I’ve always found it ironic that Rachel died in childbirth.
In despair over her infertility, early in her marriage to Jacob, she exclaimed, “give me children, or I shall die.” Little did she know that decades later, giving birth to her second son would kill her. But there is more here. Rachel went into labor while on the road:
“Then they journeyed from Bethel. When they were still some distance from Ephrath, Rachel went into labor, and she had hard labor. And when her labor was at its hardest, the midwife said to her, ‘Do not fear, for you have another son.’ And as her soul was departing (for she was dying), she called his name Ben-oni; but his father called him Benjamin. So Rachel died, and she was buried on the way to Ephrath (that is, Bethlehem), and Jacob set up a pillar over her tomb” (Gen. 35: 16-20).
There are a number of experiences and activities that are truly unfun for expecting mothers nearing their due date. Somewhere close to the top of the list I would place long-distance travel, especially on a camel. I say this as someone who experienced two occasions of riding in an otherwise comfortable modern car to a hospital over an hour away while in active labor. Not fun. But, in an interesting detail, we hear that for Rachel, there was still a midwife at hand, even in the wilderness—not that this midwife could do anything other than encourage the weary mother in the midst of a labor so hard that it killed her.
We can wonder what precisely went wrong—severe postpartum hemorrhage? Complications from a breech birth? The latter would explain why the midwife knew that the baby was a boy while Rachel (the text suggests) was still struggling to deliver the baby. But then, in both this case and in another instance of a maternal death in childbirth in the Old Testament—in the birth of Ichabod in 1 Samuel 4—the most encouraging thing the midwife can think of saying to a laboring mother is: you have a son! (With the obvious implication that to say, “you have a daughter!” would not have brought the same degree of joy).
Rachel’s tragic childbirth story highlights something else that is important. Midwives for even the most remote of births somehow turn up in the Biblical accounts of women delivering babies, albeit with one notable exception. No midwife seems to have been present when Mary delivered Jesus. At least she didn’t have to labor on a camel, in the desert. Still, we see the built-in expectation that childbirth is not something a woman should attempt on her own. While the two heroic Hebrew midwives tell the Pharaoh in Exodus 1 that Hebrew women are so strong, they have their babies before the midwives get to them, it’s clearly meant to be a noble lie. Since the expulsion from Eden, midwives have always been necessary, the biblical narratives of pregnancy and childbirth suggest.
But recently, The Guardian ran a series of harrowing investigative pieces and podcast episodes about the Free Birth Society. Run by influencers without any medical training, the FBS has attracted thousands of followers worldwide with its simple message: your body can do this. The modern medical profession doesn’t know your body, but you do. And so, FBS encourages freebirthing: “Unlike home birth—birth at home with a midwife in attendance—freebirth means giving birth without any medical support. FBS promotes a version widely seen as extreme, even among freebirth advocates: it is anti-ultrasound, which it falsely claims harms babies, downplays serious medical conditions and promotes wild pregnancy, meaning pregnancy without any prenatal care.”
The problem is, as the biblical childbirth stories remind us, while God indeed created women’s bodies to birth children, since the fall the process has been filled with pain and danger. And so, FBS is now to blame for multiple deaths and near-deaths of mothers and babies—most of which presumably could have been prevented by modern medicine. The Guardian’s report notes that the investigation included “in-depth interviews with 18 mothers who suffered late-term stillbirths, neonatal deaths or other incidents of serious harm after they or their birth attendants were heavily influenced by FBS.” The investigation found information about a further 30 mothers similarly affected but did not get to interview them.
Evidence from history, including from the Bible, leaves no doubt: Women have been dying from pregnancy and childbirth-related complications for millennia. As recently as the 1920s, pre-eclampsia was fatal—remember the episode in Downton Abbey where Lady Sybil died from it? As the doctor who diagnosed it makes clear, the only thing he could possibly do is an emergency caesarean, which also (he fears) could be fatal. Nowadays, hardly anyone dies of pre-eclampsia. Perhaps modern medicine could have saved Rachel too.
And so, in light of this history, it makes sense that the most common question I have heard in response to the freebirthing phenomenon has been: why? Why would well-educated women choose freebirthing instead of going the usual hospital birth route? The Guardian indeed addresses this in brief. Put simply, the low trust of many pregnant women in the system is entirely earned by the medical establishment and its treatment of pregnant women. Women who have had negative childbirth experiences in hospitals are trying to avoid the trauma they’ve encountered in their previous births. Consider the story of Beatrice Scudeler, who was left without care overnight with her newborn after a birth followed by severe postpartum hemorrhage. In my own case, the cascade of unnecessary interventions during my first delivery resulted in a traumatic caesarean birth, with complications from the anesthesia and subsequent infections that had likely been hospital-acquired. It took me a full year to recover from that birth.
I desperately wanted to avoid a repeat experience with my next birth, but by the third trimester, it had become increasingly clear that the traditional OB/GYN practice close to my home still largely insisted on repeat caesareans for all women who had a previous one. But that was precisely what I was trying to avoid. What to do? Spoiler alert: I did not opt for a freebirth (indeed, the idea did not even occur to me)—because I had other options. My second and third child were born in a hospital a little over an hour away from our home, because a highly successful midwife-only practice delivered there, and a friend from church had told me about it. Women drove to that Atlanta practice from as far away as Birmingham, Alabama. Why? Because nothing else existed in the region—aside from a second similar practice, also located in Atlanta. I had a wonderful experience delivering with this practice.
The midwives who took care of me in these two pregnancies had significant experience—over 35 years for one of them. Furthermore, because they delivered at a hospital, emergency resources were readily available for their patients, when they were truly needed. The practice’s VBAC success rate was over 90%, their website boasted. That is phenomenal, although this statistic reminds that sometimes emergencies did happen even there, but when they happened, they really were emergencies that required medical intervention. They weren’t caused by overly interventionist doctors to begin with. With options like this practice available to them, most women would certainly choose them over freebirthing. But what about a situation where no good options are available?
When in January 2023, I learned that I was expecting again, I picked up the phone to call my old midwives, only to learn that the practice had closed. The Atlanta Medical Center (formerly Georgia Baptist Hospital) had unexpectedly shut down that fall, and because the midwives’ practice couldn’t transfer in such a short time to another hospital, it too closed. When I looked up the other midwives-only practice in Atlanta, I learned that it too had closed recently. This left me with the option of going back to the OB/GYN in town or trying to find another option. At the end, because I have already had two unmedicated midwife-assisted births, I decided to look into the possibility of an at-home birth with a certified midwife.
For the next month, I called every midwife I could find in the state and who delivered in my county. Every single one was full and not accepting new patients. It seems that many other women had the same idea as I did around that time. Then at last, when I was at the very end of the first trimester, I found a highly recommended midwife who was willing to take me on as a patient and attend my home birth. The following week, I had a miscarriage. We never did need that midwife after all.
But as I think about my fears over that month of trying to find a midwife for my home birth, I can understand a little bit more the very desperate expecting mothers who fell for the wild promises of FBS. No crazy scheme like FBS occurs in a vacuum. It is a fact that too many mothers today find the medical system inadequate when it comes to maternity care and wish they could find an option that is more compassionate and understanding. The results speak for themselves: freebirthing is not that option. And yet, we cannot condemn the women who so desperately wished that it would work for them without demanding reform in the medical establishment’s treatment of pregnant and laboring women.
We cannot repair the real cause of death—only God can, and someday He will. But in the meantime, expecting mothers and their babies deserve better.
