EBB 410 – Evidence and Controversy Surrounding Freebirth

1. Birthplace in England Collaborative Group (BECG). (2011). “Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.” BMJ 343: d7400. https://pubmed.ncbi.nlm.nih.gov/22117057/
2. Biesele, M. (1997). “An Ideal of Unassisted Birth: Hunting, Healing, and Transformation among the Kalahari Ju/’hoansi.” In Childbirth and Authoritative Knowledge. Cross-Cultural Perspectives. Davis-Floyd, R. & C.F. Sargent (eds), Childbirth and Authoritative Knowledge. Cross-Cultural Perspectives, Berkeley: University of California Press, pp. 474-92.
3. Bjellmo, S. & Iversen, J. K. (2025). “Unassisted home births in Norway: A growing concern.” Acta Obstet Gynecol Scand 104(8): 1418-1419. https://pubmed.ncbi.nlm.nih.gov/40536244/
4. Boodman, S. G. (2007). “Do-it-yourself Delivery.” The Washington Post. July 31. https://www.washingtonpost.com/wp-dyn/content/article/2007/07/27/AR2007072702164.html
5. Bovbjerg, M. L., Cheyney, M., Hoehn-Velasco, L., et al. (2024). “Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals.” Med Care 62(12): 820-829. https://pubmed.ncbi.nlm.nih.gov/39514513/
6. Boushra, M., Stone, A., & Rathbun, K. M. (2023). “Umbilical Cord Prolapse.” In StatPearls. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542241/
7. Brandt, J. S. & Ananth, C. V. (2023). “Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management.” Am J Obstet Gynecol 228(5S): S1313-S1329. https://pmc.ncbi.nlm.nih.gov/articles/PMC10176440/
8. Carlson, K. & Vadakekut, E. S. (2026). “Amniotic Fluid Embolism.” In StatPearls. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559107/
9. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Natality on CDC WONDER Online Database. (2026). Data are from the Natality Records 2016-2024, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/natality-expanded-current.html on Jul 29, 2026.
10. Cheyney, M., Bovbjerg, M., Everson, C., et al. (2014). “Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009.” J Midwifery Womens Health 59(1): 17-27. https://pubmed.ncbi.nlm.nih.gov/24479690/
11. Dahlen, H., Kumar-Hazard, B., & Schmied, V. (2020). Birthing Outside the System: The Canary in the Coal Mine. Edited Volume. London: Routledge.
12. Dahlen, H. G., Jackson, M., & Stevens, J. (2011). “Homebirth, freebirth and doulas: casualty and consequences of a broken maternity system.” Women Birth 24(1): 47-50. https://pubmed.ncbi.nlm.nih.gov/21163719/
13. Davey, M. (2026). “Stacey Warnecke died after choosing a birth free of all medical help. An inquest wants to know why.” The Guardian. June 19. https://www.theguardian.com/australia-news/2026/jun/20/stacey-warnecke-melbourne-influencer-died-freebirth-inquest-ntwnfb
14. Davis-Floyd, R. & Cheyney, M. (2019). Birth in Eight Cultures. Edited Volume. Waveland Press.
15. Einerson, B. D., Gilner, J. B., & Zuckerwise, L. C. (2023). “Placenta Accreta Spectrum.” Obstet Gynecol 142(1): 31-50.https://pmc.ncbi.nlm.nih.gov/articles/PMC10491415/
16. Feeley, C. & Thomson, G. (2016). “Tensions and conflicts in ‘choice’: Womens’ experiences of freebirthing in the UK.” Midwifery 41: 16-21. https://pubmed.ncbi.nlm.nih.gov/27498184/
17. Feeley, C. & Thomson, G. (2016). “Why do some women choose to freebirth in the UK? An interpretative phenomenological study.” BMC Pregnancy Childbirth 16: 59. https://pubmed.ncbi.nlm.nih.gov/27000100/
18. Greenfield, M., Payne-Gifford, S., McKenzie, G. (2021). “Between a Rock and a Hard Place: Considering “Freebirth” During Covid-19.” Front Glob Womens Health 2: 603744. https://pubmed.ncbi.nlm.nih.gov/34816178/
19. Hutton, E. K., Cappelletti, A., Reitsma, A. H., et al. (2016). “Outcomes associated with planned place of birth among women with low-risk pregnancies.” CMAJ 188(5): E80-E90. https://pubmed.ncbi.nlm.nih.gov/26696622/
20. Iceland Monitor. (2024). “How do you know this woman had this child.” Iceland Monitor. May 9. https://icelandmonitor.mbl.is/news/news/2024/05/09/how_do_you_know_this_woman_had_this_child/
21. Johansson, M., Jansson, O., Lilja, F., et al. (2023). “Freebirth, the only option for women who do not fit into common practice- A Swedish national interview study.” Sex Reprod Healthc 37: 100866. https://pubmed.ncbi.nlm.nih.gov/37295181/
