Birthing Outside the System: The Canary in the Coal Mine, 1st Edition (Hardback) book cover

Birthing Outside the System

The Canary in the Coal Mine, 1st Edition

Edited by Hannah Dahlen, Bashi Kumar-Hazard, Virginia Schmied


504 pages | 8 B/W Illus.

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Hardback: 9781138592704
pub: 2020-02-06
Available for pre-order. Item will ship after 6th February 2020

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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.


"The fact that this well-written, comprehensive, thought provoking book is so timely is both shocking and reassuring. Shocking because it reveals the degree to which maternity services around the world have become blind to the impact of extreme risk aversion on the wellbeing of women and babies. Reassuring because, finally, the blindfolds have been removed: and because, rather than just pointing out the problems, the authors also provide solutions. I hope as many people as possible read the book, and that they conclude that the time has come to act. Now."Professor Soo Downe, University of Central Lancashire, UK

"Today, whatever the topic, we are in unprecedented situations. Homo has reached the limits of the domination of nature. A significant example: love hormones have been made redundant to deliver babies. It is as if we were close to the edge of a precipice. It is too late for procrastination. The only relevant strategy is to take other directions. What can we learn from mothers who find ways to escape from the dominant way of thinking? We must thank Hannah Dahlen, Bashi Kumar-Hazard and Virginia Schmied for helping us to urgently clarify vital questions."Dr Michel Odent, Director of the Primal Health Research Centre, UK

"This book takes an innovative look at what are culturally considered birthing extremes. It asks, why do so many women and families in varied cultures choose to birth completely outside of hospitals and clinics where the technocratic approach is hegemonic? These people’s choice of unconventional ‘freebirth’ or even of culturally accepted homebirths in low-resource countries where those are still normative constitutes a radical critique of the dominant system. That critique intensifies with the accounts of childbearers with complications medically considered high-risk—such as VBACs, breech and twin births—who resist this medical classification, redefining such births as simply variants of normal. A chapter on birth trauma demonstrates the emotional devastation that too often accompanies the inhumane and unnecessary interventions imposed on women who birth inside the technocratic system, and how freebirthers and others seek to avoid that trauma by utilizing normal physiologic birth as a vehicle for self-empowerment and healing. Critiques of ‘the system’ are multiplying; to them, this ‘out-on-the-edge’ book adds the telling perspectives of those who reject that system entirely. I highly recommend hearing their voices as spoken in these pages!"Dr Robbie Davis-Floyd, University of Texas Austin, USA

"Giving birth for any woman is a leap into the unknown. What we do know is that we hear from women afterwards often that they are let down and disappointed. This book could and should remind us all that birth is precious and life affirming when we listen and work with women. A woman will never put her life or that of her unborn baby at risk if we listen to her needs. It is only when her back is against the wall that she is pushed to take action alone. Read this book and learn how we must give priority to women for it is they we serve."Dr Kathryn Gutteridge, RCM President, Consultant Midwife

"This is a terrific if very disturbing book. It is a ‘must read’ for practitioners and leaders of services provided for birthing women, but also women themselves and others interested in the field. The distress that results from poorly delivered birthing services results in system avoidance. The system categorises this avoidance as a woman’s problem rather than an indictment of their own services. The book couches this correctly, in terms of human rights and abuse of women by health care. A number of us naively thought that providing evidence of best practice would be sufficient to improve care; but this book shows evidence is not enough to change poor quality and racist systems. Some women overcome this by rejecting these toxic arrangements, which this book shows us exist across a range of countries. While the book correctly places women and their stories at the centre, this is enhanced by evidence that guides practical improvement."Emeritus Professor Lesley Barclay, University of Sydney, Australia

"Birthing Outside the System: The Canary in the Coalmine shines a light into the coalmine of modern maternity care. The editors have brought together a diverse group of eminent authors whose contributions create a comprehensive analysis of the current global situation. The editors deliver on their promise – the book is indeed a ‘political opus’ that will ‘upend thinking and disburse assumptions’. However, the content also offers inspiration and practical guidance about how to create and sustain woman-centred maternity care. This is a call to action. We all need to work together to release the canary from her cage."Dr Rachel Reed, University of the Sunshine Coast, Australia

Table of Contents

Part 1: Understanding the Problem


Hannah Dahlen, Bashi Kumar-Hazard and Virginia Schmied

Freebirth in the United States

Rixa Freeze and Laura Tanner

Giving birth outside the system in Australia: Freebirth and high risk homebirth

Melanie Jackson

Understanding women’s motivations to, and experiences of, freebirthing in the UK

Claire Feeley and Gill Thomson

Birthing outside the system in the Netherlands

Martine Hollander

The rise of the unregulated birth worker in Australia: The canary flees the coal mine

Elizabeth Rigg

Identifying the poisonous gases seeping into the coal mine: what women seek to avoid in choosing to give birth at home

Heather Crawford and Hannah Dahlen

The journey of homebirth after caesarean (HBAC): fighting the system or birthing in peace

Hazel Keedle and Sarah O’Connor

Seeking control over birth in the Middle East

Suha Hussein, Virginia Schmied

Why South Asian women make extreme choices in childbirth

Kaveri Mayra and Bashi Kumar-Hazard

Birth choices in Eastern Europe and Russia

Daniella Drandic and Nickolas Rubashkin, Tamara Sadovaya and Svetlana Illarionova

The modern day witch hunt

Hannah Dahlen and Jo Hunter

Birth trauma: The noxious by product of a failing system

Maddy Simpson and Agy Cater

Part 2: Working Towards a Solution

What are women’s legal rights when it comes to choice in pregnancy and childbirth?

Farah Diaz-Tello and Bashi Kumar-Hazard

The role of the coroner in Australia: listen to or ignore the canary?

Bashi Kumar-Hazard

Keeping the Canary singing: Maternity care plans and respectful homebirth transfer

Rebecca Jenkinson and Deb Fox

Why Aboriginal women want avoid the biomedical system: Aboriginal and Torres Strait Islander Women’s Stories

Donna Hartz, Sue Cutmore, Dea Thiele, Cherisse Buzzacott, Mel Briggs

Midwifing women who make ‘off menu choices’

Kathryn Gutteridge and Hannah Dahlen

Anthropologist, midwife, researcher: a perspective on birth outside the system

Melissa Cheyney

A conversation with the ‘breech whisperer’

Andrew Bisits interviewed by Hannah Dahlen

Obstetricians discuss the coal mine and the Canary

Alison Barrett and Andrew Kotaska

About the Editors

Hannah Dahlen is a Professor of Midwifery at the University of Western Sydney, Australia. She has been a midwife for more than 25 years.

Bashi Kumar-Hazard is an Australian lawyer and the principal of B W Law, a legal practice established to support and assist women and children. She also sits on the board of Human Rights in Childbirth, an international NGO.

Virginia Schmied is Professor in the School of Nursing and Midwifery at the University of Western Sydney, Australia. She is a registered midwife and a registered nurse with experience extends across clinical practice, education, research and consultancy.

About the Series

Routledge Research in Nursing and Midwifery

Learn more…

Subject Categories

BISAC Subject Codes/Headings:
MEDICAL / Health Care Delivery
MEDICAL / Nursing / Maternity, Perinatal, Women's Health
SOCIAL SCIENCE / Gender Studies
SOCIAL SCIENCE / Disease & Health Issues