Rising use of unregulated birth attendants raises red flags

She crept downstairs, trying not to wake her partner, who had to work early the next day. She pulled out a Doppler machine, a wand that detects a fetus’s heartbeat. She moved the wand, trying to listen for 20 minutes. She couldn’t hear anything.

Cribbs tried to remind herself of reassuring words from the person she’d hired and relied on most during her pregnancy: a woman named Nidhi Seth, who called herself a “traditional birth companion.”

Earlier in her pregnancy, when Cribbs wondered about the elevated blood pressure readings she was getting with a cuff at home, Seth had instructed her not to worry. “Try to take it easy,” she told her. She’d advised Cribbs to meditate, eat protein, and drink a shot glass full of Himalayan salt.

Cribbs, then 30, had welcomed Seth’s alternative approach. She loathed the sweeping government mandates around COVID-19 vaccines. She liked the idea of treating her pregnancy and birth like a natural, “instinctual” process, not a medical event.

But that night, Cribbs couldn’t shake the feeling something was wrong.

Around midnight, she decided to go to the hospital in Barrie.

Like Cribbs, a growing number of families in Canada are looking “outside the system” for pregnancy and birth support, many of them turning to “traditional birth attendants” or “companions” like Seth, who do not have a regulatory body accrediting or overseeing them.

Families like Cribbs’ don’t just avoid obstetricians. Many also eschew registered midwives, who have undergone four years of training and are regulated by provincial law.

Expecting parents face a firehose of information and opinions. One thing they share: A desire to do the best thing for their children. Like Cribbs, some feel they want to avoid the medicalization of birth. Others sympathize with the growing number of patients who complained to Ontario’s patient ombudsperson in the last year about “insensitivity, poor communication, and lack of trauma awareness” in obstetrical and gynecological care.

But the choice to give birth without a medical professional carries risk. An Ontario panel of coroners found an “unexpected cluster” of stillbirths among people choosing not to have midwives or doctors attend their births. Most of the deaths the committee investigated involved a non-medical birth attendant. Authorities across the country have issued warnings to the public about hiring these unregulated attendants, and in some cases taken legal action.

That night Cribbs went to the hospital, nurses couldn’t find a heartbeat. A doctor arrived to do an ultrasound. He pointed to the heart wall on the screen.

“There’s no movement,” he said.

Cribbs was in disbelief. She called Seth.

“‘He’s dead,’” she remembers telling Seth. “‘I’m at the hospital, and he’s dead. He has no heartbeat. He’s dead.’”

“And she was just like, ‘No, there’s no way.’ ”

Several months earlier, in the spring of 2023, Cribbs was feeling vulnerable. She had broken her right hand in a car crash, forcing her to drop out of her apprenticeship program as a heavy truck mechanic. She suddenly needed help to shower and use the bathroom.

Her relationship with her partner, Brandon, was strained.

She was already overwhelmed when she found herself pregnant.

A woman she had met at the trucker convoy in Ottawa a year earlier had shared her distaste for government overreach into people’s private medical choices. Cribbs had almost lost her job over declining the vaccine, she said, and she found the pressure and incentives to be vaccinated bizarre.

Cribbs wasn’t opposed to the medical system entirely; she said she was thankful for scientific advances. But her convoy buddy had hired a non-medical birth attendant, and had been happy with the experience.

When it came to birth, Cribbs thought, “‘What would be the harm in being able to do it in my own home?’” she said. “I was more just open to not making it a medical emergency.”

Cribbs found Seth’s Instagram account. She was drawn to the beautiful woman with long black hair who oozed sweet encouragement.

Cribbs wanted to trust someone.

“I was so grateful for Nidhi,” Cribbs said. “I had lost so much confidence that I wanted her support and skills to remind me and support me during this crazy time.”

Seth’s contract included a disclaimer: “It’s important for you to know that I cannot — and do not — guarantee a specific outcome for your birth,” it stated.