22. Johnston, K. & MacDougall, C. (2026). “Toward Conceptual Clarity: Out-of-Hospital Birth Practices and Freebirth Entrepreneurialism.” Atlantis: Critical Studies in Gender, Culture, & Social Justice. 47(1): 44–57. https://atlantisjournal.ca/atlantis/en/article/view/5920
23. Kale, S. & Osborne, L. (2025). “Influencers made millions pushing ‘wild’ births – now the Free Birth Society is linked to baby deaths around the world.” The Guardian. November 22. https://www.theguardian.com/world/ng-interactive/2025/nov/22/free-birth-society-linked-to-babies-deaths-investigation
24. Kale, S. & Davey, M. (2026). “A US champion of ‘freebirthing’ always claimed there had been no maternal deaths linked to the movement. Is Stacey Warnecke the first?” The Guardian. June 29. https://www.theguardian.com/world/2026/jun/30/freebirth-wellness-influencer-stacey-warnecke-death-ntwnfb
25. Lou, S., Dahlen, H. G., Gefke Hansen, S., et al. (2022). “Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women’s motivations and preparations for freebirth.” Sex Reprod Healthc 34: 100789. https://pubmed.ncbi.nlm.nih.gov/36332498/
26. Mackeen, D. (2026). “She wanted a `free birth.’ It put her and her baby in grave danger.” The New York Times. April 22. https://www.nytimes.com/2026/04/22/science/free-birth-wild-pregancy-risks-home-birth.html
27. McKenzie, G., Robert, G., & Montgomery, E. (2020). “Exploring the conceptualisation and study of freebirthing as a historical and social phenomenon: a meta-narrative review of diverse research traditions.” Med Humanit 46(4): 512-524. https://pubmed.ncbi.nlm.nih.gov/32361690/
28. Miller, J. F. (2020). “Solitary and Kin-Assisted Rarámuri Birth: Ideals and realities.” In Birthing Models on the Human Rights Frontier. Daviss, B. & Davis-Floyd, R., eds. Routledge: London.
29. Payne, E. (2025). “Officials ‘strongly advise’ against freebirths after cluster of stillbirths in Ontario.” Ottawa Citizen. January 15. https://ottawacitizen.com/news/local-news/officials-advise-against-freebirths-after-stillbirths-ontario
30. Pillai, S., Cheyney, M., Everson, C. L., et al. (2020). “Fetal macrosomia in home and birth center births in the United States: Maternal, fetal, and newborn outcomes.” Birth 47(4):409-417. https://pmc.ncbi.nlm.nih.gov/articles/PMC8923081/
31. Rosenberg, K. & Trevathan, W. (1995). ” Bipedalism and human birth: The obstetrical dilemma revisited.” Evolutionary Anthropology 4(5): 161-168. https://doi.org/10.1002/evan.1360040506Sargent, C. (1982).
32. “The Implications of Role Expectations for Birth Assistance among Bariba.” Soc Sci Med 16(16): 1483-1489. https://pubmed.ncbi.nlm.nih.gov/7135022/
33. Shorey, S., Jarašiūnaitė-Fedosejeva, G., Akik, B. K., et al. (2023). “Trends and motivations for freebirth: A scoping review.” Birth 50(1): 16-31. https://pubmed.ncbi.nlm.nih.gov/36598288/
34. Shostak, M. (1981). Nisa: The Life and Words of a !Kung Woman. Cambridge: Harvard University Press.
35. Snowden, J. M., Tilden, E. L., Snyder, J., et al. (2015). “Planned Out-of-Hospital Birth and Birth Outcomes.” N Engl J Med 373(27): 2642-2653. https://pubmed.ncbi.nlm.nih.gov/26716916/
36. Sperlich, M. & Gabriel, C. (2022). “”I got to catch my own baby”: a qualitative study of out of hospital birth.” Reprod Health 19(1): 43. https://pubmed.ncbi.nlm.nih.gov/35164785/
37. Togioka, B. M. & Tonismae, T. (2023). “Uterine Rupture.” In StatPearls. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559209/
38. Uda, E. (2026). “Facing rural realities and mistrust in hospitals, these women turned to home births.” CBC Radio. April 26. https://www.cbc.ca/radio/thecurrent/freebirthing-rural-maternal-medicine-9.7172199

For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker’s book, “Babies Are Not Pizzas: They’re Born, Not Delivered!” If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Dr. Rebecca Dekker – 00:00:00:
Hi, everyone. On today’s podcast, we’re going to talk about the controversies and evidence surrounding the topic of freebirth. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi, everyone, and welcome to today’s episode of the Evidence Based Birth® Podcast.

