Introduction
Freebirth refers to when a woman or birthing person chooses to give birth at home or elsewhere without the assistance of a healthcare professional. Freebirth is also commonly called unassisted birth. It does not refer to giving birth at home before the planned arrival of a healthcare professional, perhaps because of a precipitous or fast birth, commonly known as a BBA (Born Before Arrival).
Statistics for planned freebirths or births unintentionally occurring without a healthcare professional are not currently available in the UK, as they have not been collected by the NHS.
The parents who are choosing freebirth may do so because they have made a positive choice to do so or may not feel supported and respected in the obstetric or midwifery care options available to them locally.
While supporting a parents right to autonomy over place of birth, medical and midwifery organisations generally consider freebirth to be a risky practice for mother or birthing parent and their baby. However, freebirth is a perfectly legal in the UK. Women and birthing people are not obliged to accept any medical or midwifery care or treatment during childbirth and cannot be compelled to accept care unless they lack mental capacity.
Being present at a planned freebirth is also not illegal. However, in the UK, Article 45 of the Nursing and Midwifery Order (see reference) makes it a criminal offence for anyone other than a registered midwife or doctor to ‘attend’ during childbirth, except in an emergency. This is not intended to prevent birth partners and doulas from supporting parents, but they must ensure that they do not assume the role of a midwife by performing clinical or midwifery functions, such as monitoring the progress of labour. The Nursing and Midwifery Council has produced guidance on this issue which states that birth partners, including doulas and family members, ‘may be present during childbirth but must not assume responsibility, assist or assume the role of the medical practitioner or registered midwife or give midwifery or medical care in childbirth’.
Doula UK registered doulas support the maternal right to autonomy and freedom of choice. DUK doulas recognise that a parents choices are valid and that they assume responsibility for their birth, parenting style or feeding method that they feel is right for them and their baby. DUK doulas offer practical and emotional support, but not advice, to the mother and/or parents, empowering them in their own choices. They may signpost clients to non-judgmental, knowledge-based information and resources to enable clients to make the informed choices that are right for them. Any type of medical or clinical assistance is contrary to the Code of Conduct agreed upon by Doula UK registered doulas.
Doula UK recommendations
Doula UK (DUK) does not take a stand or position on freebirth. However DUK Doulas are strongly encouraged to address the multifaceted considerations of attending a planned freebirth.
Will I be expected to perform any tasks contrary to the DUK Code of Conduct (1), such as monitoring the progress of labour, checking heart rates, etc?
Do I understand the legalities surrounding freebirth, including a midwife’s responsibility under their NMC Code (2)?
Could I be perceived to have taken the role of a midwife at the birth? I.e. contravened Article 45 of the Nursing and Midwifery Order(3) perhaps by a medical care provider, a social worker, a member of the family, or a law enforcement officer?
In the event of a bad outcome, could someone – the immediate family, their extended family, or a medical care provider – consider that I may have been responsible? This may be the case even if you weren’t perceived to have taken the role of a midwife, perhaps because you were perceived as having ‘persuaded’ the mother to choose freebirth?
Doula UK doulas should not promote or be seen to be promoting one choice over another, including the choice to freebirth, but should instead be supporting the mother or parents choices.
Am I prepared to deal with any potential consequences of such a claim, whether or not warranted?
Do I have, or want, the ability to pay for, or claim for, legal assistance with such a claim? Whilst Doula UK is able to give emotional support to members, it is unable to provide legal protection.
In the event of an emergency situation, or a bad outcome, occurring, would I regret my decision to be present at a planned freebirth?
Doula members needing support can turn to their mentor or to the Doula Support Network.
References and related documents:
Doula UK Code of Conduct
AIMS position paper on Freebirth and Birth Information Page
Royal College of Midwives (RCM) Guidance on Freebirth or Unassisted Childbirth
BirthRights : Unassisted Birth: The Legal Position
