Ayelet Karo (33) was pregnant when her timeline started to grow, she says at her kitchen table in Amsterdam. Her three-month-old daughter looks cheerfully ahead from her highchair. At first Ayelet saw small bellies, which kept getting bigger. Video after video. Home births by candlelight, women who spoke about primal power, the placenta as a sacred organ. She scrolled through it. “It was kind of a popcorn-like way of looking at it. Like: what’s going on there?” Looking back, she thinks she would have been more relaxed without all those videos. “But I also learned things from it that I would never have known otherwise.”
One thing stuck: the lotus birth, in which the placenta remains attached to the child after birth until it detaches itself after a few days. She continued reading and came across the less radical half variant – in which the umbilical cord is only cut after the placenta has been born, for example after an hour. This would provide her baby with extra blood and nutrients from the placenta.
Her boyfriend, a doctor at the AMC, was initially more reluctant. “The information comes from Instagram, so is it correct?”
Anyone who is pregnant or wants to become pregnant is quickly drawn into an endless stream of advice online. There is a whole ecosystem of pregnancy influencers on Instagram, TikTok and Facebook. Think of a midwife who shows in a video how to set up a birthing pool at home, or reveals secrets from practice in a video that promotes her own birthing course. In the caption: “Do you want to choose instead of being taken along? Respond with COURSE or start immediately via link in bio.” And then there are the non-medical coaches who sell hypnobirthing courses about ‘mindful childbirth’ and tapping into your feminine ‘primal power’.
What women encounter online sometimes provides new knowledge, offers them inspiration or courage, or gives them the feeling that it helps – even if scientific evidence is lacking.
The lotus birth, for example, where the theory behind it contains a grain of truth. Waiting before cutting the umbilical cord can be beneficial: in the first minutes, blood still flows from the placenta to the child, which ensures a better iron supply and less risk of anemia, explains gynecologist Joost Akkermans. This is especially important for premature babies, because their lungs do not yet fully take over the circulation. In the case of a premature caesarean section, Akkermans therefore waits a few minutes before cutting the umbilical cord.
This ‘tapping out’ of the umbilical cord has been common practice in the Netherlands for years. The World Health Organisation recommends waiting at least two minutes.
But the effect is in minutes. Once the umbilical cord is knocked out, the flow stops. The placenta begins to die immediately after birth and must be salted to slow down decomposition. “From a gynecological perspective, it is completely pointless to leave the placenta to a child. It is not natural, and it is of no use to a child.”
Akkermans sees why women look for information themselves. The information provided by healthcare providers is fragmented, comes too late, and does not match how this generation seeks information, he says. “There are piles of brochures in my consulting room. But the younger generation of pregnant women is not into reading books.” The algorithm fills that vacuum.
Hilde Schippers (32) is 35 weeks pregnant and wants to give birth at home, in the bath, she says on the phone at the beginning of March. She even ordered lights for the cover of the birthing pool, a string of lights that illuminates the water. “You can put it at the bottom, so that you can see your baby very nicely when it comes out. That seems fantastic to me.”
Three years ago, during the pregnancy of her first child, she entered the world of Vrije Geboorte via a Facebook advertisement. That is the movement of cultural anthropologist Anna Myrte Korteweg, who published the book of the same name in 2011. In it, she tries to create more awareness about the idea that giving birth is something that a woman should be able to control herself, at home or in the hospital, and that no interventions should be done without her permission.
The name ‘free birth’ refers to women making their own choices, rather than following protocols. It is sometimes confused with ‘free birth’a philosophy that also lives online and can stand for giving birth without medical supervision. However, this is mainly about free choice, also for example in a hospital environment.
Schippers and her partner took the online pregnancy course that Korteweg has been teaching for five years now and which is partly reimbursed by some health insurers. With meditations, zoom sessions, a WhatsApp group and a price tag of 397 euros. The course lasts nine months, which you complete at your own pace. With breathing and meditation exercises and home assignments, women learn how to recognize fear during childbirth and ‘get through’ it, for example. But they also learn, for example, how to enter into conversations with healthcare providers without it becoming a battle.
Schippers does not see the course as an alternative to regular care, she says. “There is a very strong culture of fear surrounding childbirth. The idea that it is something you should leave to the doctors, in which you as a woman have no choice.”
She also saw that culture of fear online. On well-known and reputable platforms such as the Dutch website and app 24Babywith information for (expectant) parents compiled by pediatricians and gynecologists, she came across messages in which women warned each other about a breech birth. Too much chance of an emergency caesarean section, too few experienced gynecologists, too dependent on who happens to be on duty. The implicit message, Schippers experienced, was always the same: listen to the doctor, because you will soon harm your child.
