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Women’s Motivations for “Choosing” Unassisted Childbirth: A Compromise of Ideals and Structural Barriers

Reproduction, Health, and Medicine

ISBN: 978-1-78756-172-4, eISBN: 978-1-78756-171-7

Publication date: 22 November 2019


Unassisted childbirth, also known as “freebirth,” is when a person intentionally gives birth at home with no professional birth attendant. The limited research on unassisted birth in the United States focuses on women’s reasons for making this choice. Studies suggest women are committed to birthing without a professional and that this choice is rooted in religious or natural-family belief systems. These studies do not adequately account for the ways a framework of “choice” obscures the role structural barriers play in decision-making processes. International research on unassisted childbirth finds that it is not always a first choice and may be a last resort for women who have had negative experiences with maternity care. More research on unassisted birth in the United States is needed to better understand if people face similar structural barriers. In this paper I examine how structural limitations of the US healthcare system intersect with values in decision-making processes about childbirth. Drawing on in-depth interviews with nine women who gave birth unassisted in the United States, I examine the women’s shared ideological commitments, negative experiences with health care, and barriers faced seeking care. I discovered that unassisted birth may not be a first, or even positive choice, but rather a compromise informed by ideological commitments and constrained choices. Structural barriers in the US healthcare system prevented women from having a professional birth attendant who they felt was acceptable, available, and accessible. I conclude by discussing the implications of these findings for debates about birth justice and health policy.




Thank you to the women who generously shared their personal stories with me. This paper was greatly improved with the helpful comments from an anonymous reviewer, Susan Markens and Miranda Waggoner.


Diamond-Brown, L.A. (2019), "Women’s Motivations for “Choosing” Unassisted Childbirth: A Compromise of Ideals and Structural Barriers", Reproduction, Health, and Medicine (Advances in Medical Sociology, Vol. 20), Emerald Publishing Limited, Leeds, pp. 85-106.



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