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E<\/span>rnesta Chirwa recalls the jarring moment the woman she presumed was her midwife said something unexpected. Caitlyn Collins was driving her to hospital after 6am, on 15 February 2022. \u201cShe said,\u201d says Chirwa, who is 30 and lives in Cape Town, \u201cPlease don\u2019t mention to the nurses that we were trying to have a home birth.\u201d<\/p>\n <\/p>\n The Guardian\u2019s journalism is independent. We will earn a commission if you buy something through an affiliate link.\u00a0Learn more.<\/p>\n <\/span><\/p>\n Chirwa was in too much pain to speak \u2013 she was in active labour. But she remembers feeling surprised. \u201cWhy,\u201d Chirwa recalls, \u201cis she asking us not to mention that we were trying to have a home birth?\u201d<\/p>\n This was the first pregnancy for Chirwa and her husband, Chifundo Bingala. Both are originally from Malawi, but moved to Cape Town, South Africa, for work: Chirwa found employment as a cleaner, and Bingala as a tailor. The couple met Collins through one of Bingala\u2019s friends, a local shopkeeper who had seen her deliver a friend\u2019s baby in a home birth, and vouched for her. The couple say they couldn\u2019t afford Collins\u2019s fee but she agreed to an exchange of clothing, made by Bingala, for her services.<\/p>\n When Chirwa went past her due date, to 43 weeks, Collins told the couple via text that such a late-term birth \u201ccan be normal\u201d. When Chirwa went into labour, Collins arrived at her house after midnight, turned off the lights and fell asleep. At about 2am, Chirwa and Bingala roused Collins, who briefly checked her before going back to sleep. Around 5am, they woke Collins up a second time. She checked Chirwa again, and saw a baby\u2019s foot protruding from her vagina.<\/p>\n Now, in a silence punctuated only by Chirwa\u2019s groans, Collins drove the couple to Retreat Day hospital. It was the closest hospital to their house, in the township of Westlake. But <\/strong>it specialised in low-risk care and wasn\u2019t suited for more serious emergencies. And Chirwa was very much a serious emergency. Her baby was footling breech \u2013 one of the most difficult types of breech to deliver \u2013 with a prolapsed cord. And though Chirwa didn\u2019t yet know it, she was carrying twins.<\/p>\n <\/span>Caitlyn Collins\u2019s testimonial for the Radical Birth Keeper school.<\/span> Photograph: YouTube\/Free Birth Society<\/p>\n Chirwa and Bingala recall that Collins initially tried to drop Chirwa off at the gate. Bingala intervened and demanded Collins drive them to the front entrance. Chirwa, he pointed out, couldn\u2019t walk. Collins pulled up by the entrance and dropped them off. And then she left.<\/p>\n At Retreat, midwives found a heartbeat on the monitor. But Chirwa would have to transfer to Mowbray Maternity Hospital, which had doctors and could handle complex cases. Chirwa waited two agonising hours for the ambulance to arrive.<\/p>\n Unbeknown to Chirwa, the woman she believed to be her midwife was a graduate from an online school that promoted an extreme set of beliefs, run by a business on another continent. The Free Birth Society (FBS) is a North Carolina-based business founded by ex-doula and social media influencer Emilee Saldaya.<\/p>\n Saldaya and her business partner, Canadian ex-doula Yolande Norris-Clark, embrace a dogmatic view of freebirth, meaning giving birth without any medical assistance. They promote so-called \u201cwild\u201d pregnancies, in which women avoid ultrasound tests and other prenatal care, they downplay potentially serious birth complications and discourage women from attending medical appointments.<\/p>\n In November, the Guardian published a report based on a year-long investigation which identified 48 cases of late-term stillbirths or neonatal deaths or other forms of serious harm involving mothers or birth attendants who appear to be linked to FBS.<\/p>\n Collins would later deny Chirwa hired her as a midwife, insisting she had made her and her husband aware she did not provide medical care<\/p>\n Most women find FBS through its popular podcast, which has been downloaded more than 5m times: in it, women share their empowering and uplifting freebirth stories. Others buy its instructional video course, The Complete Guide to Free Birth. Ernesta Chirwa was an unhappy exception: she unknowingly encountered FBS through Collins, the woman she thought was her midwife.