Seth saw herself in opposition to “generations of misinformation, fear, trauma, and bondage to a system that harms women.”

Seth had spent a few years in medical school, then applied unsuccessfully to nursing and midwifery school, she said on a podcast called “The Noble Mother” last year. While waiting tables, she learned about a training program to become a doula — usually a non-medical support person for someone in labour who works alongside a doctor or midwife.

Seth’s enthusiasm waned as she encountered mechanisms of birth, especially in the hospital, that, she said on her website, “were both eye-opening and disheartening.”

She met Billie Harrigan, a woman who styled herself as a matriarch of “traditional birth companions” in Ontario and who teaches $9,000 courses to aspiring birth attendants. She posts about the medicalization of births to followers on social media and maintains a free online forum connecting clients with birth companions. To join the private version of Harrigan’s online community, members pay $15 per month and sign a nondisclosure agreement.

In an email, Harrigan said the birth companions she trains “receive extensive training in trauma-informed care” and they do not engage in acts that legally only doctors and midwives can perform.

Once upon a time, midwives, themselves unregulated, fought for recognition by the Canadian medical establishment. In the 1970s and 1980s, a radical social subculture made up of second-wave feminism and alternative health movements lionized the countercultural act of having babies at home. Networks of women with this interest attended each other’s births, sometimes bartering their knowledge and help for other services in kind.

Even when midwifery became regulated, in the 1990s in many provinces, an anti-establishment and anti-government ethic persisted, with some women criticizing the compromises the professionalizing midwives were willing to make. Women like Seth and Harrigan posit now that even registered midwives have been co-opted by a medical institutional complex.

In this paradigm, a midwife or nurse checking the cervix of a woman in labour may be a form of sexual assault. A C-section is performed for the convenience of the doctors and nurses mindful of the clock ticking toward the end of their shifts.

“I will never stop sharing on the trauma & the abuse that is happening to every single woman who chooses a regulated health care professional,” Seth wrote on Instagram in 2022. “I will never stop helping women into sovereignty & body autonomy outside the system.”

Many of the births Seth attended served to confirm her more hands-off approach.

“We’ve seen miracles. We’ve seen women go to 43 weeks without one ultrasound, one test, and they have their babies,” Seth said on the podcast. “Why? It’s because their belief system.”

When Seth met Cribbs, Cribbs sensed some interests in common, including the opposition to the COVID vaccine.

“I carry ancient wisdom regarding herbs, remedies, nutrition, family and faith, and brings [sic] new knowledge in the science and physiology of healthy pregnancy and safe birth,” the contract she gave Cribbs stated.

Seth would not “judge or question your choices,” but laid out some boundaries in the contract:

“If birth is transferred to hospital, I do not accompany you and your partner to the hospital.”

It also stated that if a client decided to involve a registered midwife, Seth would leave their birth immediately.

For her “traditional birth package,” she charged Cribbs $3,000 plus mileage fees to travel to and from Cribbs’ home in Barrie.

As Cribbs’ body grew, she leaned on Seth but occasionally still visited her family doctor.

Cribbs’ family doctor sent her for tests when Cribbs was about 28 weeks along. A urine test showed protein, which can be a sign of complications.

Cribbs shared the test results and her blood pressure with Seth. Seth suggested she meditate, increase her protein intake, and try taking a “salt shot” hourly — a shot glass filled with Himalayan salt thought to provide minerals.

“You don’t have to be alarmed,” Seth texted.

“It’s not like your values are so abnormal,” she said another time.

“It’s very very very common to see a trace of protein,” Seth texted.

“So long as it’s a trace and there’s no high bp,” meaning blood pressure.

But Cribbs was experiencing high blood pressure. She would measure at home and send Seth the readings. Seth would ask about her stress levels and encourage her to take a nap and do some meditative breathing.