In today’s episode, Dr. Sara Ailshire and I from EBB are going to talk about the evidence and some of the controversial issues surrounding freebirth. Freebirth, sometimes called unassisted birth, refers to the decision to plan to give birth outside of a hospital without having a midwife or doctor present. This is a topic that has gotten a lot of attention in the last year. It was featured as a storyline on HBO’s The Pitt, and it was the subject of an award-winning podcast series by The Guardian newspaper titled The Birth Keepers. Freebirth can be challenging to talk about for a few reasons. The motivations someone might choose to freebirth can vary widely. This topic is under-researched and under-documented. There’s no concrete information available about how many freebirths happen each year around the world or in different countries. And the people who choose this option might be unwilling to disclose information to researchers or to report their birth to the government accurately or at all over concerns about criminal, legal, or social consequences for choosing this approach. Discussing freebirth is not an endorsement, but instead, as researchers, we wanted to use this opportunity to leave you feeling like you have a better understanding of what freebirth is, why rarely some people might choose this option, and what the issues can be with this approach to childbirth. We will also talk about the controversies and deaths that happened in relation to the organization known as the Free Birth Society, and what lessons our community can learn from these tragic deaths.

In our show notes today, we will include a short bibliography of the resources we used to prepare for our conversation today, including articles we referenced specifically, as well as those that we reviewed to help us understand better this topic, even if we’re not ultimately citing each study specifically. Freebirth, as we all know, can be controversial and sensational, and we want to emphasize that knowledge and research and informed consent are usually none of these things. They’re not usually controversial or sensational. Most of the resources we’re going to reference are not behind a paywall, so if this topic interests you or brings up strong emotions or you’re just really curious about it, we’d encourage you to check out the work of researchers who are building knowledge on this topic. As a heads up, in this podcast, we will be talking about stillbirth, maternal death, newborn death, and serious complications related to planned unassisted childbirth. So, Sara, are you ready to get started?

Dr. Sara Ailshire – 00:03:15:
I am.

Dr. Rebecca Dekker – 00:03:16:
So, can you start off by talking with us about what is freebirth?

Dr. Sara Ailshire – 00:03:20:
Sure. So, freebirth or a planned unassisted childbirth refers to when people plan to give birth outside of a hospital setting, usually at home, without any medical attendant, midwife, trained birth attendant present. In this podcast, we’re going to be talking about people who have the real option to go to a hospital or go to a birth center, to have a trained medical provider midwife present, but they’re specifically choosing to forego having a qualified attendant at their birth. We’re not going to be talking about people who have no choice, such as those who live in countries or in places where there’s no hospital or birth center they can go to. Or about people who accidentally give birth without a qualified attendant at home or sometimes in their car because the baby came too fast. So sometimes unintentional, unattended births happen and that’s not what we’re talking about here today. A lot of practices actually can fall under the label of freebirth. So this can be a birth with nobody present, you know, a person who chooses to give birth at home totally solo. This could be a birth at home with only immediate family present. So a spouse, other children, maybe siblings, a parent. This can be birth at home with a lay or traditional midwife present. And just to be clear, this would refer to people who might have apprentices a midwife, who might have taken some type of training, but they’re not certified midwives, certified practicing midwives, nurse midwives, etc. They don’t have a license, a midwifery license. And this could also be birth at home while in phone or text contact with a lay midwife, traditional midwife or doula. So there’s a lot of situations in which somebody might choose their freebirth, which can make it hard to talk about this topic.

Access to home birth midwifery has also changed a lot over the past 30 years. Approximately 1 to 1.5% of all births in the United States happen at home. And the vast majority of these are happening with midwife present. In some states, midwives don’t have a pathway to licensure. That can also be an issue. There are people who could be and they might actually be licensed in other states as a health care professional. But if they’re working in a state without a pathway for passing midwifery at home or without a midwifery licensure pathway, then they might be considered a lay midwife. That can also kind of muddy the waters when you’re talking about this topic. So another thing to note is that freebirth and home birth…they usually are both occurring at home, but they’re not the same thing. The statistical outcomes are also probably likely different, but we don’t know exactly what those differences are. And that’s because freebirth isn’t well documented. The articles or headlines that say, home birth ends in disaster. But if you read the article, you’ll find out that it was actually a freebirth and not a more common home birth.