<\/p>\n Chirwa, who is Black, was reassured by the fact that, when she visited Collins\u2019s \u201cbeautiful, fancy\u201d home, she saw wealthy-looking white couples there, which made her feel she was in safe hands. Because it was her first pregnancy, Chirwa did not realise that the prenatal care that Collins provided \u2013 massaging her bump and listening to the baby\u2019s heartbeat through a stethoscope \u2013 fell far short of what a licensed midwife would provide. \u201cI just thought, like, that\u2019s all that has to be done,\u201d says Chirwa.<\/p>\n <\/span>Emilee Saldaya and Caitlyn Collins on a Free Birth Society podcast.<\/span> Photograph: Free Birth Society\/YouTube<\/p>\n Collins would later deny that Chirwa hired her as a midwife, insisting that she had always made her and her husband aware that she did not provide medical care, but \u201cemotional support, birthing education and physical support in the form of massages\u201d. Collins identified by a different name: a birth keeper. But, says Chirwa: \u201cI have never heard of something like a birth keeper in my life.\u201d<\/p>\n A \u201cradical birth keeper\u201d is a term Saldaya coined, she says, to manoeuvre around the fact that, in many countries, practising midwifery without a licence is illegal. \u201cTo be crystal clear, a radical birth keeper is in practice an authentic midwife,\u201d Saldaya told her students in 2025.<\/p>\n To train these \u201cauthentic midwives\u201d, since 2020, FBS has run online schools that are estimated to have generated in excess of $4m (\u00a33m) in revenues. Among the most lucrative and long-running of these is the Radical Birth Keeper school, a three-month, $6,000 course, taught via Zoom. To date, more than 850 women, from 30 countries around the world, have graduated as radical birth keepers.<\/p>\n Collins and her business partner founded a practice called Circle of Elephants. What services it provided is subject to dispute<\/p>\n Collins is one of its better-known graduates among FBS faithful, and one of several who appear to have turned to FBS after becoming disenchanted with medical careers. Before she started calling herself a birth keeper, Collins was a trained midwife. She passed the North American Registry of Midwives exam, which meant that she could practise in the US as a certified professional midwife. But Collins, who is from Cape Town, was unable to practise legally as a midwife in South Africa, as the South African Nursing Council (SANC), refused to recognise <\/strong>US-trained midwives.<\/p>\n Collins and her business partner founded a practice called Circle of Elephants. Precisely what services it provided is subject to dispute. Documentation from the now-defunct practice, seen by the Guardian, states it was a \u201cmidwifery practice\u201d that provided an evidence-based \u201cmidwifery model of care\u201d. Collins\u2019s lawyers have denied Circle of Elephants ever purported to offer midwifery services, describing it as a traditional birthing centre staffed by \u201cbirthing assistants\u201d.<\/p>\n <\/span>Ernesta Chirwa near her home in the Western Cape.<\/span> Photograph: Chris de Beer-Procter\/The Guardian<\/p>\n In March 2020 and June 2021, two stillbirths were linked to Circle of Elephants in an 18-month period. South Africa\u2019s Mail & Guardian newspaper and investigative show Carte Blanche would later report that a doctor at Mowbray hospital \u2013 the hospital to which Chirwa had eventually been transferred while in labour after a two-hour wait \u2013 reported Collins and her partner to the healthcare authorities. Officials from the Western Cape Department of Health and Wellness interviewed them in July 2021 to discuss their concerns and, four months later, in November that year, the department ordered them to stop practising until they were registered with SANC. (Chirwa, who was by then in her eighth month of pregnancy, says Collins did not inform her of this development.)<\/p>\n It wasn\u2019t just doctors and healthcare bosses who were concerned about how Collins and her business partner were operating. The Cape Town home birth community is close-knit, and Collins and her business partner were viewed as having a laissez faire approach. Local midwives arranged two meetings with Collins and her business partner to discuss their concerns, the first in July 2021, and the second in September that year.