been a lot of angry responses to this article you know I'm in this home birth and free birth realm in various different ways and so lots of people use me as a vessel for comments and bouncing ideas and and certainly the feeling I've had is so mixed from people some who are so grateful that you've made the distinction in this article between the difference between a home birth and a free birth and also the skills of a midwife versus that of a birth keeper. There's some gratitude that a lesser known part of free birth and of this birthing outside the system realm has been brought into public view. But there's anger in a sense that often the women who are in these circles and the birth keepers who are in these circles are no strangers to being attacked in in a political sense and in in the media which I think is what gets people's hackles up is it it feels like another attack on their on their work and and against women's birth choices and we know through this discussion that that wasn't the intention but why do you think now that you've investigated this for so long for really over a year why do you think people are angry that you're writing about this

Charlotte:
[1:10:07] Well, I think you're right that there are people in the free birth community and, you know, in this sort of off-grid world generally that are used to being maligned by, you know, the mainstream society. You know, there's a lot of crossover with free birth advocates and, you know, homeschool and anti-vaccination networks, that kind of thing. So I think there's a lot of distrust generally and that's directed towards, you know, so-called mainstream media, which the ABCs often roped in in the same basket. You know, people have their reasons for distrusting those institutions and those outlets. I don't know all the reasons why this article would make people angry, but they're, you know, they have a right to feel however they want about the article. All we can do is put the information out there in a way that is carefully verified. It's been very thoroughly fact-checked. It's been through all the processes, the editorial processes that we go through. It's not just myself and Andy who worked on it. There are other people at the ABC that have, you know, that have given their advice and guidance around whether this is the right way to frame the story. It's a very careful process. and at the very centre of it are the families who reached out to us at the outset and wanted to do this.

Charlotte:
[1:11:36] So it's actually part of our role is to provide them a platform to give their voice, to put their voice out there in a way that is deemed to be in the public interest because what they have to say matters and we believe it matters and there are other people that believe it matters. My job is just to put it out there in a way that I'm happy with and that the families are happy with and that is accurate and respectful. What happens after that is up to everyone else.

Mel:
[1:12:07] And this really is that the two families who came forward and that whose stories were presented in this article, it feels very much like this was their story and you told it at their request. So if people have got an issue with this story, then their issue is with women sharing what happened to them. This is information that's come directly from women. It wasn't something that was peddled by the ABC in the interest of self-gain. If you hadn't have put this out and your article back in February 2024, the birth world would actually not know that these events are happening. Because they're not monitored, governed, there's no recording or reporting in any traceable way of how many women are free birthing, how many babies are damaged, how many babies are well during a free birth. The vast majority would be absolutely well because birth works well most of the time.

Charlotte:
[1:13:05] Well, we actually don't know that either.

Mel:
[1:13:06] We don't.

Charlotte:
[1:13:06] We just don't know whether they're well or unwell or the number of free births, planned free births that are ending up in hospital with various outcomes. Outcomes in Queensland has tripled. The latest data shows and we don't know how many original planned free births are not ending up in hospital. So it's just impossible to know. And that is the whole point is that this information is just contributing to our knowledge base about this practice. It's not an attack, it's information. And my job is not to advertise free birth. That's not what we do as journalists we don't advertise anything um we interrogate what's going on in the world around us and and whether that you know it's something that people should know about then we then we try where we do our best to do that in a way that's evidence-based so you know if you think that it's an attack it's there's a bigger picture here and the abc doesn't tell us what to do it was our decision to do this story the abc supports our work and stands by it charlotte.

Mel:
[1:14:11] As i said i think we could be talking for another hour and a half if we were going to get anywhere near being thorough in working through this. But I feel like this is a lot of information that readers, it's new information as well. I love that you shared that actually the women and families came to you with their stories and I want to express so much gratitude to these families for offering up this information. This is a huge emotional investment for them to be sharing with you and I imagine the amount of back and forthing that went on would have been great. Just exhausting in so many ways for them. And so I want to just acknowledge them for having the strength to bring this and put it out in the public. I do hope that you don't stop sharing, that families don't stop sharing their birth experiences across the scope. You know, there's been so much change in the birth world because women who were traumatized by the hospital system came forward, offered their stories in the birth trauma inquiry and consumer advocate groups are seeking these stories to help generate change in the maternity care system. And I see this as another way of doing that and putting in checks and balances to keep working towards a maternity care system that actually serves the women's needs properly and is as safe across all elements of safety as we can possibly make it. Thank you, Charlotte.

Mel:
[1:15:34] As our podcast episode comes to a close, my reflections on this topic are that the families who offered up their stories wanted to share them because their experience was that the role of their birth keepers was obscure and unclear.

