Free or unassisted birth (often referred to as ‘free birthing’) means a woman giving birth without medical or professional help. (‘Free birthing’ should not be confused with ‘natural childbirth’ or with a birth attended by a self-employed, often known as an independent midwife).
‘Free birthing’ is legal as long as the birth is not attended or the responsibility for care is not assumed or undertaken by an ‘unqualified individual’. An ‘unqualified individual’ is a person who is not a registered doctor or midwife but acts in that capacity during birth. The woman assumes full responsibility for her child’s birth, but she may and can have her partner, a relative or a friend present in a supportive role If a woman chooses not to contact or engage a midwife it is her right to do so.
Whilst acknowledging and supporting the right of any woman to decide to have a ‘free birth’, the NMC strongly recommends that before embarking on this course of action, a woman discusses the pros and cons of ‘free birthing’ with a suitably qualified person and gives serious consideration to any identified risks that may be associated with ‘free birthing’ and their personal, individual circumstances.
Attendance by unqualified persons at childbirth
The Nursing and Midwifery Order 2001, Part 9 Article 44 explains that it is illegal for an unqualified person to undertake the role of a registered midwife. Article 45 further explains that no person other than a registered midwife or a registered medical practitioner shall attend a woman in childbirth (assume responsibility) unless in an emergency or in supported recognised training.
An ‘unqualified’ person is an individual who gives medical or midwifery care but may not lawfully do so. This ‘unqualified’ person may include a non registered midwife, a doula (also sometimes known as a ‘labour coach’, a ‘doula’ is a non-medical person who assists a woman before, during and after childbirth by providing information, physical assistance and emotional support), a nurse, the woman’s partner, a relative or a friend who is not a registered midwife or registered doctor.
They 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. This is unlawful and may incur sanctions and a conviction. If you suspect an ‘unqualified person’ has acted illegally you should inform a supervisor of midwives, your employer or line manager for additional support immediately.
Notification of births
It is a legal requirement to notify all births and deaths in the UK. The duty of notifying a birth to the appropriate medical officer within 36 hours rests with the father or any other person present at the birth or within six hours of the birth. If a midwife is in attendance at a birth this is normally undertaken by the midwife. The relevant form can be obtained from the health authority.
Registration of births
The father or mother must give the Registrar of Births and Deaths, within 42 days (21 days in Scotland) of the birth, information about the birth. If the father or mother does not do this, it falls to any other person present at the birth, including the midwife.
If a woman decides to plan and implement a free birth event, she will assume full responsibility for the birth of her child and will decide not to call or be attended by a qualified person. The midwife must respect the woman’s choice to have an unassisted birth and if called prior to, during or after completion of the birth, the midwife should adhere to The code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008) and the Midwives rules and standards (NMC 2012).
If a midwife is called to attend for whatever reason and the birth has not occurred, any benefits, risks or concerns should be discussed with the woman and documented. It is possible that the woman and her family may or may not have previously engaged with maternity services and whilst this service should be offered the woman may choose to decline and her decision should be respected. Should you have any concerns in relation to the mother’s physical or psychological wellbeing, mental capacity or safety you should refer to the appropriate professional and inform your line manager and a supervisor of midwives.
If you are summoned during labour or birth, all remaining care should be performed, findings documented and emergency help requested if needed. Further care may include third stage and perineal management. If child protection or safeguarding concerns are an issue you must inform your employer, child protection lead and supervisor of midwives as per national and local policy.
This information was updated September 2013.
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