The Willing Women
Radical midwives are staging a birth rebellion. Oscar Schwartz is just happy to be there.
A few weeks ago, I left my pregnant wife and two-year-old daughter at home to travel to Sydney for The Convergence of Rebellious Midwives. This weekend-long conference, in its inaugural year, was being convened by Melanie Jackson, a midwife and charismatic host of The Great Birth Rebellion, a podcast whose logo depicts a faceless woman in a deep squat giving birth to a rainbow. In each episode, Melanie has a wide-ranging chat to a midwife, doctor, doula, mother, or anyone, really, who is critical of how new life is brought into our world: that is, beneath the fluorescent glow of hospital lights and oftentimes with the help of the surgeon’s scalpel. At the Convergence, these dissenters would, according to the conference website, have the opportunity to come together at the Sofitel Ballroom in Darling Harbour, to “learn new skills and practical information”—and plot the overthrow of modern obstetrics.
When I arrived at the hotel the harbour was pink with sunset and a man was revving a bright orange Lotus Elise in the valet car park. A raucous clan of puffer-vested gentlemen cheered, and kept palming cash tips to the hotel doorman, who wore a comically high top hat. I stood there for a moment, mesmerised by the scene, until I heard someone say the word “naturopath.” I followed the sound and saw two women in linen dresses, one with a single dreadlock curling down her back and the other grasping a Yeti water bottle, weaving their way through the crowd. I trailed them inside, up a flight of elevators, and into a cavernous lobby where hundreds of women, sipping on complementary Aperol Spritzes, waited in line to enter the ballroom for the opening ceremony of the Convergence.
I took my spot at the end of the queue and felt the gaze of several dozen midwives assessing my presence all at once. Mostly, the glances were curious, some even expressing tenderness, though a security guard with a severe black bob looked me up and down with undisguised suspicion, and then muttered something into her lapel walkie talkie. (Did she think I was an obstetric spy?)
Inside the ballroom, the midwives were standing in circles, chatting, kissing cheeks, hugging, and asking about each other’s children. Some were dressed up in splashy frocks, while others wore jeans and Birkenstocks. I was dressed as plainly as possible, in slacks and a polo, and yet my presence hung like a male-shaped question mark in the room. The only other fellows I could see were serving champagne and carefully prepared salmon nigiri. I considered picking up a tray and joining in, disappearing into service. Instead, I hid behind a pylon and started taking notes, until I noticed a presence by my right shoulder. One of the midwives had crept up behind me and was pretending to read from my notepad to the delight of her colleagues who pointed and giggled only a few metres away. I laughed along, trying to be good-humoured, but I felt like an interloper, an anomaly—like one of those women who dared to get a medical degree in the nineteenth century. Sweat condensed on my brow. Get a grip, I said to myself. Most of your friends are women. You grew up with three sisters. You were invited to the Flippy’s Formal. You can handle some rebellious midwives.
*
To my relief, I spotted, across the ballroom, the unmistakable profile of a renowned childbirth educator and doula named Rhea Dempsey, who was, in no small part, responsible for my presence at the Sofitel that evening. A few years ago, when my wife Jess was pregnant with our daughter, we went to Rhea’s birthing course. Over two days, in a church hall in East Melbourne, she mapped out precisely what labour would look like for a woman who opted to go without medical intervention and simply push the thing out herself. She called such women “willing women,” and argued that they are a dying breed and should be, in some sense, revered. She said that their reward for vaginal birth would be a body flooded with naturally-occurring oxytocin, which would transform the pain into the high of a lifetime, a rush of love so profound as to bond her with the newborn for life. (As for male partners, she said, the low registers of their voices could sometimes frighten the baby, so if they had to be in the birth space, it was best they kept quiet.)
I was, at first, sceptical of what appeared to be Rhea’s reverence for “the natural.” Plus, I didn’t really feel like I fit in with the other male participants at her course, who either sat there silent in their beanies, stealing glances at the Sportsbet app, or had man buns and did Yogic headstands during the coffee break. But then a few months later, Jess, who had decided to become a willing woman, went into labour for 24 hours. I was shaken by the sheer intensity of the undertaking, but throughout, Rhea’s wisdom kept coming back, as if she were a spirit guide leading us through an awesome if occasionally frightening trip. Rhea had taught us, for instance, that the labouring woman would, just before they were ready to start pushing, begin to look like they were high on heroin—nodding off. At nine centimetres dilation, this is almost exactly what Jess began to do. Without Rhea’s wisdom, I might’ve panicked. Instead, I knew that this was just the natural course of things. Everything was going to be ok.