<\/p>\n The meetings were peer reviews, meaning an opportunity to learn from what had happened, but Collins appeared to perceive them as an attack. According to minutes of the September meeting, she told the midwives in the room that she felt \u201cfear, anger and sadness\u201d.<\/p>\n Collins told the midwives that she was navigating a world in which the systems were failing women<\/p>\n They discussed the two stillbirths, and Collins and her colleague defended the care they had provided.<\/p>\n Collins stood firm in her views. She told the midwives that she was navigating a world in which the systems were failing women. \u201cInstead of taking things personally,\u201d she said, \u201cwe should look at the fact that we are building a new <\/em>way of doing things.\u201d<\/p>\n In an appearance on the FBS podcast in 2022, Collins talked about how low she felt before she discovered Saldaya\u2019s organisation. She told Saldaya, its host, that in South Africa: \u201cThe midwives have no solidarity with one another. It\u2019s like, it\u2019s really sad.\u201d But then she enrolled in the Radical Birth Keeper School.<\/p>\n \u201cBeing part of the community of the Radical Birth Keeper School,\u201d Collins said, \u201cfeels like I\u2019ve circled back to the little girl that I was and like totally trust in the magic again of life and death, birth, life and death, [and] everything in between.\u201d<\/p>\n In a 2021 video testimonial for the school, Collins, who is referred to in the FBS clip as a \u201cmidwife\u201d, smiled as she explained that the Radical Birth Keeper school had taught her \u201cintense yet really amazing light-bulb moments\u201d in which she realised how she had been \u201caffected by the industrial medical model and how this compromised my own health and wellbeing\u201d.<\/p>\n Now, said Collins on the FBS podcast, she was working to support women who \u201cwant to be radically responsible\u201d for their own births. In this, she was also echoing FBS language. Saldaya and Norris-Clark teach that women should take \u201cradical responsibility\u201d for their lives by choosing free birth.<\/p>\n It is a term that Saldaya, through the Radical Birth Keeper school and her enormously popular podcast, has exported to every continent on Earth. And now, through Collins, the term arrived in South Africa.<\/p>\n Before the ambulance arrived to take her to Mowbray hospital, Chirwa watched on the monitor as her daughter Kweli\u2019s heart stopped beating. \u201cOne of the nurses,\u201d she says, \u201ctold the other nurse: \u2018You know what? There\u2019s no longer any heartbeat here. There\u2019s nothing happening.\u2019 And then out of the blue, [the nurses] all just scattered.\u201d<\/p>\n After she was transferred to Mowbray, staff informed her that she had been pregnant with twins, but that both of her children were now dead, her son Kwesi having died in utero a day or so before. Chirwa was the only mother on the ward without a living child in her arms. \u201cI just felt so empty,\u201d she says.<\/p>\n On 16 February 2022, the day after Chirwa delivered her dead children, Collins posted on her Instagram account. \u201cMidwifery means with women. It doesn\u2019t mean with the system \u2026 let\u2019s take back birth, sisters.\u201d<\/p>\n Chirwa and Bingala would later report Collins to Cape Town police, and launch a separate lawsuit against Collins for alleged negligence. In court filings, they alleged that Collins provided \u201cshockingly poor\u201d medical advice and care, failed to inform them that she was not a licensed midwife, and failed to disclose information about the stillbirths linked to her practice.<\/p>\n An expert review for the purpose of civil litigation, based on the parent\u2019s\u2019 accounts and Chirwa\u2019s medical records, was carried out on behalf of Chirwa and Bingala by local obstetrician Dr Linda Murray. She described the outcome as \u201ca shocking case of misconduct and substandard care\u201d.<\/p>\n She identified multiple alleged failings: the fact that Chirwa went to 43 weeks of pregnancy, not knowing she was carrying twins, despite the fact that experts typically recommend a planned birth for twins at between 36 and 38 weeks. The lack of prenatal care Collins provided: no recommendations for ultrasounds, no blood tests, no blood-pressure checks, no urine samples, and no measurement of her baby bump. The fact that, when Chirwa went into labour, her baby bump was so big that it was off the measuring charts.