There have been seven stillbirths or deaths associated with the trend in Ontario since 2020.
An Ontario coroner’s committee is warning about the risks of so-called freebirths after an increase in stillbirths associated with the trend.
In its latest report, the province’s Obstetrics and Perinatal Death Review Committee (OPDRC) identified an “unexpected cluster” of stillbirths and deaths in 2022 that occurred in home deliveries where there was no medical professional present.
“This phenomenon – known widely as ‘freebirth’ – involves intentionally delivering at home without the help of midwives or physicians,” the report said.
Since 2020, there have been seven stillbirths or deaths associated with the trend in Ontario. That is a “marked increase” from previous years, according to the report. Three stillbirths related to unattended births were recorded between 2013 and 2019 across the province. In 2020, two babies were stillborn in Ontario after a freebirth and in 2022, there were four stillbirths and one maternal death linked to the practice.
The deaths follow an increase in the trend toward unassisted births across the province. Although the numbers are small compared to attended births and births in hospitals and health centres, unattended births are increasing rapidly.
In 2013, Ontario registered about 40 births without a physician or midwife present at delivery. By 2022, that number had more than quadrupled to about 180 unattended births.
Unattended births also include those that occur when parents don’t have time to get to the hospital – sometimes attended by paramedics or others. Those unplanned unattended births are unlikely to have played a role in the steep incline being seen, according to the committee.
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The freebirth trend has been widely reported on and talked about in recent years around the world, promoted online by activist groups such as the Free Birth Society.
Researchers have studied the motivations of some of the mothers choosing to give birth with no health professionals in attendance, citing a rejection of the medicalization of birth, previous negative experiences and a wish to remain in control.
Investigators with the OPDRC said the reasons provided to them for parents choosing to have an unattended birth included religious beliefs, previous negative experiences with childbirth and dissatisfaction with COVID-19 restrictions that were in place at the time, such as masking or vaccination requirements.
Among the 10 stillbirths and deaths related to unattended births in the last 10 years, 30 per cent were the individual’s first delivery and 60 per cent had a designated birthing assistant present who was not recognized as an obstetrical care provider in Ontario.
The committee will further review the issue and make recommendations. In the meantime, it “strongly supports the attendance of a recognized obstetrical care provider at all births.”
Dr. Louise McNaughton-Filion, who chairs the committee, said its members were not expecting to see the rise in deaths associated with freebirths.
“This honestly was a bit of a surprise. It is something that seemed to be showing up in the news at the time, but we wanted to make sure what we were seeing was not just a blip,” she said. “We wanted to know if this truly was significant.”
She said an epidemiologist helped the committee better understand trends, and data from the provincial registrar confirmed it was a growing trend.
She said the committee will further review the issue and make recommendations. She said it is important that the message get out about the risks.
“People are making a considered decision (to have an unattended birth) from what I can see. In order for people to make an informed decision, it is important that they be aware that we are seeing this increase in stillbirths,” she said.
Although the committee report focused on deaths up until 2022, McNaughton-Filion said there have been more cases since then which have been referred to the committee for further investigation.
A study published in the Canadian Medical Association Journal in 2016 found that low-risk home births attended by a midwife were no riskier than hospital births.
The Obstetrics and Perinatal Death Review Committee also looked at the rise of deaths involving substance use. McNaughton-Filion said many of the people who died of substance use while pregnant had a number of high risk factors such as precarious housing, a history of domestic abuse and no prenatal care.
A subgroup has been formed to do a deeper dive into those deaths in order to help improve outcomes, she said. Another subgroup will look more deeply into deaths by suicide and mental health.
“(Pregnancy) is a time where there is the opportunity to offer assistance, to intervene and to improve the circumstances and the healthcare of a person,” she said.
The report analyzed a total of 21 deaths during pregnancy, 39 during the postpartum period, 79 neonatal deaths and 47 stillbirths, many of which resulted in recommendations to prevent future deaths.
Poverty was a factor in the lives of some of those who died, according to the report. “Fifty per cent of deaths during pregnancy were among individuals living in areas with the highest level of material deprivation,” the report said.
In addition, 37 stillbirths and 35 neonatal deaths resulted from pregnancies where no prenatal care had been received.
“While much of the discussion about health and health care during the 2021-2022 period focused on the COVID-19 pandemic, in Ontario there continued to be many potentially preventable perinatal and obstetric deaths reported to the Office of the Chief Coroner,” the report said.
Among anonymous cases described in the report was one that detailed the death of a mother unvaccinated from COVID-19 shortly after delivering by C-section and the stillbirth of a baby whose mother presented to the nearest hospital in pre-term labour. That hospital had no obstetrical services and officials were unable to transfer her in time.