When push came to shove, I was more than grateful for having completed Rhea’s course, and in the months after our daughter was born, I wondered about my initial resistance to her teachings. She had presided over thousands of births and written two books on the subject, and yet I had been ready to dismiss her expertise. Why? Was it a commitment to science and rationality, or a deeply held patriarchal bias? (Or were these two linked?) Curious to learn more, a few months ago I interviewed Rhea at her inner-North apartment, with the vague notion of writing a profile about her teachings. We spoke for close to two hours about her life—country girl, phys-ed teacher, London hippy, mother, author, queen doula—but then, at the end of it, she self-abnegated.
“Don’t get me wrong, I’m very interesting,” she said. “But this birthing world is so much bigger than me. There’s a whole army of us who are fucking angry and trying to do something about it. You should write about the movement. You should join us at the Convergence of Rebellious Midwives.”
In the Ballroom, Rhea greeted me with a wide smile. She has cascading blonde ringlets, beaming eyes, and, although now a grandmother of five, she still exudes the physical confidence of a sports teacher, the kind who doesn’t just instruct, but participates in the kickball game. “You made it!” she said, and then took me by the forearm and led me around the room, introducing me to her comrades—those who have been rebelling against the system since long before Melanie’s podcast came on the scene. I met midwives from Alice Springs, Adelaide, Gippsland, and Thursday Island, and all greeted me graciously and exuded self-possession, as if their professional mode of unflappability, that ability to remain calm in crisis, now informed their character. (I should mention: not everyone at the conference was a midwife. There were a few dissenting obstetricians, spurned by the medical system in which they were trained, as well as a spattering of doulas who brought the essential woo woo.)
I was chatting to Claire, a midwife from Melbourne who has delivered home births for 36 years, when suddenly a dozen or so strapping men with perfectly trimmed beards burst through the ballroom and began beating tablas. The midwives ran to the dance floor, where they spun around and leapt into the air. I had no idea what was happening but the mood was ecstatic, like a wedding. One midwife with purple hair was even ululating. I stood to the side and watched. It was as if my Jetstar flight had passed through a wormhole to an alternate reality. Had I entered… the matriarchy?
*
The next morning, the ballroom was set up with rows of chairs, conference style, though many of the midwives elected to sit on the floor in little huddles, sipping coffee from thermoses and nibbling croissants. Melanie skipped up on stage at 9am sharp to debrief on last night’s revelries. I left the opening ceremony early, but apparently the midwives stayed late into the night. There had been a run in with a security guard who chastised them for dancing without their shoes on. “The shoe police incident,” as Melanie called it. “He won’t be troubling us anymore.”
Despite this, none of the midwives looked dusty at all, particularly not Melanie, who was in a constant state of exuberance. “As for toilets,” she said, moving onto housekeeping. “Usually at these events there is a long wait for the womens.” Not to worry. The festival organisers converted the men’s toilets into a unisex unit. “Guys, if you want to go to the toilet… all three of you… you can go down to the lobby.” The midwife sitting next to me nudged me in the ribs and snorted.
As the first day of talks got underway, I discovered the one truth that all rebels held to be self-evident: that the current maternity system does not only need some amendments around the edges, but is utterly “fucked.” (The midwives were quite partial to dropping the f-bomb.)
The system, otherwise known as “medicalised childbirth,” is a paradigm in which labour routinely happens in a hospital, under the authority of an obstetrician. For most, this would seem normal, if not necessary. Isn’t childbirth a dangerous procedure? And aren’t hospitals the safest place to do it? To these questions, the rebels would cry a resounding, “No!” Childbirth is not a medical procedure. It is a normal physiological process that can be successfully completed by otherwise healthy people. Things can go wrong, of course, and having an experienced practitioner around is important. But there are people who occasionally die from obstructed bowels; that doesn’t mean we all pack a bag and rush to the ED every time we need to take a shit.
The system, I learned, is a product of industrial modernity. Up until the seventeenth century, birth worldwide was handled almost exclusively in the female domestic arena, usually under the watchful eyes of an experienced elder. Then, as Westerners moved to cities and traditional family systems were atomised, more and more pregnant women gave birth on their backs in hospitals with the help of professional midwives (usually female) who worked under a surgically trained obstetrician (usually male). The move to hospital coincided with an astronomical reduction in maternal mortality rates in childbirth. In England, in the year 1700, eleven women would die in every 1000 births. Some three hundred years later, it is more like eleven in every 100,000. Seems like a self-evident win for women, if not humanity. But, as the rebellious midwives reminded me, correlation doesn’t mean causation.
