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Scoping review suggests that reasons for choosing unassisted birth (‘freebirth’) vary depending on income, previous negative health care experiences and personal and cultural beliefs
  1. Mickey Sperlich
  1. School of Social Work, University at Buffalo, Buffalo, New York, USA
  1. Correspondence to Dr Mickey Sperlich, University at Buffalo, Buffalo, New York, USA; msperlic{at}

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Commentary on: Shorey S, Jarašiūnaitė-Fedosejeva G, Akik BK, Holopainen A, Isbir GG, Chua JS, Wayt C, Downe S, Lalor J. Trends and motivations for freebirth: A scoping review. Birth. 2023 Mar;50(1):16-31. doi: 10.1111/birt.12702. Epub 2023 Jan 4.Commentary

Implications for practice and research

Providing maternity care that is trauma informed, respectful, supportive and promotes patient autonomy, agency and cultural beliefs may encourage lower rates of freebirth.

More research is needed to articulate motivations for freebirth among diverse populations and translate trauma informed and respectful maternity care principles across systems and service providers.


Unassisted childbirth (outside a hospital facility with no professional attendant) is common in low-income and middle-income countries (LMICs), where barriers to access and poverty delimit engagement in maternity healthcare services. However, even in high-income countries (HICs) where maternity healthcare services are more attainable, a small percentage of birthing people are choosing unassisted birth, a phenomenon known as ‘freebirth’. This …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.