‘Free birthing’ and planned home births might sound similar but the risks are very different
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The death of premature twins in Byron Bay in an apparent “wild birth”, or free birth, last week has prompted fresh concerns about giving birth without a midwife or medical assistance.
This follows another case from Victoria this year, where a baby was born in a critical condition following a reported free birth.
It’s unclear how common free birthing is, as data is not collected, but there is some evidence free births increased during the COVID pandemic.
Planned home births also became more popular during the pandemic, as women preferred to stay away from hospitals and wanted their support people with them.
But while free births and home births might sound similar, they are a very different practice, with free births much riskier. So what’s the difference, and why might people opt for a free birth?
What are home births?
Planned home births involve care from midwives, who are registered experts in childbirth, in a woman’s home.
These registered midwives work privately, or are part of around 20 publicly funded home birth programs nationally that are attached to hospitals.
They provide care during the pregnancy, labour and birth, and in the first six weeks following the birth.
The research shows that for women with low risk pregnancies, planned home births attended by competent midwives (with links to a responsive mainstream maternity system) are safe.
Home births result in less intervention than hospital births and women perceive their experience more positively.
What are free births?
A free birth is when a woman chooses to have a baby, usually at home, without a registered health professional such as a midwife or doctor in attendance.
Different terms such as unassisted birth or wild pregnancy or birth are also used to refer to free birth.
The parents may hire an unregulated birth worker or doula to be a support at the birth but they do not have the training or medical equipment needed to manage emergencies.
Women may have limited or no health care antenatally, meaning risk factors such as twins and breech presentations (the baby coming bottom first) are not detected beforehand and given the right kind of specialist care.
Why do some people choose to free birth?
We have been studying the reasons women and their partners choose to free birth for more than a decade. We found a previous traumatic birth and/or feeling coerced into choices that are not what the woman wants were the main drivers for avoiding mainstream maternity care.
Australia’s childbirth intervention rates – for induction or augmentation of labour, episiotomy (cutting the tissue between the vaginal opening and the anus) and caesarean section – are comparatively high.
One in ten women report disrespectful or abusive care in childbirth and some decide to make different choices for future births.
Lack of options for a natural birth and birth choices such as home birth or birth centre birth also played a major role in women’s decision to free birth.
Publicly funded home birth programs have very strict criteria around who can be accepted into the program, excluding many women.
In other countries such as the United Kingdom, Netherlands and New Zealand, publicly funded home births are easier to access.
Ink Drop/Shutterstock
Only around 200 midwives provide private midwifery services for home births nationally. Private midwives are yet to obtain insurance for home births, which means they are risking their livelihoods if something goes wrong and they are sued.
The cost of a home birth with a private midwife is not covered by Medicare and only some health funds rebate some of the cost. This means women can be out of pocket A$6-8,000.
Access to home birth is an even greater issue in rural and remote Australia.
How to make mainstream care more inclusive
Many women feel constrained by their birth choices in Australia. After years of research and listening to thousands of women, it’s clear more can be done to reduce the desire to free birth.
As my co-authors and I outline in our book, Birthing Outside the System: The Canary in the Coal Mine, this can be achieved by:
- making respectful care a reality so women aren’t traumatised and alienated by maternity care and want to engage with it
- supporting midwifery care. Women are seeking more physiological and social ways of birthing, minimising birth interventions, and midwives are the experts in this space
- supporting women’s access to their chosen place of birth and model of care and not limiting choice with high out-of-pocket expenses
- providing more flexible, acceptable options for women experiencing risk factors during pregnancy and/or birth, such as having a previous caesarean birth, having twins or having a baby in breech position. Women experiencing these complications experience pressure to have a caesarean section
- getting the framework right with policies, guidelines, education, research, regulation and professional leadership.
Ensuring women’s rights and choices are informed and respected means they’re less likely to feel they’re left with no other option.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Survival of the Prettiest – by Dr. Nancy Etcoff
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Beauty is in the eye of the beholder, right? And what does it matter, in this modern world, especially if we are already in a happy stable partnership?
The science of it, as it turns out, is less poetic. Not only is evolutionary psychology still the foundation of our perception of human beauty (yes, even if we have zero possibility of further procreation personally), but also, its effects are far, far wider than partner selection.
From how nice people are to you, to how much they trust you, to how easily they will forgive a (real or perceived) misdeed, to what kind of medical care you get (or don’t), your looks shape your experiences.
In this very easy-reading work that nevertheless contains very many references, Dr. Etcoff explores the science of beauty. Not just what traits are attractive and why, but also, what they will do for (or against) us—in concrete terms, with numbers.
Bottom line: if you’d like to better understand the subconscious biases held by yourself and others, this book is a top-tier primer.
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What Menopause Does To The Heart
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World Menopause Day: Menopause & Cardiovascular Disease Risk
Today, the 18th of October, is World Menopause Day.
The theme for this year is cardiovascular disease (CVD), and if your first reaction is to wonder what that has to do with the menopause, then this is the reason why it’s being featured. Much of the menopause and its effects are shrouded in mystery; not because of a lack of science (though sometimes a bit of that too), but rather, because it is popularly considered an unimportant, semi-taboo topic.
