Facing rural realities and mistrust in hospitals, these women turned to home births

On a sunny forenoon in aug 2024, 13 years yesteryear her due date stamp, Sarah Essiambre woke up to contractions.

She had a history of high-risk pregnancies, with one of her deliveries ending in a C-section. The obstetrician who performed the caesarean told Essiambre she would never have a vaginal childbirth, she said. This and the hyper-medicalization of her births left her feeling disappointed, even traumatized.

She was determined to have this third baby at her home on Vancouver Island.

Essiambre listened to freebirthing influencers and podcasters, talking about taking control of their bodies, choosing where and how to give birth.

Freebirthing refers to giving birth without medical support or intervention — there’s no midwife or doctor at delivery — and may include refusing prenatal testing or other fetal monitoring during pregnancy. Though no one is tracking medically unassisted births in Canada, infant mortality data from the Ontario coroner, the challenges of accessing maternal medicine in rural B.C., and a growing online freebirthing community suggest more women are choosing this route. And while physicians say they worry about the risks this presents, some acknowledge it represents the medical system’s failure to listen to expectant mothers. 

Essiambre said her wishes were disregarded when she asked about a future vaginal birth after her C-section, a major operation that takes at least six weeks of recovery. 

“One hundred per cent, I would have chosen freebirth,” Essiambre said, had she not been able to find a midwife who would support her choice of a home birth.

The fear of being ignored is common among new patients now, Dr. Lynn Murphy-Kaulbeck said. Since the pandemic, maternal medicine specialists told The Current, more women are declining medical intervention during pregnancy and childbirth for myriad reasons.

“We’ve been hearing more about freebirths,” said Murphy-Kaulbeck, national president of the Society of Obstetricians and Gynecologists of Canada.

But since there’s little data, it's hard to know how widespread it is — or how to address it, she said.

An obstetrician for more than two decades, she strongly recommends having a registered midwife or physician during pregnancy and at childbirth, because if things get complicated during delivery, it quickly becomes an emergency. 

“I'm not needed for probably 90 per cent of deliveries — you go in, you catch the baby, it’s good,” she said. “But for that 10 per cent — or, you know, when intervention is needed, it can go very, very wrong.”

Conveying that to patients when there’s a “real distrust in science and in the medical system” can be challenging, she said, and she fears women are turning to misinformation.

Registered midwife Amanda Emsley has also observed that type of distrust when people come to her clinic in Nanaimo, B.C., where she serves rural communities on Vancouver Island. She agrees it may be a holdover from the pandemic.

“An idea that the institution may push something on me and that I'm going to be in a vulnerable state, and the thing I care the most about — my little one — is going to be at the mercy of somebody else's decision-making.”

She’s seen fear around fetal ultrasounds and vitamin K shots administered to newborns to prevent severe bleeding, both of which pose no proven risks. Emsley says she manages those fears by trying to understand her clients.

“I don’t get oppositional,” she said. “They don’t just conjure it out of nowhere, so if we can not gaslight, [and we] listen to them, then we move forward.”

Murphy-Kaulbeck agrees that trust is fundamental in a doctor-patient relationship. But she notes that it can be a challenge in a health-care system already under pressure, pointing to the maternity staffing crisis in British Columbia that has led to maternity ward closures — and it means sending maternity patients a long distance for care. Last fall, seven obstetricians in Kamloops, B,C., walked out, saying they could no longer provide in-hospital care due to “extreme physician burnout.”

“That's not a system that's going to instill … the most confidence that these women are going to be cared for where and in the way they need and want,” Murphy-Kaulbeck said. “As a provider, your back’s against the wall and you're trying to meet the demands that are placed on you and you don't have enough support or you don't have the time.”

It’s those systemic deficiencies, she said, that are contributing to women seeking alternatives. The B.C. Ministry of Health did not respond to a request for comment about these issues by deadline, despite multiple attempts.

That’s certainly part of the story for women living in remote areas.

Jaclyn Neufeld lives on a homestead in rural northern British Columbia. She says women in her community have to drive two-and-a-half hours to reach a midwife in Prince George. The nearest delivering hospital is an hour away in Vanderhoof.

Women have to pay to stay near the town around their due date if they want a hospital birth, part of the reason, she said, why she chose to freebirth four of her seven children.

“I’ve had a baby in an hour-and-45 minutes,” she said. “I don’t think I’d make it in the hour-and-a-bit where we live to a delivering hospital with maternity care.”

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She only goes to a doctor when she needs to, she said, and does her own prenatal care; she has a glucose monitor to check her blood sugar, and when she’s in the city, she uses the blood pressure monitor at the grocery store.

And she says she treasures giving birth surrounded by family.

“Being in my own home, being in my own bed, just the safety, the autonomy,” she said. “I'm with my own bacteria. I'm not in someone else's hospital with other sick people and the bacteria and the sterile lights.”

But she doesn’t think that freebirthing is the answer to ailing maternal health services. “What British Columbia needs is more midwives in rural communities, and we need our hospital maternity care units open, not closed” for complex and high-risk cases

She doesn’t recommend freebirthing for everyone, describing it as a “unique thing for women who are supported and are willing to take on that responsibility.”

These figures underscore why Dr. Shiraz Moola says he “wouldn’t condone” a decision to give birth without a doctor or registered midwife present.

“It's like me trying to land an airplane by reading about it,” the University of British Columbia obstetrics professor said. “I'll get on the ground, but I'm not gonna get down on the ground in one piece.” 

He’s a rural obstetrician in Nelson, a town in southeastern British Columbia. He says the hospital sees fewer than six women a year come in with complications following a freebirth.

“When these women arrive, they’re often very unwell, or their newborn might be unwell, and newborns arrive and there’s a tremendous amount of resources that we have to bring to  bear unexpectedly.”

He stresses the risks of freebirthing, noting that mothers can hemorrhage during delivery and lose half their blood volume within minutes. In other cases, he said, women have laboured at home too long and come to the hospital once it is already a stillbirth. 

These cases are rare, he said, but tragic — and he cannot help but think back to his previous work in South Africa and Zimbabwe, areas in which women have more limited access to maternity care.  

“Someone willingly choosing to not access care is very much a disconnect that they find very difficult to accept,” he said, speaking of himself and colleagues who worked abroad.

Emsley, the registered midwife in Nanaimo, B.C., worries about women she’s unable to reach, or has had to turn away, because she didn’t feel safe with their choices. She hopes to see more hospitals operate like a birth centre, incorporating things like water births and other requests. 

On that day in August nearly two years ago, Essiambre laboured in her home all day and into the night. She called Emsley at 3 a.m., and, roughly 12 hours later, baby Paisley arrived — a very different journey to motherhood after the disappointment of her in-hospital births. 

Had she not found Emsley, she was planning to freebirth in her trailer or a hotel by the hospital in case of an emergency since she lives roughly an hour away from her local hospital.

Producer | The Current

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