Why is “freebirth”, home birth without a midwife, developing in France?

” I needed to prove to everyone that it was possible: that I could have a healthy pregnancy. I am proud to have offered my baby a free birth when he was born by caesarean section. These are the words of Marion D., who less than a year ago gave birth at home without assistance. Unassisted delivery (ANA) is different from accompanied home delivery (AAD): it occurs voluntarily without the presence of a caregiver, while AAD is accompanied by a midwife.

Even though it’s technically legal because a person giving birth can do it anywhere and with anyone, meit is viewed with a very bad eye by medical-social institutions. We remember in particular the scandal of the placement of two children in Brittany last June, because their mother had made this choice.

Despite the legal risks, and those of walking away from a maternity ward or carer in the event of complications during childbirth, more and more people are making this choice. Thus, the Facebook group Autonomous Childhood and Unaided Childbirth has more than 5,300 members. Some people even freely share their experience on the networks, such as Marion Calmel, who gave birth two years ago in her home in Ariège.

She says to to miss that this delivery was the result of a long preparation:

“I read a lot on the subject and my wife too, we attended a seminar, listened to podcasts. We had confidence, both in my ability to do it, but also in his ability to play the role that he was going to play. We told ourselves that if at any point one of us had any doubts, we would go to the hospital. »

But they didn’t need to: after just 5 hours of contractions, their baby was born in their bedroom:

“It was too good, a suspended moment. We were very warm, we didn’t have hospital neons on our faces, we were too good. »

No midwife to accompany

” Several times a month we receive calls from people in difficulty, because they can’t find a midwife to take them home, and who are forced to choose between hospital and ANA, which for many is not really a choice. », says Laura, president of the Defense Collective of the AAD, a collective of users. Each year, the collective, supported by APAAD, the association of AAD professionals, conducts a census of waste from AAD support. ” 25% of those interviewed who have been refused support turn to unassisted birth. This is an enormous figure that alarms us a lot, because it is interpreted as a choice out of spite in the face of the lack of adequate medical support.. »

This is what happened to Marion D.: she suffered the rejection of three technical platforms, a birth centre, five AAD midwives, ” and when I went to see the physiology-friendly maternity ward that was recommended to me, the gynecologist offered me epidural and continuous monitoring. »

Finding a midwife who is available to accompany an AAD is an obstacle course: it is already necessary to ensure that among less than a hundred of them practicing home care in France, one of them will be available to be contacted at her date time, and not too far from home so I can get to work on time. Isabelle Koenig, co-director of APAAD, explains that in the face of growing demand, she is forced to refuse a large number of patients. When to miss he calls her, he traveled more than 800 km in three days to accompany four parties, and he got very little sleep. “ I agree to hire five families a month, I cover different departments and more I have to refuse three quarters of the requests. The situation is the same for his colleagues: “ A patient I accompany called 200 midwives before I accepted her application. »

” By law, midwives are free to practice at home, but today politics is not in their favor explains Laura of the CDAAD. The Kouchner Act of 2002, which describes among other things the concept of informed consent, also obliges midwives to take out professional and civil liability insurance. No law regulates the price of home care insurance, and most are around €30,000 a year, the average annual salary of a midwife..

A culture of risk

The lack of midwives is one of the reasons, but far from being the only factor of refusal of the AAD for the people who request it: to access it, a perfectly physiological pregnancy is necessary, which includes, among others, a child in normal presentation, only one pregnancy, and no history of cesarean section.

These three criteria are not unanimous elsewhere in Europe and the United States, where we can see twins and breech babies born at home. The president of the CDAAD explains:

“In France, midwifery is based on a culture of risk: we are emerging from three decades of hypermedicalisation of birth which have left their mark on medical minds and practices. Childbirth is considered normal in the aftermath, when the placenta was delivered. In the collective imagination, childbirth can end in a bloodbath at any time, while 80% of births are safe. »

Israel Nisand, professor of obstetric gynecology and former president of the National Council of Obstetricians-Gynecologists, said in France Culture in 2021:

“For me it is a danger for me and for the baby to give birth at home, even if we are helped. A child can be born in a state of apparent death without anything preventing it, bleeding complications can arise. »

However, accompanied home births have some less risky aspects than maternity births. On the APAAD website, we see that there is a lower risk of medical intervention, a near-zero episiotomy rate, but also a lower risk of stained amniotic fluid, postpartum hemorrhage, and fetal distress. even if there is never zero risk during childbirth, at home or elsewhere “, points out Isabelle Koenig.

Faced with the question of the selection of candidates, the co-director of APAAD understands the dismay of families who dream of a physiological birth and who are deprived of this opportunity: ” In France, healthcare professionals are at much less risk accepting breech births and vaginal twins and often prefer a caesarean section. For my part, I accept the VBACs [ndlr : accouchement par voie basse après une césarienne]if there are no contraindications which remains a rare exception compared to his colleagues.

That’s just what happened to Marion D, who, with her background, was denied one accompaniment after another:

“I had it all mixed up during my first pregnancy: twins, cholestasis of pregnancy, pre-eclampsia and C-section. Given my background, even though my second pregnancy was going well, no one wanted to take the risk of driving me home. »

A rejection of interventionism and violence

Faced with a lack of midwives to support their physiological project, expectant mothers are faced with a difficult choice: give birth in a hypermedical environment that does not meet their expectations, or potentially risk having to rush to the hospital if a complication occurs. “ I was in a lot more pain than I thought », admits Marion D., for whom everything did not go as planned:

“I had seven hours of active labor and pushed for two hours, the baby wouldn’t come down. Over the phone, a midwife advised us on the positions. It released and an hour later my baby was born. If I had been in maternity hospital, after half an hour of pushing, the gynecologist would arrive and end up in instrumental extraction or caesarean section. »

Isabelle Koenig believes that the hypermedicalization of childbirth is too often the cause of a cascade of interventions, which can lead to a caesarean section:

“A person giving birth needs the presence and availability of a carer to reassure her about her ability to give birth. If not, he will be offered the placement of an epidural very early in the process, which will prevent him from moving and slow down his labor. »

Loss of progress will in turn require interventions to regain a good rhythm and, if the delivery does not proceed fast enough, a caesarean section or an instrumental delivery. Laura of the CDAAD summarizes as follows:

” This culture of risk and hyper-medicalisation is in contrast with the rest of Europe. Midwives who practice AAD are in another culture, that of physiology, which respects the rhythm of childbirth. »

For Cécile, who chose the ANA for her two parts, the refusal of medicalization also goes beyond the simple distrust of obstetric violence:

” Culturally, our depictions of childbirth are very disturbing. To me, it really scared me, this idea that I was deprived of my freedoms and that I had to submit. Obstetric violence is not only in isolated acts, it is institutional, because it is intrinsic to modern obstetrics ”, she says. She therefore believes that it is the entire culture around birth that must be rethought, to allow each person who gives birth to do so in sovereignty, whatever their choices for childbirth.