In the prehospital era, some leading causes of maternal mortality included infection, haemorrhage, and dangerous abortions. These were mitigated in large part by antibiotics and safe blood transfusion protocols, but also family planning, improved diet, higher standards of living, and female reproductive rights—none of which have much to do with hospital obstetrics. The major technological developments in the field—like forceps, vacuum, epidural, C-section—proved extremely effective in dealing with rare, high-risk, or emergency cases. Nevertheless, by the twenty-first century, these tools were being used routinely in low-risk births that, according to the rebels, did not require any intervention at all.
Today, 97% of births in Australia take place in labour wards. Around half these births involve vacuum (7.2%), forceps (4.9%), or caesarean (38%). This trend is tracking upward, too, at a rate of around 1% every two years. (In private hospitals it is even higher, with almost half of all women having caesarean births.) And yet, for the past decade, maternal and newborn mortality rates have remained functionally unchanged. What has increased, though, is what’s known as “birth trauma.” Some surveys have found that a third of mothers describe birth as traumatic, and one in every 25 develop PTSD in the aftermath. These statistics are concerning enough to have prompted a NSW parliamentary inquiry into birth trauma last year.
According to the rebels, the rise in birth trauma can be mapped directly onto the medicalisation of childbirth. In hospital settings, they argue, women are more likely to experience a loss of agency at some point, whether that be threatening language (“if you don’t consent to monitoring, your baby will die”) to intervention without consent (see: Fleishman is in Trouble). This is what’s known in the field as “obstetric violence,” but it isn’t about a few evil doctors that can be weeded out. It is a natural outgrowth of a system that treats births, by default, as a medical emergency—a risk that needs to be mitigated. You go into hospital in labour, and as long as you and baby get out alive, that’s all that matters.
*
In other words, the system needs to change. On this point, the speakers on the first day were unanimous. They did diverge, however, on how best to go about it.
Sarah Buckley, an GP obstetrician turned researcher, marshalled evidence indicating the significant protective benefits of oxytocin released naturally during physiological childbirth, hoping that such evidence would convince other obstetricians to intervene less. Sheryl Sidery gave a talk about leading the first publicly funded home birth program in Sydney. Grey-mulleted and pragmatic, she advocated for change within the hospital system, describing the painstaking process of developing risk criteria that the hospital would sign off on. In the end, the program was only available for uncomplicated, singleton pregnancies for women with no drug or alcohol dependencies, no previous c-section, and a BMI of less than 30, though Sheryl said she was lenient this final statistic. And then there were the self-professed witches from the Northern Rivers, Jane and Tane, who shared their shamanic vision: “A doula, a midwife and an obstetrician walk into the wilderness,” intoned Jane, while banging a canvas drum. “And the Great Mother says, build a hospital!”
Despite this methodological diversity, there was, I felt, a philosophical throughline running across all the talks. Or, more precisely, an intellectual aesthetic with broadly capital-R Romantic undertones. The central argument seemed to hinge on a “back to nature” premise. Women, in a state of nature, were able to give birth just fine, and then meddling civilization came along and “mis-shaped the beauteous form of things,” as Wordsworth would put it.
This is not to suggest that the politics of the conference were entirely reactionary. I noticed that the midwives present avoided using the word “natural” to describe vaginal birth, opting instead for “normal physiological childbirth.” A couple of the presenters even referred to “birthing people” instead of “mothers.” Nevertheless, there was an undeniable Thoreauvian impulse that permeated the conversations. The rebellious midwives wanted to return to the hearth with their sisters, where birth was good and noble and true, as opposed to the hospital, where it is augmented, traumatic, and dehumanising.
The moral undertones made me wonder how the Convergence would land for women who preferred to give birth in a hospital, who find comfort and safety in that antiseptic environment. Not to mention those who elect to have c-sections in order to avoid “normal physiological childbirth,” for whatever reason that may be. Most c-sections in Australia are pre-planned, not emergencies, which suggests at least some agency or informed consent on the part of the pregnant woman beforehand. And I had spoken to plenty of women who gave birth via emergency caesar and felt, afterwards, that their options had been laid out clearly during labour. Did some rebels believe that these women had been manipulated by the system? That they had come to love their oppression and adore the technologies that undid their almost god-like power to create new life?