Dr. Rebecca Dekker – 00:06:12:
Yeah, I remember this happened with the maternal death of a popular natural influencer and nutritionist. Her name was Stephanie Warnecke, and she freebirthed in Australia in the year 2025. She was planning a freebirth at home with her husband and a quote unquote birth keeper who was named Emily Lal. This birth keeper was not practicing as a doula or midwife, but had trained through an organization known as the Free Birth Society, which we’re going to talk about later on. But I wanted to mention her up front because this particular situation, this tragic death, was what put freebirth on the map for a lot of people who are not in the birth world. And that’s usually when freebirth makes the news is when there is a tragedy. And yet freebirth is often confused with home birth. Many of the news headlines said Stephanie’s death was a result of a home birth, when more specifically, it was a result of a freebirth. So freebirth can sometimes have negative connotations for home birth for people who are planning to birth at home with a certified licensed attendant. Sara, when preparing for freebirth, I know you’ve talked about there’s a variety of situations someone might birth at home totally alone, with just family, with a doula, et cetera. But there’s also a variety of attitudes about prenatal care. So, can you talk a little bit about the different paths that prenatal care might happen with a freebirth, a planned freebirth?

Dr. Sara Ailshire – 00:07:41:
So, some people who freebirth receive prenatal care in a typical office setting from a midwife or OBGYN, and they don’t disclose that they plan to have a freebirth at home. Some people might consider this to be a sort of deception. They’re using deception to get prenatal care in a clinic. The provider thinks that they’re going to give birth in a hospital or at a birth center, all while the client is actually preparing and intending to give birth at home unassisted. And they might decide to go to a hospital after the birth for routine newborn procedures to register the birth and potentially receive postpartum monitoring. However, a person who’s doing this might not consider this to be deception. And I think it’s also important to note a person who’s interested in freebirth, but wants to receive sort of standard prenatal care might view this as doing what they have to do to pursue the birth they want, they might feel like there’s no other option. And anecdotally, we have come across birth stories from freebirthing parents who describe working with a home birth midwife and eventually choosing not to call the midwife to attend their birth. Again, they might say, oh, like, baby just came too fast. I didn’t know. You know, depending on where you sit, it could feel like, oh, I was lied to.

Meanwhile, the person doing this might feel like I have to do this in order to pursue the type of birth I might have. Some people may choose to receive a few types of prenatal care, like a dating ultrasound or gestational diabetes testing, but they might otherwise decline all other forms of prenatal monitoring or testing. They may or may not share their plans of freebirth with a clinic or the midwife with whom they do these prenatal visits. Some people will choose just to go to a boutique ultrasound studio for an ultrasound, either to confirm the pregnancy or to do a sort of DIY anatomy scan around the 20th week, but will otherwise receive no other prenatal care or monitoring at all before their freebirth. And some people will choose to decline absolutely all forms of prenatal testing and monitoring before their freebirth. This has come to be known as having a wild pregnancy, though not everybody who chooses to decline all forms of prenatal care will use this terminology. And if you happen to have watched the second season of The Pit, the HBO medical drama series, you might recall in the last episode of season two that they featured a storyline about a person in labor who presented to the ER with symptoms of preeclampsia who had had a wild pregnancy. She had received no prenatal care until presenting at the hospital for a headache that would just not go away.

Dr. Rebecca Dekker – 00:10:10:
And that episode was what brought a lot of people also to learn about this subject.

Dr. Sara Ailshire – 00:10:15:
Yeah, it seems like it’s been in the news a lot in the past year or so. So, you know, with all the attention that, you know, this topic has garnered, Rebecca, what do we actually know about how common freebirth is?

Dr. Rebecca Dekker – 00:10:30:
That is a really good question. And we tried really hard to find the answer. And the short answer is there is no answer. But we did attempt to find a rough estimate of how many people might pursue a freebirth each year. So looking at the US, we used the CDC Wonder Statistics Program. We queried the number of intended home births between 2016 and 2024, where there was either a non-medical attendance that could be like your spouse, or the attendant was unknown or not stated on the birth records. And over that eight-year period, only 7,804 births in the whole country met those criteria. And that’s a pretty small number. And it could be those people were planning to have an attendant there, but perhaps the attendant didn’t make it in time. So it’s not an exact number by any means. And we also don’t know if those people who had those unattended births would consider themselves to be freebirthers. Sometimes people who choose freebirth will not disclose that they were planning a freebirth. It’s kind of their own private knowledge that they choose not to share with anyone. They might say that they went into labor too fast to get to the hospital. And then they would be counted as having an unplanned or unintentional home birth in the official birth records. You might also have someone who planned a home birth and they have a midwife who was not licensed to practice in their state, and they might record it as a non-medical attendant or leave the midwife off the birth records because they don’t want people to know a midwife was there. That 7,804 over eight years was a really rough estimate, but it kind of gives us a sense, you know, when we have millions of births happening every year in the United States, that this is pretty rare, pretty uncommon.

