Ernesta 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. “She said,” says Chirwa, who is 30 and lives in Cape Town, “Please don’t mention to the nurses that we were trying to have a home birth.”
Chirwa was in too much pain to speak – she was in active labour. But she remembers feeling surprised. “Why,” Chirwa recalls, “is she asking us not to mention that we were trying to have a home birth?”
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’s friends, a local shopkeeper who had seen her deliver a friend’s baby in a home birth, and vouched for her. The couple say they couldn’t afford Collins’s fee but she agreed to an exchange of clothing, made by Bingala, for her services.
When Chirwa went past her due date, to 43 weeks, Collins told the couple via text that such a late-term birth “can be normal”. 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’s foot protruding from her vagina.
Now, in a silence punctuated only by Chirwa’s groans, Collins drove the couple to Retreat Day hospital. It was the closest hospital to their house, in the township of Westlake. But it specialised in low-risk care and wasn’t suited for more serious emergencies. And Chirwa was very much a serious emergency. Her baby was footling breech – one of the most difficult types of breech to deliver – with a prolapsed cord. And though Chirwa didn’t yet know it, she was carrying twins.
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’t walk. Collins pulled up by the entrance and dropped them off. And then she left.
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.
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.
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 “wild” pregnancies, in which women avoid ultrasound tests and other prenatal care, they downplay potentially serious birth complications and discourage women from attending medical appointments.
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.
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.
Chirwa, who is Black, was reassured by the fact that, when she visited Collins’s “beautiful, fancy” 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 – massaging her bump and listening to the baby’s heartbeat through a stethoscope – fell far short of what a licensed midwife would provide. “I just thought, like, that’s all that has to be done,” says Chirwa.
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 “emotional support, birthing education and physical support in the form of massages”. Collins identified by a different name: a birth keeper. But, says Chirwa: “I have never heard of something like a birth keeper in my life.”
A “radical birth keeper” is a term Saldaya coined, she says, to manoeuvre around the fact that, in many countries, practising midwifery without a licence is illegal. “To be crystal clear, a radical birth keeper is in practice an authentic midwife,” Saldaya told her students in 2025.
To train these “authentic midwives”, since 2020, FBS has run online schools that are estimated to have generated in excess of $4m (£3m) 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.
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 US-trained midwives.
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 “midwifery practice” that provided an evidence-based “midwifery model of care”. Collins’s lawyers have denied Circle of Elephants ever purported to offer midwifery services, describing it as a traditional birthing centre staffed by “birthing assistants”.
In March 2020 and June 2021, two stillbirths were linked to Circle of Elephants in an 18-month period. South Africa’s Mail & Guardian newspaper and investigative show Carte Blanche would later report that a doctor at Mowbray hospital – the hospital to which Chirwa had eventually been transferred while in labour after a two-hour wait – 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.)
It wasn’t 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.
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 “fear, anger and sadness”.
They discussed the two stillbirths, and Collins and her colleague defended the care they had provided.
Collins stood firm in her views. She told the midwives that she was navigating a world in which the systems were failing women. “Instead of taking things personally,” she said, “we should look at the fact that we are building a new way of doing things.”
In an appearance on the FBS podcast in 2022, Collins talked about how low she felt before she discovered Saldaya’s organisation. She told Saldaya, its host, that in South Africa: “The midwives have no solidarity with one another. It’s like, it’s really sad.” But then she enrolled in the Radical Birth Keeper School.
“Being part of the community of the Radical Birth Keeper School,” Collins said, “feels like I’ve 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.”
In a 2021 video testimonial for the school, Collins, who is referred to in the FBS clip as a “midwife”, smiled as she explained that the Radical Birth Keeper school had taught her “intense yet really amazing light-bulb moments” in which she realised how she had been “affected by the industrial medical model and how this compromised my own health and wellbeing”.
Now, said Collins on the FBS podcast, she was working to support women who “want to be radically responsible” for their own births. In this, she was also echoing FBS language. Saldaya and Norris-Clark teach that women should take “radical responsibility” for their lives by choosing free birth.
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.
Before the ambulance arrived to take her to Mowbray hospital, Chirwa watched on the monitor as her daughter Kweli’s heart stopped beating. “One of the nurses,” she says, “told the other nurse: ‘You know what? There’s no longer any heartbeat here. There’s nothing happening.’ And then out of the blue, [the nurses] all just scattered.”
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. “I just felt so empty,” she says.
On 16 February 2022, the day after Chirwa delivered her dead children, Collins posted on her Instagram account. “Midwifery means with women. It doesn’t mean with the system … let’s take back birth, sisters.”
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 “shockingly poor” 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.
An expert review for the purpose of civil litigation, based on the parent’s’ accounts and Chirwa’s medical records, was carried out on behalf of Chirwa and Bingala by local obstetrician Dr Linda Murray. She described the outcome as “a shocking case of misconduct and substandard care”.
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.
Angela Wakeford, a midwife who reviewed Chirwa’s medical notes, reached a similar conclusion. “Those twins,” she says, “should not have died.”
Collins’s lawyers, in her defence, insisted that she had always presented herself as a birth keeper, not a midwife or any sort of medical provider – 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’s 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.
They also sought to flip the script, arguing that it was Chirwa and Bingala – rather than Collins – who were at fault. It was their “negligent” failure to attend professional maternity services for checkups, Collins’s lawyers argued, that “contributed to the death[s] of their twin babies”.
The legal action continues. Cape Town police did not respond to questions about whether an investigation was launched.
After the twins died, Collins met Bingala twice. She brought oils and offered to massage Chirwa’s 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 “holding the space” for them.
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. “I’m here to show you I care,” she said. “I’m here, I’m not trying to run away.” “I trusted you,” Bingala said. “I trusted you the first day we met in [my friend’s] shop; when [my friend] stood me in front [of you] and said: ‘This one is a midwife.’” 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 “misunderstanding in what my role was”.
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).
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’s Matriarch Rising festival, held on Saldaya’s 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 “embodied dance ritual”.
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’s investigation into FBS, although in one email Saldaya said: “Some of these allegations are false or defamatory.” On 22 November, the day the Guardian published its investigation into FBS, Saldaya posted a statement on Instagram criticising “propaganda on mainstream news”.
FBS appears to view Collins’s involvement in Chirwa’s 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. “Any 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,” she said.