“Just keep up hydration, protein and salt,” she texted. “You are good :)”

At Cribbs’ family doctor’s urging, Cribbs saw an obstetrician who was worried about her blood pressure and protein in her urine and recommended she go on medication. It was about a month before her due date.

Cribbs did not want to take the medicine. The OB agreed to do an ultrasound, and with her baby looking healthy, Cribbs felt OK skipping the drugs.

Less than two weeks before her due date, Cribbs felt something was wrong. Anytime she would stand up, she would feel a strange heaviness in her abdomen.

That evening, Cribbs couldn’t feel her baby moving. That’s when she decided to take a bath, and ended up in the exam room at the hospital.

Cribbs called her partner and told him to come. The doctor repeated the ultrasound. Nothing had changed.

Seth suggested they try another hospital. There, another doctor told them the same thing.

Two days later, on June 15, 2023, Cribbs birthed her stillborn son, Liam, and went home to fall apart. The walls of Liam’s nursery were already painted blue, his crib decorated with a baby jungle animal quilt.

That Sunday was Father’s Day. They went to the funeral home and sat with Liam’s body. Seth joined them, bring​​ing some herbs and holding Cribbs’ hand while she cried.

In the aftermath of Liam’s death, Cribbs and her partner started to wonder about getting some of the money back that they had paid Seth. They corresponded with her for a refund, but they weren’t happy with the amount she sent. Then Cribbs got a letter from a lawyer representing Seth, offering more of a refund, but requiring her to sign a nondisclosure agreement.

Cribbs tried to text Seth. Her number had been blocked, Cribbs said.

Cribbs did not want to sign an NDA, and in her grief, started to post angry messages online about the care she’d received, and Seth’s refusal to talk.

Seth is the second birth attendant in two years who has faced legal action by the College of Midwives of Ontario. The regulator says it takes action against unlicensed birth attendants in order to protect the public trust in registered midwives.

The college has issued a public advisory on its website, warning about four people in the province, including Seth, who it deemed to be operating unauthorized or illegal practices.

Regulators emphasize they’re not advising people against a well-recognized stream of Indigenous midwifery, which is integrated in the regulated system. The Association of Ontario Doulas takes a “firm position against” its members adopting the “traditional birth attendant/companion” moniker, noting that Indigenous communities have long used the “traditional” description to refer to culturally knowledgeable care in often-remote places.

Nova Scotia’s college of midwives issued its first-ever warning this summer saying it is aware of people “managing home births when they are not licensed to do so.” In 2018, Saskatchewan’s midwife college brought legal action against a longtime doula who admitted to conducting internal exams at a home birth.

In the last two years, B.C.’s College of Nurses and Midwives has issued public advisories about 12 people who are not registered midwives but who “may be performing restricted activities” in births.

One of them, Gloria Lemay, has been in the college’s regulatory crosshairs for more than 20 years. Lemay, now 78, is awaiting trial for manslaughter after a baby died following a home birth she attended in 2023, years after she had been banned from delivering babies.

None of the allegations against her have been proven in court. Lemay declined an interview about her case while proceedings continue.

Almost two years after Cribbs delivered her baby stillborn, the Ontario college went to court against Seth, citing provincial law that restricts laypeople from performing certain controlled medical acts, like giving a diagnosis, managing labour or performing cervical checks.

The college alleged Seth gave an “ineffective alternative treatment plan” and advised Cribbs to “ignore medical advice” from health care professionals.

In August, a court ordered Seth “permanently refrain” from issuing diagnoses or giving medical advice that might cause “serious bodily harm.” It ordered her to pay $3,000 to the college within 90 days. Court documents indicate Seth settled the dispute with the college and consented to the order being made against her.

Seth did not respond to multiple requests for comment.

About a year-and-a-half after Liam died, Seth shared her side of the story on an Ontario-based podcast that bills itself as being for “sovereign mothers,” women choosing to give birth outside of the medical system.