So then we looked at other countries because it’s not just in the US. That this is making the news. You know, Australia, England, Ireland, Scandinavian countries are all having news articles about this. In Norway, they recorded 20 freebirths between the years 2020 and 2023. And then in the year 2024, there were 21 freebirths recorded. So in one year, they had as many as they had had in the previous four years. In Iceland, there were only six freebirths recorded in the year 2023. And there were three recorded in 2024 by news reporters in Iceland. Otherwise, there is very little data on the number of freebirths that we could find recorded in official records in countries like Canada, United Kingdom, Australia, etc. Usually what happens is freebirths are lumped in with accidental or unintended home births or other out-of-hospital births. Also in the US, each state has different timelines and methods for when a birth needs to be reported. And sometimes it can be difficult for people to get their birth registered if they didn’t have an attendant with them. And so we just have a lot of difficulty with finding these freebirths on these birth records. However, although it seems pretty rare, it gets a lot of attention when things go wrong. And we’re going to talk about this in a little bit. But there’s a lot of reasons why things might go wrong at a freebirth. Also, doulas and midwives who are seen as experts in unmedicated birth, you might be more likely to be approached. By a parent who is thinking about having a freebirth. So it might seem more common to those of you listening who are birth workers. You might have run into people who are planning a freebirth or who had one. So we’ve talked about what freebirth is, how common it is, which it’s pretty uncommon. Sara, can you share a little bit about like historically where this concept of freebirth comes from? It’s been getting a lot of attention, but it’s not necessarily a new phenomenon, correct?

Dr. Sara Ailshire – 00:14:27:
Yeah. So freebirth, as we know it, and it’s, you know, the sense that we’re talking about today, it emerges from the natural childbirth movement that gets its start in the mid 20th century. I’m just going to go ahead and plug McKenzie et al, 2020. They’re in our references. Their article is really helpful for doing the research on this part. Some researchers have identified writings about intentionally freebirthing as early as the 1950s, again, in connection to that natural birth, natural childbirth movement. The term freebirth is attributed to a person named Parvati Baker. She’s passed away, but she was a yoga practitioner, a lay midwife, sort of a spiritual new age thinker and writer on natural and alternative childbirth methods and beliefs. She’s also believed to have coined the term birth keeper when referring to somebody who is not a, you know, trained midwife, but who supports people in freebirth. So an interest in freebirth has been present in natural and alternative birthing spaces fairly consistently, but at a low level since the 1970s. And with the advent of social media, awareness of, and I would say even before that, blogs, awareness of freebirth has increased because people are more able to share their perspectives, their birth videos using platforms like Instagram, Facebook, YouTube, now TikTok, etc.

Dr. Rebecca Dekker – 00:15:44:
I know you’re saying that this kind of term and method became known at a lower level. Like it’s still not common in the mid, you know, in the 1950s through 1970s. But I want to know, is the concept of freebirth like historically accurate? Because I know midwives are mentioned even in the book of Genesis in the Old Testament. Like for as long as we know thousands of years of written and artistic history, midwives have been discussed. And I’m sure there’s always been a very small number of people who choose to be alone or who don’t have access to a midwife. But wouldn’t the vast majority of people choose to have a skilled attendant at their birth throughout history if they could? Like is it more natural to want to have someone there with you who knows what they’re doing?

