An increasing number of women and birthing people in the UK are choosing to give birth outside NHS maternity services. These decisions reflect a complex interplay of personal values, past experiences, and systemic challenges within mainstream care. For professionals, this trend raises important questions about how to uphold safety, autonomy, and accountability in ways that are both lawful and respectful.
Supporting people who make these choices requires a nuanced understanding of their rights, a commitment to non-judgmental care, and a clear grasp of professional and legal responsibilities in diverse birth settings.
This month, we spoke with experienced midwife and Bond Solon trainer Eleanor Healer, author of Bond Solon’s new Freebirthing and Birth Outside the System courses, about how practitioners can navigate these complex areas of practice and uphold both human rights and professional standards.
1. Eleanor, could you start by explaining what is meant by ‘freebirth’ and ‘birthing outside the system’?
The terms are often used interchangeably, but they describe quite distinct situations.
- Freebirthing occurs when a woman or birthing person intentionally chooses to give birth without the attendance of a registered health professional, such as a midwife or doctor. It is a lawful choice in the UK when made by an informed, capacitous adult.
- Birthing outside the system, by contrast, usually describes situations where a woman or birthing person declines specific elements of NHS guidance, policy, or recommended interventions — for example, choosing to birth at home despite the national guidance. Professionals can legally uphold these choices, provided they are made with informed consent.
For practitioners, understanding the distinction matters. In both cases, the woman or birthing person’s right to bodily autonomy and informed decision-making is protected in law. In addition, it is the professional’s responsibility is to provide clear information, document carefully, and respect lawful choice while working safely within their own legal and professional frameworks.
2. Media coverage sometimes highlights tragic cases involving births that take place outside NHS settings. How can practitioners interpret these narratives in context?
Such stories can understandably create concern, but it’s vital to contextualise them. They rarely reflect the full picture as to what went wrong or the reasons behind a woman or birthing person’s choices.
Practitioners should remain grounded in evidence, uphold legal rights, and ensure their own practice remains transparent, lawful, and respectful.
3. What can practitioners do to provide safe, rights-based care when women or birthing people make choices outside NHS pathways?
Clear communication, contemporaneous documentation, reflective, non-judgemental practice and an understanding of the relevant law, professional guidance and local governance frameworks are central.
Crucially, practitioners must recognise that a woman or birthing person’s right to bodily autonomy is absolute: their body, their choice. Under the Human Rights Act (Articles 3 and 8), an adult with capacity has the legal right to accept or decline any aspect of care, and the interests of the fetus do not override the rights of the woman or birthing person.
Understanding this legal and ethical framework enables midwives, obstetricians and other practitioners to maintain safety and professional integrity while supporting autonomy.
4. Why did you develop these Bond Solon courses, and what can delegates expect to learn?
These courses were designed to equip practitioners with the legal literacy, confidence and ethical reasoning needed when women and birthing people choose care that falls outside standard NHS provision. They explore relevant case law, human rights principles, and professional accountability — all within a supportive, practical learning environment.
The purpose of these courses is to support professionals in navigating more complex births that may feel outside their usual remit or comfort zone, helping to build confidence in providing safe, individualised maternity care.
5. What are the main benefits for practitioners who attend?
The core benefits of attending these courses include gaining:
- A clearer understanding of how to balance professional duty with the rights of women and birthing people.
- Improved confidence in complex decision-making.
- Tools to navigate real-world challenges safely and lawfully.
The aim is to move away from fear-based reactions toward an informed, compassionate, and legally robust practice.
Bond Solon’s one-day Freebirthing – Legal, Ethical and Professional Considerations and Birth Outside the System – Law, Choice and Professional Duties courses are designed for midwives, obstetricians, maternity professionals, Directors and Heads of Midwifery, birth workers and doulas.
They explore the legal and professional responsibilities when a birth takes place without a registered health professional present. The focus is on reducing risks to both families and practitioners, while reducing fear of supporting free choice and alternative birthing options.
Both courses are available as in-house (virtually or face-to-face) and public courses. The next public course dates are xxx
Please call 020 7549 2549 or email info@bondsolon.com to book onto the next available public course or discuss or book an in-house course.