What drives women to have a ‘freebirth’ without a midwife or doctor? Here’s what the research says

A coronial inquest is this week examining the death of Melbourne wellness influencer Stacey Warnecke after a freebirth at her home in September.

About 25 minutes after her son, Axel, was born, Warnecke had a postpartum hemorrhage (severe blood loss after birth) and, without timely treatment, went into cardiac arrest.

The inquest is trying to determine why Warnecke decided to have a freebirth, in order to prevent similar deaths in the future. It heard Warnecke believed a freebirth was the only way to have a baby entirely on her terms.

But what does the research say about other women who seek a freebirth? My colleagues and I have been researching this question for the past decade. Here’s what we’ve found.

What is a freebirth and a birth keeper?

A freebirth is when a woman chooses to give birth, usually at home, without a registered health professional, such as a midwife or doctor, in attendance. This is different from a homebirth, where women are cared for by a registered midwife.

Freebirths are also referred to as unassisted or wild births.

Sometimes only the partner or a friend or relative is there, but more often women hire an unregulated birth worker such as a “birth keeper” or doula for support.

Unregulated birth workers don’t have the formal training, medical equipment or skills to detect and manage complications.

But our research has shown unregulated birth workers often provide care that is clinical, such as assessing the growth of the baby or listening to the baby’s heart during labor.

What are the risks of freebirth?

There are risks with freebirths that a trained midwife at a homebirth could identify early and manage, or that would prompt a timely transfer to a nearby hospital.

Home births with a registered midwife linked to a responsive health system have a good safety record in Australia.

Midwives now provide more than 20 publicly funded homebirth services linked to public hospitals across Australia as well. But most homebirths are with privately practicing midwives that families pay for out of pocket.

Even when a woman’s pregnancy and birth are considered low risk, emergencies can occur: postpartum hemorrhages, the newborn needing resuscitation, or the mother needing extra medical care.

These emergencies require specialized skills and equipment, and timely transfers to a hospital.

Rising popularity but little data about harms

We don’t know how the statistical risks of freebirths compare with homebirths that have a private registered midwife or are linked to a hospital, as these data aren’t collected.

However, the number of coronial findings and media reports of harms from freebirths over the past few years is a cause for concern.

In recent years, and particularly since the COVID-19 pandemic, social media influencers have set up communities of like-minded people to share content about freebirths. These messages have gained momentum and interest, while trust in institutions and experts has declined.

Why women might make this choice

Women who choose to freebirth are more likely to have had a baby before (77%), and to be white and well-educated.

Freebirths seem more common in regions with higher rates of homebirths, where communities seek a more natural approach to life.

A previous negative birth experience—which may result from a traumatic event, health provider abuse, coercion or care delivered without consent—is a major motivator for having a subsequent freebirth.

A previous negative birth experience may include an unwanted medical intervention such as a cesarean section, or a lack of choice, such as not being able to have a homebirth or a vaginal birth after cesarean in mainstream maternity care.

Some women who have a freebirth tried to make the process safer for themselves and their baby. They may have tried to find a midwife to see them at home but couldn’t afford the cost or were not able to access a homebirth because it was considered too risky.

Sometimes, a woman had a birth that went very well the first time or was very fast, which made a freebirth seem like a safe alternative.

It’s not that women who choose a freebirth are unaware of the risks. Women carefully consider the risk but often consider things such as unwanted intervention and birth trauma as a risk in itself that they find unacceptable.

The recent New South Wales Birth Trauma Inquiry received thousands of submissions from women who reported their traumatic experiences. We analyzed 1,213 of these publicly available submissions and found more than 75% of reported birth trauma was due to disrespect, abuse or health care provided without consent.

What can we do to reduce freebirths?

Our maternity system needs to give women choices and humanize the care it provides.

Sometimes health services unintentionally recreate conditions and memories of a previous traumatic experience or a past birth experience that prompt women to avoid this care in the future.

Health care providers need to be part of the solution, not part of the problem. Like any skill, they need training in informed consent and trauma-informed care.

A landmark Victorian judgment in March clarified the legal stakes of coercive maternity care. Plaintiff Larissa Gawthrop’s birth plan stated: “I decline all vaginal examinations unless there is an urgent medical reason to do so.”

When she arrived at Bendigo Health in labor, she was told she would not be admitted unless she agreed to a vaginal examination. After several hours, she relented. Bendigo Health was ordered to pay A$275,000 in damages becauspe consent was not given in a free, informed or voluntary way.

This judgment, alongside the 2024 NSW Birth Trauma Inquiry, represents a significant shift in how women’s autonomy and informed choice must be respected.

Addressing systemic changes and behaviors would then reduce the number of women choosing to freebirth.

High rates of birth intervention in Australia are also leading to more birth trauma and fear about birth.

Likewise, the lack of birth centers and the availability of homebirth without huge private fees need to be addressed to provide women with safe and acceptable options.

Who’s behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021.

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Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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This article is republished from The Conversation under a Creative Commons license. Read the original article.