Dr. Sara Ailshire – 00:16:25:
Yeah, no, I mean, you’re right. Like mentioning, you know, the narratives that become, you know, the Old Testament. Those are thousands of years old and around the world and throughout history, people don’t usually tend to give birth by themselves. They’re attended by family members, sometimes by birth specialists. You know, we might think of as a layer traditional midwife by maybe their spouse, a female neighbor, etc. So yeah, and like in those writings in the Bible and ancient Egyptian accounts of midwives and carvings and artwork about birth, we usually see birth attendants. And you know, I’m an anthropologist. And something that I found so interesting when we were preparing for this episode, because I was really curious, you know, what is it, you know, what is it to be a human and give birth? Evolutionary anthropologists who do work on human and hominin birth will sometimes use this term of phrase I found so fascinating and they call it obligate midwifery. And there are evolutionary anthropologists who have argued, I guess I should say biological anthropologists who have argued that as a species, like we evolved to give birth with somebody else around to help us. A lot of other primates give birth by themselves. And humans are way more social in the way that we give birth compared to our closest relatives. But what this looks like and how it works can really vary across time and across cultures. Generally, people want someone who is knowledgeable and experienced with birth to be present, especially if they’re giving birth for the first time. However, access to traditional knowledge and expertise in pregnancy and childbirth can vary for all sorts of reasons. There can be social forces that can disrupt the transmission of birth knowledge. Sometimes people cannot afford birth care, even if it’s present in their community, their culture, their society. And sometimes people are socially excluded from accessing birth care. You know, there are patterns of inequality, of discrimination in many cultures, you know, in history, in the present. And something that can mean that a person who might want somebody there might not be able to access that care.

In recent American history, for example, we see a real decline of midwifery knowledge. Transmission occur as birth became the domain of medical doctors in the 19th and the early 20th centuries. And then in the latter half of the 20th century, we see a return of midwifery as a medical science, the domain of nurses and direct entry midwives who receive licensure and go through this accredited training process. But even though we kind of see this like break, right, in like midwifery knowledge, it’s not like midwifery disappeared during this downturn because in rural communities, especially the grand midwives and Black communities in the South, midwifery was preserved even throughout this sort of like 20th century downswing. And as an anthropologist, again, I do want to say that there’s no human universals. There actually are a few cultures and communities around the world where intentionally solitary birthing practices are present. And this would include the Kung in Botswana, the Raramuri in Mexico, the Bariba in Benin, and actually, of course, our own, right? So even in a community where solitary birth is or has been an existing practice, like there can be a diversity of thought on the matter, right? We have a community where solitary birth is an existing practice, this freebirth exists, and it’s very contested. So just some interesting background. And it’s really like fun opportunity, actually, to kind of go back into like reproductive anthropology literature and do some reading about birth throughout the world.

Dr. Rebecca Dekker – 00:19:34:
But overall, the pattern, the human pattern is to have somebody there who knows what they’re doing to assist you in birth.

Dr. Sara Ailshire – 00:19:40:
Overwhelmingly. It’s like those exceptions, they kind of stand out because someone’s like the exception that proves the rule. Right. If we can only list like a small handful of communities where solitary birthing practices take place, that’s because in the vast majority of communities, like support can look different. Birthing expertise can look different. Who the attendants are can look different. But, you know, overwhelmingly, people tend to give birth with other people present and they tend to desire a person who’s trained and experienced in childbirth, whether that’s a traditional birth attendant, a midwife, a medical doctor, et cetera.

Dr. Rebecca Dekker – 00:20:12:
Yeah. That reminds me too of how, you know, some of the freebirthing community, which we’ll talk about later, really looks down on midwives as being like government operatives or something like that. But I know in the past, when we lived in small villages, you would have a midwife who was held accountable, you know, by the community, right? If she was unsafe or did not practice in a safe manner, the community would not abide that, right? But when we have larger communities, urban areas, lots more people living together and you can’t know everybody, we do tend to lean on the government to help hold those medical practitioners, midwifery practitioners accountable, at least to some extent, which is why as societies, we developed things like licensures that we would have some kind of system in our larger societies to be able to identify who is actually qualified to be there at a birth.

Dr. Sara Ailshire – 00:21:05:
Yeah, absolutely. You know, and like in a lot of ways, that license you’re at, sort of continuing accreditation stands in for a word of mouth that, you know, you might otherwise have relied on. And I think for people who are birthing outside the system, if you are encountering somebody who maybe they’ve had like bad outcomes with other people they’ve served, but there’s no sort of external means of accountability, you won’t know. And you might not find out until, you know, it unfortunately happens to you too.

Dr. Rebecca Dekker – 00:21:30:
To me, it’s fascinating to see. And I know the system isn’t perfect and I can understand why people don’t like different restrictions that a government entity might place on midwives and how midwives might sometimes feel like their hands are tied in different situations, but it’s not perfect. And some people might even say it’s broken, but it’s the accountability system that societies have usually put in place to protect birthing people.

Dr. Sara Ailshire – 00:21:55:
Yeah, you know, I mean, we’ve definitely met our purview as researchers. We’re pretty familiar with how, you know, some of the limitations of the existing system, as well as what people are trying to do, right, to improve upon it. And, you know, thinking actually with that in mind, Rebecca, would you be able to share what we learned about why people might choose freebirth over other options?

