Eroding Rights, Trust, and Safety in Maternity

Legislating against maternity care decisions does not protect women;

rather, it compounds trauma and deters timely care seeking.

While the goal of protecting vulnerable, often traumatised women from exploitation by rogue and unscrupulous persons is commendable, the joint call by RANZCOG and ACM to implement “Restricted Birthing Practices” law across Australia, raises serious concerns about human rights, reliable evidence, and unintended consequences; most especially for women who choose to freebirth, their chosen support people, and trained doulas working within their scope of practice while failing to address deeper systemic issues in maternity care.

We acknowledge the proposed legislation’s aim to safeguard maternal and neonatal outcomes. However, emerging evidence and lived experience suggest it may have the opposite effect, particularly for women who feel excluded from mainstream care and turn to freebirth as a last resort ^1-4. Criminalising women’s care decisions risks compounding trauma and deterring emergency care access; without evidence that such laws improve outcomes⁵.

The proposed legislation effectively criminalises a woman’s decision to birth without a registered professional, even in private settings. This represents a profound intrusion into bodily autonomy and reproductive rights. It sets a dangerous precedent: that the state can override women’s decisions about their own body during one of life’s most intimate and vulnerable experiences. Respect for autonomy is not conditional on compliance with medical norms^6-8.

Too often, if a tragic event occurs during a birth at home, it is automatically deemed preventable. If the same event occurs under professional care, it is seen as inevitable. We must acknowledge that stillbirths and other adverse outcomes also happen in hospitals—they just rarely make headlines⁵. While such tragedies must never be dismissed, the evidence does not support blanket criminalisation as an effective or proportionate response³.

Evidence shows that people who freebirth are not naïve to risks of childbirth but rather assess that birthing in the hospital system is riskier than birthing outside of the medical system⁴. These concerns point to a deeper truth: true safety is built not on legislation, but on trust, respect, and access to high-quality, culturally safe care^7-10.

The proposed legislation creates a legal grey zone: support persons may be scrutinised or blamed if present at adverse outcomes, even when not acting in a clinical capacity. It risks prohibiting family members or traditional birth attendants or doulas, from offering support during labour or birth⁵.

There is no robust evidence that South Australia’s law has improved maternal or neonatal outcomes. The lack of transparency of its impact raises further questions. Before advocating for national replication, professional bodies must demonstrate that such legislation achieves its stated goals without causing harm^3-5.

Medicalised maternity care continues to pathologise pregnancy, most especially for healthy women, despite robust evidence that pregnancy and birth are normal physiological processes for most¹¹. When medical care is applied appropriately, it is life-saving and transformative. But when applied universally, it can cause harm and violate the core medical principle: first, do no harm^12-14-15.

Research consistently shows that women who choose to freebirth often do so not out of disregard for safety, but after experiencing trauma, coercion, disrespect, or lack of access to culturally appropriate care^1-4-6-8.  Studies from Australia, the UK, Denmark, and Sweden reveal that freebirth is often a response to systemic failures, not personal recklessness^1-4-6-8. Criminalising these decisions risks deepening mistrust and disengagement^7-9-13. Advocacy experts and researchers urge a shift toward collaborative, rights-based solutions that centre lived experience and expand access to culturally safe, evidence-informed care^3-7-8-14-15.

This proposal risks entrenching a punitive, one-size-fits-all model that reinforces medical gatekeeping rather than addressing the underlying drivers of freebirth. Women are often pushed toward birth options with little or no clinical support due to systemic issues such as limited access to midwifery continuity of care, unaffordable or under-resourced home birth services, coercive clinical practices, and culturally insensitive care.^5-7-8.

Unless we address the systemic disrespect and lack of relationship-based care in maternity services, freebirth will persist. Medicalisation, silencing of women’s voices, and the lack of respectful care all contribute to the persistence of freebirth^1-4-6-8.

We urge health ministers, RANZCOG, and ACM to engage meaningfully with those who have chosen or considered freebirth, including First Nations women and people with lived experience of trauma in the system^7-8-13.