So, let’s be the change we want to see, and try to fix that!
What does CVD have to do with the menopause?
To quote Dr. Anjana Nair:
❝The metabolic and clinical factors secondary to menopause, such as dyslipidemia, insulin resistance, fat redistribution and systemic hypertension, contribute to the accelerated risk for cardiovascular aging and disease.
Atherosclerosis appears to be the end result of the interaction between cardiovascular risk factors and their accentuation during the perimenopausal period.
The increased cardiovascular risk in menopause stems from the exaggerated effects of changing physiology on the cardiovascular system.❞
Source: Cardiovascular Changes in Menopause
See also: Menopause-associated risk of cardiovascular disease
Can we do anything about it?
Yes, we can! Here be science:
- Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association
- Cardiovascular risk in menopausal women and our evolving understanding of menopausal hormone therapy: risks, benefits, and current guidelines for use
This (in few words: get your hormone levels checked, and consider HRT if appropriate) is consistent with the advice from gynecologist Dr. Jen Gunter, whom we featured back in August:
What You Should Have Been Told About The Menopause Beforehand
What about lifestyle changes?
We definitely can do some good things; here’s what the science has to say:
- Mediterranean diet: yes, evidence-based
- High soy consumption: mixed evidence, unclear. So, eat it if you want, don’t if you don’t.
- Supplements e.g. vitamins and minerals: yes, evidence-based.
- Supplements e.g. herbal preparations: many may help, but watch out for adverse interactions with meds. Check with your pharmacist or doctor.
- Supplements; specifically CBD: not enough evidence yet
- Exercise: yes, evidence-based—especially low-impact high-resistance training, for bone strength, as well as regular moderate-intensity exercise and/or High-Intensity Interval Training, to guard against CVD.
For a full low-down on all of these:
Revealing the evidence-based lifestyle solutions to managing your menopause symptoms
Want to know more?
You can get the International Menopause Society’s free downloadable booklet here:
Menopause & Cardiovascular Disease: What Women Need To Know
You may also like our previous main feature:
What Does “Balance Your Hormones” Even Mean?
Take care!
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The Power of Hormones – by Dr. Max Nieuwdorp
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First a quick note on the author: he’s an MD & PhD, internist, endocrinologist, and professor. He knows his stuff.
There are a lot of books with “the new science of” in the title, and they don’t often pertain to science that is actually new, and in this case, for the most part the science contained within this book is quite well-established.
A strength of this book is that it’s not talking about hormones in just one specific aspect (e.g. menopause, pregnancy, etc) but rather, in the full span of human health, across the spectra of ages and sexes—and yes, also covering hormones that are not sex hormones, so for example also demystifying the different happiness-related neurotransmitters, as well as the hormones responsible for hunger and satiety, weight loss and gain, sleep and wakefulness, etc.
Which is all very good, because there’s a lot of overlap and several hormones fall into several categories there.
Moreover, the book covers how your personal cocktail of hormones impacts how you look, feel, behave, and more—there’s a lot about chronic health issues here too, and how to use the information in this book to if not outright cure, then at least ameliorate, many conditions.
Bottom line: this is an information-dense book with a lot of details great and small; if you read this, you’ll come away with a much better understanding of hormones than you had previously!
Click here to check out The Power of Hormones, and harness that power for yourself!
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What Different Kinds of Hair Loss/Thinning Say About Your Health
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Dr. Siobhan Deshauer shows us different kinds of hair loss, what causes them, and what can be done about them:
Many different causes
Here’s how to tell them apart:
- Alopecia areata is an autoimmune condition where the immune system mistakenly attacks hair follicles, causing hair loss that can occur at any age and affects about 1 in 50 people. It often presents as smooth patches of hair loss and can be treated with steroid injections. Severe cases may require high-dose prednisone, which can restore hair growth over time.
- Discoid lupus is an autoimmune disease that affects the skin, leading to inflammation, scarring, and permanent hair loss. Unlike alopecia areata, it causes visible damage to the scalp and hair follicles. This type of lupus typically does not involve internal organs, unlike systemic lupus.
- Telogen effluvium occurs when a major systemic shock, such as an infection, surgery, or significant stress, triggers many hair follicles to enter the resting phase simultaneously, resulting in delayed hair shedding. The condition is diagnosed with a “hair pull test” and is typically temporary, as the resting phase is followed by normal hair growth phases.
- Allergic reactions to products, such as hair dye containing PPD, can cause hair loss due to scalp irritation and inflammation. An allergic response may trigger hair follicles to enter a resting phase, leading to hair loss by the same mechanism as telogen effluvium. Treatment with steroids can calm the reaction, and hair usually regrows after recovery.
- Syphilis, a sexually transmitted infection, can present with varied symptoms, including hair loss in a distinct moth-eaten pattern. Hair loss due to syphilis is reversible and curable with penicillin treatment, with hair regrowth typically occurring a few months after treatment.