I am happy that we still have a vaginal breech birth in the Netherlands
When her own baby turned out to be in a breech position and not turning over, Schippers submitted her question to the course’s WhatsApp group, and then to the Facebook group Stuitgeboorte Nederland, which also includes gynecologists. In a breech birth, the baby’s buttocks or feet lie down instead of the head, with more risks for the baby than with a normal birth. Through the Facebook group she found a doctor at the Meander Hospital in Amersfoort with experience with breech births. “I was really on the verge of having a caesarean section. If I had not sought that out, I might have made a choice that I would have regretted afterwards.”
Joost Akkermans recognizes Hilde’s story. “I am happy that we still have a vaginal breech birth in the Netherlands.” In most of the world, a caesarean section is the standard procedure for a breech presentation, he says. The Netherlands continued to offer breech births, and according to Akkermans, that choice is now paying off in more experience. “We did not just go along with something, but continued to think critically, asking: can we not continue to do this? That is indicative of where we stand in the Netherlands.”
Anna Myrte Korteweg is now a well-known pregnancy influencer. Her Facebook and Instagram pages (49,000 and 24,000 followers) contain sequences of videos of people giving birth. Almost all women do this at home in a birthing pool. The videos contain texts that sing about the ‘primal power’ of the woman in labor.
Korteweg is critical of maternity care, but not against it. The images are accompanied by the women’s birth stories. Some videos explain how your body “knows what it needs”, even during a hospital birth. For example, it can be seen that a woman gives birth standing on a hospital bed, instead of lying down. Inspired, people respond how beautiful they think it is “however it can go”. Other messages are about clashes with the medical world. In a much-liked birth story, a woman says that her gynecologist insisted on an induction at 42 weeks and she therefore felt pressured. She ultimately gave birth in the hospital, but she says on her terms – and attributes that to her preparation through books like Free Birthwhich, according to the report, made her so confident about her choices that she stuck with them.
But doesn’t all that visual material raise expectations that reality does not always meet? “You can just go for it,” says Korteweg. “And even if things turn out differently, it still makes such a difference if you have really made your birth your own.” She calls the films that portray childbirth as a horror experience, an ordeal that you have to go through. “As far as I am concerned, that is completely incorrect, and to break that, I am sharing those images.” But anyone who thinks that free birth is only about receiving your baby in ecstasy is wrong, according to her. “It’s about keeping it as close to yourself as possible.”
A momfluencer himself might think the advice is great. But you are not her and she is not you.
Maternity nurse Saadet Tokyay (42) is skeptical about the expectations that pregnancy influencers create. She is the owner of Kraamzorg Dunya in Utrecht, which she founded fourteen years ago. According to her, what influencers sell is not just information, but also a lifestyle that is financed through paid collaborations with brands. “A momfluencer may think the advice is great and it suits her situation. But that does not mean it suits the person who takes over. You are not her and she is not you.” If a maternity woman becomes a perfectionist as a result, things often go completely wrong, she says. She advises women to keep in mind that things can turn out differently. “For women who have that in mind, things go well nine times out of ten.”
Akkermans also sees that a pregnant woman who ends up in an online corner too often sometimes develops wrong images or expectations. “As long as you do the right preparation, the right hypnobirthing course, then you have that control. But that is dangerous.” Because, he says: “Every birth is different. That has nothing to do with how high your pain threshold is, or how well you have prepared.”
He sees what can go wrong if the vacuum is not filled by healthcare providers, but by influencers. Pregnant women receive the message through all kinds of channels that synthetic oxytocin damages the mother-child bond, or that it would lead to autism in the child – associations that, according to Akkermans, have been extensively researched and refuted. Oxytocin plays an important role in contractions and in preventing severe blood loss after birth – the leading cause of maternal death worldwide. In hospitals, synthetic oxytocin is used if a delivery stagnates, to prevent it from ending in a caesarean section.
Akkermans notes that recently there has also been a report that women are allergic to oxytocin. He asked about it in a national app group of gynecologists, but no one had ever seen it. “But it does lead to conversations in the delivery room where we have to convince people that it is wise to do it.”
In the most extreme case, international accounts promote childbirth without any medical supervision. A year-long investigation The Guardian to the American Free Birth Society describes a platform that reaches hundreds of thousands of women through a podcast that has been downloaded millions of times, an Instagram account with more than 130,000 followers and online video courses. Since 2018, this would have generated more than $13 million in revenue. The platform opposes ultrasounds and promotes pregnancies without prenatal checks.
FBS promotes a version that is widely seen as extreme, even among proponents of free birth who, if medically justified, prefer to give birth at home with a midwife present.
Akkermans developed an app to give pregnant women the right information at the right time, in the hope that the need to search online themselves will decrease. The Birth Care app is now used in eight major Dutch hospitals and in Twente, pregnant women are now also asked to download it in all midwifery practices. “People now come in prepared. They say: I read this, because it is important to me.”