Dr. Rebecca Dekker – 00:22:16:
Yeah, so this is actually the area that we have the most research on in freebirth. So if you go do a PubMed search or any other literature search for research on freebirth, this is usually what you find is research on why. Why would someone choose to kind of forego the tradition of having a skilled attendant and birth by themselves or just with a family member or maybe a lay practitioner? So in the show notes, there’s going to be bibliography that we’ve mentioned of all the sources if you want to read the research for yourself. One of the first themes that keeps coming up in the research is distrust in the medical establishment and a wish to avoid hospitals. So there is this desire to give birth outside of the system, but then to take it a step further and also not have a midwife present. Some of that may be due to the fact that a lot of these people say they had negative prior experiences with hospitals, with medical professionals, with midwives. So it’s kind of like, you know, you have this bad customer experience that’s actually, you know, but you’re more than just a customer. It’s one of the most vulnerable moments of your life. And you decide, you know, from here on out, I’m not interacting with anyone in that field. Instead of looking for someone different, they just choose to not interact with healthcare professionals. They may lack money or access to preferred care options. So maybe somebody really wants a home birth, but they can’t afford the $6,000 to $10,000 it might cost. Or maybe home birth midwifery is not available, or they can’t get licensure locally. Or maybe there’s other local hospital options or birth center options, but they’re unavailable. Maybe they’re shut down for that year or they’re unappealing for whatever reason. But there is a big drive in the preference to give birth at home and to control the birth setting and your autonomy over decision-making and childbirth. And an understanding of, they believe that the risks are higher in the medical model or the hospital and that that going to the hospital is riskier than birthing completely alone or without any kind of trained attendant.

Then some people choose it for religious or spiritual beliefs. But I want to acknowledge that research is really clear that the very small number of people who are choosing freebirth are doing so related to fears of previous traumas and fears related to the healthcare system and healthcare providers. And then they also have this increased desire for control and bodily autonomy. So they’re really valuing being the one to make all the decisions and being in charge of their body. And then they really want to avoid. Hospitals, and healthcare providers. And Stephanie Warnecke, who I mentioned earlier, We’ll tell more about her tragic story later in this podcast when we get into the controversies. She’s an example of someone whose reasons for choosing a childbirth, a freebirth at home, really lined up with what has been shown in the research. And the reason we know so much about Stephanie’s choices is because there was a whole inquest into her maternal death. And what they found is that Stephanie was heavily embedded in the natural health and wellness world. And they found that she had a deep fear of invasive or painful interventions happening to her if she gave birth in the hospital. And they also, you know, when they were trying to investigate what happened to Stephanie, you know, there’s a valid reason why people have fears of the hospitals. For example, in the part of Australia where Stephanie lived, their published statistics show that 28% of women report experiencing birth trauma. And so there is, you know, a large number of people who are experiencing birth trauma. And then a small percentage of them or a percentage of people who hear about that birth trauma think, well, the solution is to freebirth. So- That brings us to what are the risks of freebirth? You know, what are exactly are they choosing and do people know those risks? So, Sara, can you kind of get us started on the topic of the evidence on risk in freebirth?

Dr. Sara Ailshire – 00:26:14:
Certainly. So, again, what we know about freebirth is in a concrete sense kind of limited, right? Because of those issues of accounting, because of how many practices can fall under that umbrella, etc. We don’t have concrete information on what risks are most common with freebirth or how those risks might compare with other out-of-hospital births, like a home birth or a birth-underbirth, for example. In Ontario, Canada, the Obstetrics and Perinatal Death Review Committee has been tracking deaths associated with freebirths. And between 2020 and 2024, this committee documented 11 stillbirths, as well as the death of one mother related to freebirthing. And that was up from just one reported casualty in five years before that four-year period. And then, of course, in that Guardian series, which we referenced and we’ll talk about in more detail later, that covered the Free Birth Society, which was an online freebirthing community. This group had a private paid-for online community that they called the Lighthouse. This Lighthouse group had around 600 people in it. And the Guardian reporters identified around eight of those 600 people who appeared to have experienced stillbirths or neonatal deaths during their investigation. And it’s also important to note that of those 600 people in the Lighthouse group, most of those people were probably not pregnant. So we don’t actually know how many.

Dr. Rebecca Dekker – 00:27:36:
So we don’t know the denominator, but we do know that there were eight stillbirths or newborn deaths out of a group of about 600 people, most of whom were not pregnant.