- Biotin deficiency is rare due to its production by gut bacteria and presence in foods such as nuts, seeds, and beans such as soybeans. Deficiency can result from excessive consumption of raw egg whites, which block absorption. Severe deficiency causes hair loss and skin issues but can be treated effectively with biotin supplements.
- Iron deficiency anemia can cause hair thinning along with symptoms like fatigue and breathlessness. It often results from inadequate dietary intake, but can also occur after heavy menstrual bleeding. Treatment with iron supplements, or blood transfusions in severe cases, can restore both hair and energy levels, leading to significant improvements.
- Trichotillomania is a psychological condition marked by an uncontrollable urge to pull out one’s hair, often associated with anxiety or depression. Hair patches may show different stages of regrowth. While it can be challenging to manage, the condition can be treated with appropriate psychological and medical support.
- Traction alopecia results from hairstyles that exert prolonged tension on the hair, causing it to thin or fall out. This type of hair loss can be prevented by reducing the strain on the hair. Loosening hairstyles and giving the scalp a break can help hair regrow over time.
- Hypothyroidism causes symptoms like fatigue, dry skin, and hair thinning due to insufficient thyroid hormone production—however, it can be managed with diet, and if necessary, thyroid medications.
- Zinc deficiency may also cause hair loss and a characteristic rash. Treatment with zinc supplements can significantly improve hair growth and other symptoms.
- Medications, such as chemotherapy drugs, Accutane, and anti-seizure medications like valproic acid, are known to cause hair loss as a side effect. This type of hair loss is often reversible once the medication is stopped.
- Male pattern hair loss, or androgenic alopecia, is influenced by testosterone and genetic risk factors—which, contrary to popular belief, can come from either or both sides of the family. Early onset, especially before age 40, is linked to an increased risk of heart disease. However, effective treatments are available, and early intervention is beneficial.
- Female pattern hair loss is basically the same thing as male pattern hair loss (indeed, it is literally still androgenic alopecia), just a) almost always much less severe and b) with a gender-appropriate name. It affects up to 40% of women by age 50 and is characterized by thinning hair at the top of the head. It’s related to hormonal imbalances involving testosterone, such as those seen in PCOS and menopause, amongst other less common causes. Early treatment can be effective, and research is ongoing to develop more targeted therapies.
Dr. Siobhan Deshauer advises, if you’re experiencing hair loss, to monitor other symptoms too if applicable, take photos for tracking, and consult a doctor early for diagnosis and potential treatment.
For more on all of this plus visual illustrations, enjoy:
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Want to learn more?
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Hold Me Tight – by Dr. Sue Johnson
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A lot of relationship books are quite wishy-washy. This one isn’t.
This one is evidenced-based (and heavily referenced!), and yet at the same time as being deeply rooted in science, it doesn’t lose the human touch.
Dr. Johnson has spent her career as a clinical psychologist and researcher; she’s the primary developer of Emotionally Focused Therapy (EFT), which has demonstrated its effectiveness in over 35 years of peer-reviewed clinical research. In other words, it works.
EFT—and thus also this book—finds roots in Attachment Theory. As such, topics this book covers include:
- Recognizing and recovering from attachment injury
- How fights in a relationship come up, and how they can be avoided
- How lot of times relationships end, it’s not because of fights, but a loss of emotional connection
- Building a lifetime of love instead, falling in love again each day
This book lays the groundwork for ensuring a strong, secure, ongoing emotional bond, of the kind that makes/keeps a relationship joyful and fulfilling.
Dr. Johnson has been recognized in her field with a Lifetime Achievement Award, and the Order of Canada.
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Chew On This… But Don’t Swallow − by Dr. Blanche Grube & Anita Vasquez-Tibau
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Dr. Blanche Grube is a dentist with over 40 years of experience, and Anita Vasquez-Tibau is a well-respected research scientist with many peer-reviewed publications to her name, and both have lectured extensively.
So, what do they want us to know?
It’s mostly about the iatrogenic (i.e., caused by treatment) harm done by many common conventional dental practices (including dental mercury amalgams, metal crowns, root canals, implants, and even braces), and how we can avoid such, and enjoy better treatment instead.
After an introductory overview of the basics (and also where her own work came from in the first place, namely, her own root canals that were established as largely responsible for her leukemia), the largest part of the book is practical advice, laid out practically. What things come with what risks, what things get advertised differently than they really are, and which way to go in the case of unenviable situations where one must choose the “least bad” option out of a bunch of bad options.
Lastly, she discusses a range of solutions that can help side-step most problems, provided one implements them early. The good news is, they are “do these small things every day” recommendations, not “get this prophylactic surgical treatment” options. And yes, they are beyond the obvious of good dental hygiene, though she does cover that too.
The style is in part narrative, in part explanatory, and/but very readable throughout.
Bottom line: if you love having teeth and/but don’t love going to the dentist, this book will help you take good care of yourself, and also mean you can safely and informedly advocate for yourself if you do find yourself in the dentist’s office.
Click here to check out Chew On This… But Don’t Swallow, and protect your teeth!
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