We call for:

• Transparent evaluation of the legislation’s impact on freebirth rates and outcomes^3-5
• Expanded access to continuity-of-midwifery-care services and publicly funded homebirth^7-8.
• Development of a Woman-Centred Maternity Care Standard, co-designed with consumers and embedded in the National Safety and Quality Healthcare Standards framework.
• Commitment to respectful maternity care—care that upholds autonomy, dignity, and informed decision-making, based on the human rights principles of dignity, the right to health, and the right to be free from harm and mistreatment¹¹.

Balancing safety with rights and trust remains the central challenge. In 2005, the World Health Organization urged health practitioners not to ask:

“Why don’t women accept the service that we offer?”

but instead to ask,

“Why don’t we offer a service that women will accept?”^10.

This question remains as relevant today as ever.

Let us co-design solutions that expand access to respectful, evidence-based care rather than narrowing choices through legislation.

References:

1. Andersen, C. B., & Johansen, M. (2022). Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women’s motivations and preparations for freebirth. Women and Birth, 35(6), 573–580. https://doi.org/10.1016/j.wombi.2021.09.005
2. Feeley, C., & Thomson, G. (2020). Why do some women choose to freebirth in the UK? An interpretative phenomenological study. BMC Pregnancy and Childbirth, 20, 171. https://doi.org/10.1186/s12884-020-02862-2
3. Hazard, Bashi. (2025), How to criminalise birth podcast, Pregnancy, Birth and Beyond Media, https://www.spreaker.com/episode/how-to-criminalise-birth-with-bashi-kumar-hazard–68410484?utm_campaign=&utm_medium=email&utm_source=newsletter
4. Jackson, M., Dahlen, H., & Schmied, V. (2020). Birthing outside the system: The motivation behind the choice to freebirth or have a high-risk homebirth in Australia. BMC Pregnancy and Childbirth, 20, 490. https://doi.org/10.1186/s12884-020-03129-6
5. King, C., & Burns, A. (2025, June 14). Homebirth, freebirth and doulas: Casualty and consequences of a broken maternity system. ABC News. https://www.abc.net.au/news/2025-06-14/freebirth-stories-movement-called-out-for-cult-behaviour/104724512
6. Lindgren, H., & Erlandsson, K. (2010). Women’s experiences of non-institutional births in Sweden: A qualitative study. Sexual & Reproductive Healthcare, 1(3), 61–66.
7. McKenzie, Gemma (2024), Freebirth, risk and the spectre of obstetric violence, The Conversation, https://theconversation.com/freebirth-risk-and-the-spectre-of-obstetric-violence-223916
8. Shaw, R. (2020). Freebirthing: A meta-narrative review examining the birth choices of women who choose to birth without medical assistance. Medical Humanities, 46(3), 367–377. https://doi.org/10.1136/medhum-2019-011751
9. The Conversation. (2024, March 14). Freebirth, risk and the spectre of obstetric violence. https://theconversation.com/freebirth-risk-and-the-spectre-of-obstetric-violence-223916
10. The World Health Report 2005: make every mother and child count. World Health Organisation Geneva. https://scholar.google.com/scholar?q=WHO.+The+World+Health+Report+2005%3A+make+every+mother+and+child+count.+World+Health+Organisation+Geneva%3B+2005
11. World Health Organization; (2025), Compendium on respectful maternal & newborn care. Geneva, https://www.who.int/publications/i/item/9789240110939
12. Wickham, S. (2020). In Your Own Time: How Western Medicine Controls the Start of Labour and Why This Needs to Stop. https://www.sarawickham.com/time/
13. Wynter, V, (2023), Growing freebirth trend due to broken maternity system, The Pineapple, https://thepineapple.net.au/2023/07/11/growing-free-birth-trend-due-to-broken-maternity-system/
14. NSW Select Committee on Birth Trauma, Birth Trauma Report, 2024, Sydney, https://www.parliament.nsw.gov.au/lcdocs/inquiries/2965/FINAL%20Birth%20Trauma%20Report%20-%2029%20April%202024.pdf
15. Keedle H, Lockwood R, Keedle W, et al; What women want if they were to have another baby: the Australian Birth Experience Study (BESt) cross-sectional national survey; BMJ Open 2023;13:, doi: 10.1136/bmjopen-2023-071582; https://bmjopen.bmj.com/content/13/9/e071582