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.

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.

Microplastics and nanoplastics are everywhere in our environment – including in our oceans and lakes, farmland, and even Arctic ice algae.

Microplastics have also been found inside of us – with studies detecting them in various tissues including in the lungs, blood, heart and placenta. Understandably, concern is rising about the potential risks of microplastics on our health.

However, while a growing body of research has focused on microplastics and nanoplastics, there’s still a lack of direct evidence that their presence in human tissues is harmful to our health – and it’s uncertain if they are related to particular diseases.

A new study has uncovered a correlation between microplastics and heart health, though. The researchers found that people who had detectable microplastics and nanoplastics in the plaque in their arteries had a higher risk of heart attack, stroke and death.

Heart health

The researchers looked at 257 people altogether. All of the patients were already undergoing preventative surgery to remove plaque from their carotid arteries (the main arteries that supply the brain with blood). This allowed the researchers to collect plaque samples and perform a chemical analysis. They then followed up with participants 34 months later.

Of the 257 participants, 150 were found to have the presence of microplastics and nanoplastics in their arterial plaque – mainly fragments of two of the most commonly used plastics in the world, polyethylene (used in grocery bags, bottles and food packaging) and polyvinyl chloride (used in flooring, cladding and pipes).

A statistical analysis of this data found that patients with microplastics and nanoplastics in their plaque had a higher risk of suffering a heart attack, stroke or death from any cause, compared with those who had no microplastics or nanoplastics in their plaque.

The researchers also analysed the macrophages (a type of immune cell that helps remove pathogens from the body) in the patients’ arteries. They found that participants who’d had microplastics and nanoplastics in their plaque also had evidence of plastic fragments in their macrophages.

They also looked at whether certain genes associated with inflammation (which can be a sign of disease) were switched on in the participants. They found that the participants who’d had microplastics and nanoplastics in their plaque also had signs of inflammation in their genes.

These results may suggest an accumulation of nanoplastics and microplastics in carotid plaque could partly trigger inflammation. This inflammation may subsequently change the way plaque behaves in the body, making it less stable and triggering it to form a blood clot – which can eventually block blood flow, leading to heart attacks and strokes.

Interestingly, the researchers also found the presence of nanoplastics and microplastics was more common in participants who had diabetes and cardiovascular disease. This raises a lot of questions which have yet to be answered – such as why microplastics were more common in these participants, and if there may be a correlation between other diseases and the presence of microplastics in the body.

Other health risks

This study only focused on patients who had carotid artery disease and were already having surgery to remove the build-up of plaque. As such, it’s unclear whether the findings of this study can be applied to a larger population of people.

However, it isn’t the first study to show a link between microplastics and nanoplastics with poor health. Research suggests some of this harm may be due to the way microplastics and nanoplastics interact with proteins in the body.

For example, some human proteins adhere to the surface of polystyrene nanoplastics, forming a layer surrounding the nanoparticle. The formation of this layer may influence the activity and transfer of nanoplastics in human organs.

Another study suggested that nanoplastics can interact with a protein called alpha-synuclein, which in mouse studies has been shown to play a crucial role in facilitating communication between nerve cells. These clumps of nanoplastics and protein may increase the risk of Parkinson’s disease.

My published PhD research in chicken embryos found that nanoplastics may cause congenital malformations due to the way they interact with a protein called cadherin6B. Based on the interactions myself and fellow researchers saw, these malformations may affect the embryo’s eyes and neural tube, as well as the heart’s development and function.

Given the fact that nanoplastics and microplastics are found in carotid plaque, we now need to investigate how these plastics got into such tissues.

In mice, it has been demonstrated that gut macrophages (a type of white blood cell) can absorb microplastics and nanoplastics into their cell membrane. Perhaps a similar mechanism is taking place in the arteries, since nanoplastics have been identified in samples of carotid plaque macrophages.

The findings from this latest study add to a growing body of evidence showing a link between plastic products and our health. It is important now for researchers to investigate the specific mechanisms by which microplastics and nanoplastics cause harm in the body.

Meiru Wang, Postdoctoral Researcher, Molecular Biology and Nanotoxicology, Leiden University

This article is republished from The Conversation under a Creative Commons license. Read the original article.