Birthing Outside the System
The Canary in the Coal Mine
Routledge Research in Nursing and Midwifery Series

This book investigates why women choose ?birth outside the system? and makes connections between women?s right to choose where they birth and violations of human rights within maternity care systems.

Choosing to birth at home can force women out of mainstream maternity care, despite research supporting the safety of this option for low-risk women attended by midwives. When homebirth is not supported as a birthplace option, women will defy mainstream medical advice, and if a midwife is not available, choose either an unregulated careprovider or birth without assistance. This book examines the circumstances and drivers behind why women nevertheless choose homebirth by bringing legal and ethical perspectives together with the latest research on high-risk homebirth (breech and twin births), freebirth, birth with unregulated careproviders and the oppression of midwives who support unorthodox choices. Stories from women who have pursued alternatives in Australia, Europe, Russia, the UK, the US, Canada, the Middle East and India are woven through the research.

Insight and practical strategies are shared by doctors, midwives, lawyers, anthropologists, sociologists and psychologists on how to manage the tension between professional obligations and women?s right to bodily autonomy. This book, the first of its kind, is an important contribution to considerations of place of birth and human rights in childbirth.

Part 1: Understanding the Problem 1. Freebirth in the United States 2. Giving Birth Outside the System in Australia: Freebirth and High-Risk Homebirth 3. Understanding Women’s Motivations to, and Experiences of, Freebirthing in the UK 4. Birthing 'Outside the System' in the Netherlands 5. The Rise of the Unregulated Birth Worker in Australia: The Canary Flees the Coal Mine 6. Identifying the Poisonous Gases Seeping into the Coal Mine: What Women Seek to Avoid in Choosing to Give Birth at Home 7. The Journey of Homebirth after Caesarean (HBAC): Fighting the System or Birthing in Peace 8. Seeking Control over Birth in the Middle East 9. Why South Asian Women Make Extreme Choices in Childbirth 10. Birth Choices in Eastern Europe and Russia 11. The Modern-Day Witch Hunt 12. Birth Trauma: The Noxious By-Product of a Failing System Part 2: Working Towards a Solution 13. What are Women’s Legal Rights When it Comes to Choice in Pregnancy and Childbirth? 14. The Role of the Coroner in Australia: Listen to the Canary or Ignore it? 15. Keeping the Canary Singing: Maternity Care Plans and Respectful Homebirth Transfer 16. Why Aboriginal Women Want to Avoid the Biomedical System: Aboriginal and Torres Strait Islander Women’s Stories 17. Midwifing Women Who Make ‘Off-Menu' Choices 18. Anthropologist, Midwife, Researcher: a Perspective on Birth Outside the System 19. A Conversation with the ‘Breech Whisperer’ 20. Obstetricians Discuss the Coal Mine and the Canary 21. Conclusion: Keeping the Canary Singing into the Future

Hannah Dahlen is the Professor of Midwifery and Higher Degree Research Director in the School of Nursing and Midwifery at Western Sydney University in Australia. Hannah is also a privately practising midwife with a group practice called Midwives@Sydney andBeyond. Hannah has been the Doctoral/Masters/Honours supervisor for seven of the contributors to this book. In 2012 Hannah was named in the Sydney Morning Herald’s list of top 100 leading ‘science and knowledge thinkers’. In 2019 she was made a Member in the General Division of the Order of Australia for her services to Midwifery, Nursing and Medical Education and Research.

Bashi Kumar-Hazard is an Australian trained competition and consumer rights lawyer, and the upcoming Chair of Human Rights in Childbirth. Bashi has represented families in coronial inquests and hospital midwives pursued by the healthcare regulator. Internationally, she has prepared Amicus briefs and UN human rights submissions on mistreatment in childbirth and women’s reproductive rights. Bashi is currently working on a doctorate in Competition Law and Human Rights at the University of Sydney, examining anti-competitive practices in the provision of maternity healthcare in Australia.

Virginia Schmied is Professor of Midwifery and Deputy Dean Research and Engagement in the School of Nursing and Midwifery, Western Sydney University. Her research focuses on transition to motherhood and perinatal mental health with a strong focus on the organisation of healthcare, workplace culture and the facilitators and barriers to the delivery of high-quality and compassionate maternity and child healthcare. Most recently, Virginia and her colleagues have been studying the experiences of women and men from diverse cultural backgrounds living in western Sydney.