<\/p>\n Angela Wakeford, a midwife who reviewed Chirwa\u2019s medical notes, reached a similar conclusion. \u201cThose twins,\u201d she says, \u201cshould not have died.\u201d<\/p>\n Collins\u2019s lawyers, in her defence, insisted that she had always presented herself as a birth keeper, not a midwife or any sort of medical provider \u2013 and claimed she had advised the couple to seek medical support. They denied Collins told Chirwa not to tell staff at Retreat hospital that she had been attempting a home birth, and said that when Collins dropped them off at the facility she told a person she presumed was an orderly that Chirwa needed immediate medical attention. Collins\u2019s lawyers said there was no contractual agreement with Chirwa and Bingala, and described a skirt Bingala sewed for her as a gift rather than an exchange for services.<\/p>\n <\/span>Ernesta Chirwa holds mementos gifted to her and her husband, Cifundo Bingala, after the loss of their twins.<\/span> Photograph: Chris de Beer-Procter\/The Guardian<\/p>\n They also sought to flip the script, arguing that it was Chirwa and Bingala \u2013 rather than Collins \u2013 who were at fault. It was their \u201cnegligent\u201d failure to attend professional maternity services for checkups, Collins\u2019s lawyers argued, that \u201ccontributed to the death[s] of their twin babies\u201d.<\/p>\n The legal action continues. Cape Town police did not respond to questions about whether an investigation was launched.<\/p>\n A<\/span>fter the twins died, Collins met Bingala twice. She brought oils and offered to massage Chirwa\u2019s stomach, an offer Bingala declined. In a visit on 22 February 2022, which he recorded, Bingala challenged her about the care she had provided his wife. Collins insisted that she had never presented herself as a midwife.There was a back-and-forth about why, on the night Chirwa went into labour, Collins had fallen asleep. Collins talked about the physiology of birthing mammals, the need to keep the space safe and quiet, and said she was \u201cholding the space\u201d for them.<\/p>\n On the second visit, on 28 February 2022, which he also recorded, Collins continued to tell Bingala that she had never presented herself as a midwife. \u201cI\u2019m here to show you I care,\u201d she said. \u201cI\u2019m here, I\u2019m not trying to run away.\u201d \u201cI trusted you,\u201d Bingala said. \u201cI trusted you the first day we met in [my friend\u2019s] shop; when [my friend] stood me in front [of you] and said: \u2018This one is a midwife.\u2019\u201d Collins reiterated: she was not a midwife, but a birth keeper. Eventually, after nearly an hour of conversation, Collins acknowledged that there might have been a \u201cmisunderstanding in what my role was\u201d.<\/p>\n After civil proceedings were issued in the high court of South Africa in March 2024, Collins left South Africa for an overseas trip (she has since returned).<\/p>\n During her time abroad, Collins visited Saldaya at home. The two women are close, and holidayed together in June this year in Mexico. Collins is now a senior figure in FBS, leading online calls within the closed membership, and helping to organise this year\u2019s Matriarch Rising festival, held on Saldaya\u2019s land. At the festival, Collins DJed tribal music under the DJ name DJ Kundi. In footage, Collins, dressed in black shorts and a black top, also led women in an \u201cembodied dance ritual\u201d.<\/p>\n Neither Saldaya nor her business partner, Norris-Clark, responded to a request for comment about the Chirwa case. Neither has provided a substantive response to the Guardian\u2019s investigation into FBS, although in one email Saldaya said: \u201cSome of these allegations are false or defamatory.\u201d On 22 November, the day the Guardian published its investigation into FBS, Saldaya posted a statement on Instagram criticising \u201cpropaganda on mainstream news\u201d.<\/p>\n FBS appears to view Collins\u2019s involvement in Chirwa\u2019s tragic loss through the same lens. Asked about the case in 2023 on a call with radical birth keeper students, Norris-Clark was dismissive of the criticism. \u201cAny mainstream press organisation, all of which are owned by the medical-industrial complex, will find whatever way they can to frame an independent birth keeper,\u201d she said.<\/p>\n The Birth Keepers, a multipart Guardian podcast series investigating the Free Birth Society, is released this week. (Subscribe now to The Guardian Investigates feed.)<\/em><\/p>\n