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
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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

"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

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