Seth didn’t use Cribbs’ name, but the details of an episode called “Death Is a Part of Life” matched Cribbs’ story.

Seth described hearing from Cribbs about her blood pressure concerns and her urine test.

“There are so many variations of normal,” Seth said on the podcast.

“The one comment that I made was, ‘Hey, protein in the urine can be normal,’” Seth said. “That’s not medical advice, though. That’s just me suggesting it can be normal.”

When Cribbs’ baby, Liam, died in utero, Seth was anxious for an explanation. Seth blamed ultrasounds and Cribbs’ strained personal relationships.

A week after the College of Midwives of Ontario filed an application for an injunction to keep her from attending births, Seth’s account posted a defiant statement.

“There are moments in life where you don’t just reclaim your voice … you reclaim your entire being,” she wrote. “You don’t birth a new world by pleading for permission.”

The trend to choose to give birth while intentionally not having medical help picked up after COVID, the Ontario coroners committee found.

Between 2013 and 2020, there were three stillbirths connected to home births where there was no midwife or doctor present, according to an Ontario coroners committee review.

But there were more than double that number of deaths in just three years between 2020 and 2022: Six stillbirths and one parental death.

Six of the 10 deaths investigated by the committee were in families that had chosen a non-medical attendant.

The committee “strongly supports” parents involving a midwife or physician in all births.

Dr. Louise McNaughton-Filion, a physician since 1990, chairs that committee and said she cares most that people have information about their options when making health and birth decisions.

That includes knowing that there has been a spike in stillbirths associated with the choice to not have a medical person there — not just hearing from an unlicensed attendant that “if anything happens during your pregnancy, it’s normal.”

“I can tell you that death is normal, but you don’t necessarily want it to happen earlier than it needs to happen,” she said.

In an email, Harrigan said the choice to give birth with a traditional birth companion can be a “healing and empowering experience.”

“The terrible experience of one mother whose precious baby passed away in utero doesn’t reflect the broader issue of rising stillbirth, or more favourable outcomes when women take responsibility for their own well-being along with adequate training for birth companions who therefore have no interaction with medical experts or coroners.”

Cribbs, who refers to herself still as “Liam’s mom,” gave birth to another son a year later. Cribbs went into her second birth, this time with midwives, armed with a list of dos and don’ts, only to be told the things she wanted were common practices.

Cribbs’ experience with Seth had made her fear registered midwives and hospital staff.

“I was so amped up to think that everyone is just out to get you,” she said.

“This one extreme to the other, it’s not healthy, and it’s not good because the people that get caught in the middle are mothers and new families, like myself,” she said.

That all-or-nothing idea of medical involvement in pregnancy and birth is concerning to Vicki Van Wagner, a veteran midwife who understands the desire many parents have to think critically about the medical system’s approach to birth.

“It’s sad to have it so polarized,” Van Wagner said. “And really, my dream of the best midwifery is the midwives who will certainly support out-of-hospital birth, birth with very little intervention, but also be there to say, ‘You know what? This is one of those times when a caesarean is needed, or when induction for hypertension would be extremely helpful.”

When Van Wagner was working as a lay midwife in the 1980s, a birth she attended ended in tragedy. A coroner’s inquest focused on the nascent push to legalize midwifery and catalyzed the health care system to take up the midwives’ efforts to have their work recognized and integrated.

By the early 1990s, Van Wagner helped to launch the midwifery school at Toronto Metropolitan University. “It seems so clear that the way forward is to say, how do we avoid unnecessary intervention?” she said.

Three years have passed since Cribbs met Nidhi Seth while pregnant with Liam. She and her partner are expecting again. Cribbs is working with the same team of midwives this pregnancy, and even considered a home birth.

“Even though I’ve had such a poor experience,” Cribbs said of her time with Seth, “she didn’t ruin my idea of how beautiful birth is because I still very much know it is, and I believe it is.”