Throughout the morning, I was also thinking about my friends with babies, and those planning, many of whom are in queer or same-sex relationships, or are approaching their mid-30s. In our social world, IVF is a normal part of the conversation, as it is for an increasing number of millennials who want to have babies. This cohort was not really discussed at the Convergence. (I heard IVF mentioned in passing by a somewhat jaded midwife who said, offhandedly during morning tea, that IVF mothers are often “harder work” in the birth suite.) And yet, IVF and “geriatric” (35+) pregnancies are more likely to result in caesarean births, which might account for some part of the statistical growth that the rebels are concerned about. It seemed like an oversight to me. I wondered whether it had anything to do with the fact that IVF is a type of medical intervention. Come to think of it, so is contraception.
*
The morning sessions wrapped up and I ventured out into Darling Harbour, my brain rattling with birth data. The city was crawling with life, like some fecund cyborg. Young couples slurped tapioca eggs from their bubble teas. Children scurried along a playground that hung beneath a freeway overpass like a spider’s nest. A heaving, glass-faced luxury hotel rose out of the ground like a mechanical womb.
When I arrived back at the Sofitel ballroom there was a man on stage. His name was Stuart Fischbein. His claim to fame among the rebels is being one of the only obstetricians in the world who will do home birth deliveries for breech (feet first) pregnancies. Dr. Stu’s talk offered detailed technical instruction, and given that I had no plans to deliver a breech baby myself, I took the chance to peruse his Instagram account (75,000 followers). I was surprised to find, in a recent post, Dr. Stu beefing with Joe Rogan. Strange. I would’ve thought there would be solid overlap between libertarian Roganism and the home birth world. But Rogan is apparently a sceptic who has used his platform to spread anti-home birth misinformation.
By now, Dr Stu was projecting home breech births on the big screen in slow motion. In every clip, the birthing woman was in the pushing stage, that is to say, in immense pain, with the baby arriving arse first from the cervical canal—white and compressed like an uncooked, vacuum-sealed roast chicken. At some point, in each video, the male partner would hover on screen, ashen-faced, stressed, offering meek pronouncements of support, and whenever this happened, the midwives in the ballroom would chuckle, as if the men were comic relief in an otherwise epic drama. (Maybe this is why Rogan et al aren’t natural allies to the rebels—they don’t know how to play a supporting role.)
The exception was the final video. In this recording, the male partner had main character energy. He jumped in the bath, got his top off, massaged, stroked, and kissed. At the end, the baby was taken from the mother and placed on his hairy chest. “Isn’t that beautiful,” Dr Stu said. I wanted to feel the same, but honestly, it looked kind of freaky. When the baby tried to suckle from the father’s nipple, two midwives burst out laughing. Traitor to my kind, I joined in.
*
Later, at the Convergence dinner, a lavish three-course affair with free flowing wine, I spoke to some of the younger attendees, many of whom told a similar story. They started out idealistic and passionate, but soon found themselves in a hospital setting where they were treated as “obstetric nurses”—that is, there only to follow orders. The system was so entrenched, they said, that any pushback was either ignored, or put them in the bad books with senior surgeons or hospital executives. The workplace began to feel adversarial, an ideological battleground. Now in their 30s, they were burned out. There was that despondency, so common amongst health care workers, of being overworked and undervalued. Two women told me that they had experienced second-hand birth trauma after witnessing women violated during the labour, as they watched on, powerless to intervene. One left hospital to work at a private midwifery practice, and the other continued to work at hospitals on short-term contracts, because the money was better. She was saving up to start her own private practice.
The midwives were happy enough to answer my questions. By now, my presence at the Convergence was less novel, though there was still, I felt, some hesitation in being totally candid. Fair enough. Much reporting on the home birth scene tends to link it to “free birthing,” an outlier movement within the rebellion that advocates for birth at home with no intervention at all: no instruments, no pain relief, no midwife, no emergency transfer. Just the mother and her labouring body. Every year, there is some horror free birth story—a woman bleeding out in the back of a car on the way to hospital. Reporters jump on the scandal, and often inadvertently lump the home birth movement in along with it, casting the whole thing as some whacky, fringe affair.
“What’s your angle?” a midwife from Adelaide asked me directly.
I said I didn’t have one.
“Have you ever written a story about something similar?” she continued.
“I wrote a story last year about raw milk,” I answered, but then regretted it instantly. There were some ideological overlaps between the raw milk rebels and the rebellious midwives: an anti-authoritarian impulse, a preference for the natural. But whereas raw milk is a libertarian lifestyle choice with few proven health benefits, birth trauma is a genuine public health crisis.
