In the UK, it is illegal for anyone other than a midwife or doctor to deliver a baby, except in an emergency situation. Doulas should not be present at a freebirth. It is not, however, illegal for women to choose to freebirth.
I have been reading several articles online about freebirthing, and in many have found misused quotes or statistics from sources. Not surprisingly, many of these articles have been written by women who have previously freebirthed.
Whilst these freebirths often happen without a problem, there are a number of risks associated with childbirth which need dealing with almost immediately otherwise there is a risk to the life of mother or baby. A risk during labour is that of cord prolapse. There are a number of factors which cause this to be a risk, and these are anything which prevents the presenting part of the fetus (hopefully the head) descending in to the pelvis before the waters break. These may include an ill-fitting presenting part, such as small fetus, a malpresentation (such as a shoulder presentation instead of a head presentation) or polyhydramnios (too much fluid). If a cord prolapse happens, there are a number of techniques the midwife is able to use to keep the fetus's head off the cord to stop it cutting off it's own oxygen supply. The midwife must maintain the technique until the woman is in theatre and the baby is being delivered by caesarean section. A woman freebirthing wouldn't be able to use these techniques.
Another risk is that of shoulder dystocia during delivery. From the time the head is delivered, there is only 8 minutes to deliver the fetus. If the shoulders are stuck, and the baby isn't delivered within 8 minutes, the baby is likely to have a poor outcome due to there not being enough oxygen getting to the brain. Again, midwives have the knowledge to deal with this, but women freebirthing will not be able to use some of the techniques.
A risk to the mother is that of postpartum haemorrhage (PPH). Some blood at delivery is normal, but until the placenta is out, there is a risk of bleeding. There is a risk after this, too, but whilst the placenta is in, the risk is greatest as the uterus is unable to fully contract. Breastfeeding can help to cause uterine contractions which may speed up the delivery of the placenta. If the woman starts to haemorrhage, large volumes of blood can be lost in a very short space of time. Midwives have drugs which can reduce the bleeding, and are skilled in the techniques used to cope with haemorrhaging. There are a number of risk factors which can increase the likelihood of a PPH, and these include an overly stretched uterus (such as having a multiple pregnancy (twins or more) or polyhydramnios), a fast labour (less than 3 hours) or a slow labour. Women who are 'grand-multips' (having baby number 5 or greater) are also at increased risk.
A number of the articles I looked at seem to confuse freebirthing with home birth. For instance, this articles by the Daily Mail discusses the safety of freebirthing by looking at the statistics and findings of the Birthplace Study. Yes, giving birth at home is safe, and in most cases is safer than giving birth in a consultant led labour ward. But, this study looks at women who are low risk and who give birth at home (or in a midwife led unit or a consultant unit) with midwives. Even if there are no adverse outcomes, these women and their fetus are still monitored and many of the women would still have opted for an active third stage (an injection to deliver the placenta). Using this study to advocate the safety of freebirthing is wrong.
This article by the Guardian discusses a woman stating that she knew she could do it because she had seen a cat give birth. Humans have very different anatomies to cats (the cat's anatomy is shown to the left, with a straight birth canal) - to most other animals, even. The human pelvis has had to adapt to our ability stand upright. This means that, unlike almost every other animal (and I said almost every other animal as I am not an animal specialist - I assume it is in fact every single animal except us humans), humans do not have a straight birth canal. We have a feature called the curve of carus - this is caused by the S shape of our spine, and the lower part of our spine (the sacrum) intruding in to our pelvic cavity. This means that the fetus has to navigate a bit of a bend, between the sacral verterbraes and the rest of the pelvis in order to be delivered safely. This diagram shows a fetus passing through the curve of carus as it descends through the birth canal. The dimensions are already a snug fit, and a fetus who's head doesn't go in the normal way may not be able to pass through this structure very easily. This may cause a longer labour, increasing the risk of a PPH, or causing fetal distress, causing the fetus to pass meconium (stick poo), and this may be aspirated (breathed in to the lungs) and cause breathing problems in the newborn.
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