Mel:
[1:15:48] Their birth keepers weren't, and birth keepers aren't, midwifery trained, and therefore can't and couldn't provide the service that the families believed they were getting. From the family's stories, it's been made clear that the actions of the birth keepers created a barrier to the families and women to use their own intuition and reasoning when making decisions. The families gave some responsibility over to the birth keepers to tell them if they should seek help And on the information provided by the birth keepers, the women delayed seeking help where it was clearly needed

Mel:
[1:16:24] My impression of both these stories is that the women and families would have transferred to hospitals sooner, if not for the clinical advice given by their birth keepers. And my feeling is that if they were having a completely unattended free birth, they would have relied on their own reasoning and intuition when making decisions and would not have had the reassurance that their birth keepers gave them. Perhaps without the birth keeper there, they would have been motivated to seek help sooner because they would have trusted their own knowledge more than the confidence they had in the clinical assessment of their birth keepers.

Mel:
[1:17:02] When you hire a birth keeper and no midwife to attend and you're at home, it's important not to have the expectation that your birth keeper can do anything to keep you and your baby safe if there's a complication. They can't diagnose and nor should they diagnose if things are going normally or abnormally. That's a responsibility placed on the woman if it's a free birth and if there's a midwife then the woman and midwife work together in partnership and each bring their own unique knowledge and skills to the decision-making process and to the management of complications. And when women hire a doula, they can be mostly confident that that doula is going to offer them expert birth support, but a doula working within their scope will not claim to be able to provide clinical care that will help women make decisions about their health and the health of their babies. Doulas aren't regulated because they don't need to be, because they don't provide clinical or medical care or care for your clinical needs during an emergency. They are experts in so many elements of care that a woman needs during her labour and birth but that expertise does not extend to clinical care or care during complex circumstances. Any birth keeper who claims to be able to help you identify red flags or even tell you that your labour and birth are progressing normally is working outside of the scope of a doula.

Mel:
[1:18:28] Midwives on the other hand are able to provide midwifery care which includes being able to make clinical assessments and recommendations and they have clinical knowledge about what is normal and abnormal and are highly skilled to deal with complications. The vast majority of women choose free birth because it presents itself as a better and safer option than when they look at the options they are offered by the mainstream maternity care system.

Mel:
[1:18:57] Often, they choose free birth or unregulated birth workers because they can't access a midwife to attend them for a home birth. And on the whole, the maternity care system is not providing women with a service that suits their needs, and it's leaving women with physical damage from overzealous and unnecessary intervention and emotional and psychological trauma from disrespectful care. There's no doubt about that, and I understand why women would want to avoid that. And certainly within the birth world amongst doulas and women who choose free birth and women who choose home birth, we're very quick to praise women when they share their stories of trauma within the system.

Mel:
[1:19:39] What I noticed though, and what women have shared with Charlotte, is that these stories of circumstances that arise within free birth communities and stories that women share about birth keepers not as openly received as stories about traumas that occur at the hands of medical clinicians in hospital. So I would remind you that if you value stories of women about trauma that they've experienced at the hands of the maternity care system, of the mainstream maternity care system, then it would also be on brand to be caring and thoughtful about stories that are shared from within the way that you work and critically approach those in the same way as you would stories about the maternity care system.

Mel:
[1:20:27] The issue that this episode addresses and the attention of the families who shared their stories is that unregulated birth workers are claiming to be able to offer some intermediate option between doulas and midwives and claiming to have a level of clinical expertise that they don't have. And if they do have some clinical skill, they're still not 100% prepared and equipped for all the possible circumstances that they are encountering in a birth.

Mel:
[1:20:55] This grey area in which birth keepers exist appears to span across the scope of doula care and midwifery care, but the public can't truly know the skill of their birth keeper or of their capacity to keep them safe because they work outside of the gaze of any regulation or training requirements. And because of the actions of a small portion of doulas or birth keepers, the regulation bodies who regulate midwifery and other healthcare providers are whispering about applying regulation to other birth workers. I personally think that if doulas and birth keepers are working within their scope and not claiming to offer midwifery type care, then there's no reason to regulate them. But when stories like this one that we have shared are revealed, I can understand why there might be a call to regulate birth workers. But in fact, we know that when you put pressure on a marginalised and already repressed group and you expect them to comply, they just become more radical and go deeper underground. It's just a common social phenomena.

Mel:
[1:21:59] And this brand of birth keeper wants to operate without restrictions or boundaries.

Mel:
[1:22:05] Regulation is far from perfect, but when you hire a midwife, you at least know that there is a minimum standard for their training and competency. In fact, when you hire a private midwife, you know they have at least 5,000 hours of hands-on clinical experience and they maintain continual training, professional development and surveillance.

Mel:
[1:22:26] If their practice is unsafe, at some point they will come under scrutiny and be required to be accountable for their actions. They're trained to assess for normal and abnormal circumstances in pregnancy, labour and birth. And there are always going to be a portion that won't get it right. We're all humans and we don't get it right all the time. But they will be far more accurate than a birth keeper and know how to manage emergencies. None of this regulation exists for birth keepers. So if you choose to hire one, just know that it's not their responsibility to keep you safe and manage complications. And if they claim to be able to do that, they're working outside of their capabilities and work in the hope that they won't meet a complication that they can't manage. 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 @TheGreatBirthRebellion. All the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
©2026 Melanie The Midwife

Episode 128 - Birth keepers an investigation with journalist Charlotte King ABC

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