“Oh, I’m a raw milk fanatic,” she said, to my relief. She once kept goats in her backyard to enjoy their unpasteurised goodness. Sometimes they would get pregnant and give birth in the garden, quietly, without anyone knowing. One time, she lay on the trampoline in her backyard and watched the process unfold. Hours passed and she began to worry that the goat was in some distress.
“I’m no vet,” she said, “but I figured I could go help her. I literally ended up having to get in there and pull them out.”
Turns out the goat had twins. One of the kids emerged with a severe deformity. If she hadn’t been there, there’s a chance the mother might have died.
“But hey,” the midwife said. “That’s nature.”
*
The next morning, we picked up again in the ballroom bright and early. This time, there was a distinct morning after seediness wafting about in the Sofitel air. I left dinner exhausted after mains, but apparently dessert had given way to a DJ. Things got loose. There was a rumour going around that a rebel stumbled out into the city night and returned with a uterus tattoo. To rally the hungover troops, Melanie ascended the stage in nothing but a woollen pregnancy suit, complete with sewn on areolas and pubic hair, and proceeded to do a Jane Fonda-esque aerobics routine to “Firework” by Katy Perry. In no time, the rebels were back on their feet, clapping along, whooping. Dr. Stu was pumping his fists in the air, wearing a t-shirt that said: “I Will Not Comply.”
For a professional development conference, the atmosphere was downright carnivalesque. Not only had the midwives come together to learn, they were here to buoy each other’s spirits. The Convergence was a place where anger at the status quo was encouraged, and also where pronouncements of a certain female power could be made unadorned and without shame. I heard one woman describe “puffing out” her chest with pride after having a vaginal birth following her first caesarean. Another said that delivering babies outside hospital made her “feel like superwoman.” Rhea Dempsey gave a talk about how pain in childbirth should not be feared, but embraced. “Pain is power,” she shouted, and the rebels shouted back, “Yes!”
I knew it would be hard to describe this atmosphere to my friends when I got back. I could picture some of them rolling their eyes as I described the scene. They might see the rebellious spirit as a kind of female machismo, a reverence for the natural, an over-determined relationship between identity and biology. Maybe. All I can say is that I was just happy to be there. (Is this what it’s always been about? Do I have womb envy?)
More than that, I was convinced that the rebels’ cause was just. These midwives were not advocating for splendid home births on five-acre permaculture hobby farms in the Blue Mountains for hippies who can afford it. This was about systems change for the general public: a maternity care that is government-funded, midwife-led, and with an option for home birth with quick transfer to hospital in case of emergency.
Crucially, substantiating the conference was tons of evidence-based research, like Dr Kirsten Small’s work on cardiotocography (CTG) machines. These devices, strapped to a woman’s tummy during labour, monitor foetal heart rate, and have been used routinely in hospitals since the 1960s. The idea is that if the pulse drops suddenly, the obstetrician will be alerted, and can then intervene to save the baby from cerebral palsy or death. But, according to data Small has compiled from medical trials stretching back to the 1970s, there is no robust evidence demonstrating that CTG monitoring reduces rates of either outcomes for women in low-risk pregnancies. And in high-risk pregnancies, the data suggests that CTG actually correlates with higher rates of cerebral palsy, for reasons unknown. In all cases, using a CTG machine correlates with higher likelihood that the pregnancy ends in the operating theatre. And yet, CTG remains the most common foetal monitoring technology used in Australian hospitals.
Presentations like Small’s made the current hospital maternity system appear outdated and under the spell of an almost superstitious belief in technology. (Small compared CTG use to devout Christians who “want to see Jesus’ face in a piece of toast.”) By contrast, the maternity system that the rebels were pushing for sounded innovative, progressive, and downright reasonable.
So, who was holding it back?
According to various of the rebels: capitalism, patriarchy, Old White Men. Besides these classic enemies, there was no thorough, material analysis of who the current system is serving. In its absence, “the system” remained somewhat nebulous, just another symptom of our instinct for self-domestication, like the tapioca balls in the bubble tea, the heaving freeways, the playgrounds, the luxury hotels, the plane that would take me home. Sometimes, when you’re up there, sipping highly processed tomato juice from a single-use plastic cup, your elbows bruised from the drinks cart, your nerves frayed from the screaming baby behind you (“Hush little one. There, there”) you look around and think: how did we all end up here? Why are we squashed into this heaving chunk of metal flying directly into a vicious storm cell developing over Tullamarine airport?
The Convergence didn’t have the answer, yet. But—as the midwives reminded me throughout the weekend—this was only their first year together. The rebellion is only just beginning.