Dr. Sara Ailshire – 00:27:45:
Yeah. And those same journalists, you know, as they were investigating the Free Birth Society, they interviewed 18 people who suffered a late-term stillbirth, a newborn death, or other incidents of serious harm. And through their investigation, they were able to identify a total of 48 cases of late-term stillbirths, infant deaths, or other, you know, serious negative outcomes involving mothers, babies. To those people who they believe were linked to the Free Birth Society. Either they were participants themselves or they had a birth attendant present who was allegedly linked to the Free Birth Society. So again, we don’t really have research on the health outcomes with freebirth, like the percentage of women who might experience preeclampsia, postpartum hemorrhage, stillbirth, or newborn death. But what we can’t do is talk about how midwives have actually really excellent outcomes with midwife-attended planned home births or planned freestanding births, or births. Then we can demonstrate sort of theoretically what safeguards and supports would be missing if a person chooses a freebirth at home without a trained midwife, a trained birth attendant present. So first, let’s go ahead and go over what the health outcomes are for infant mortality in community birth, either home births or freestanding births, attended by a midwife or a physician in general. These statistics are coming to us from studies that were published between 2011 and 2024. And the research in these studies took place in the UK, Canada, and the United States. So the first study we’ll look at at home birth is called the Birthplace in England study, and it was published in 2011. Overall, the researchers found 4.3 adverse newborn outcomes per 1,000 home births. And these adverse outcomes included stillbirth or early neonatal death, as well as other complications, including meconium aspiration or birth injuries. And they also found a statistically significant difference in risk for first-time mothers, but an overall low absolute risk of adverse perinatal outcomes with home birth.

Dr. Rebecca Dekker – 00:29:41:
So, the first-time mothers were more likely to have one of these bad outcomes.

Dr. Sara Ailshire – 00:29:45:
Yeah, were more likely but still had an overall low risk. But the risk was, you know, slightly higher enough that the researchers said, you know, this matters. A 2014 study of home births by Cheney et al. In the United States analyzed the outcomes of 16,924 planned home births. And they found that when you excluded newborn deaths related to sort of lethal congenital anomalies, things that would also probably cause mortality in a hospital setting as well as at home. They found that the rate of intrapartum death or a stillbirth during labor was 1.3 per 1,000. The rate of early newborn death was 0.41 per 1,000. And I think early newborn death, we would say, is in the first week of life. And they found that the rate of late newborn death was 0.35 per 1,000, respectively. The next study we’ll mention is from 2015 by Snowden et al. And this study included all births in Oregon from 2012 to 2013. So nearly 80,000 births. And only 5% of the sample included planned out-of-hospital births. And the researchers found that rates of perinatal and newborn deaths, so deaths either due to stillbirth during labor or deaths immediately after birth, were higher in planned out-of-hospital births compared to planned in-hospital births. Perinatal deaths occurred in 3.9 per 1,000 planned out-of-hospital births compared to 1.8 per 1,000 planned in-hospital births. Newborn deaths occurred in 1.6 per 1,000 planned out-of-hospital births compared to 0.6 per 1,000 planned in-hospital births.

Dr. Rebecca Dekker – 00:31:20:
And I also want to point out that in that study, some of those planned out-of-hospital births were being attended by people who are not certified midwives, such as family or other people.

Dr. Sara Ailshire – 00:31:31:
Yeah, like lay midwives, a family, you know, it was kind of a mixed sample. Also, I think some people had conditions that might risk them out of a planned home birth in some other settings.

Dr. Rebecca Dekker – 00:31:41:
Yeah, and they decided to continue with the home birth anyway. So the Snowden et al. Study has kind of a higher risk group, I think, for home births.

Dr. Sara Ailshire – 00:31:49:
Yeah, certainly. Another study, this is a 2016 study by Hutton et al., they compared 11,493 planned home births in Ontario, Canada, to a random sample of 11,493 matched planned hospital births. And these researchers found that the perinatal mortality rate was 1.15 per 1,000 among planned home births versus 0.94 per 1,000 in low-risk births planned at the hospital. So there was no statistical difference in the risk of death or other serious newborn health outcomes between the settings. These findings actually applied to both first-time mothers as well as people who had given birth more than once. And the last study we’ll talk about is a 2024 study by Boveberg et al. They used two large American community birth registries to compare maternal and neonatal outcomes for a planned home birth versus a planned birth center birth. They found that the intrapartum or neonatal death rate, so again, either death during labor, stillbirth, or death shortly after birth, was 1.4 per 1,000 for planned home births and 1.48 per 1,000 for planned birth center births. What we see is that there was not a statistically significant difference in terms of the negative outcomes between either the planned home births or the planned birth center births.

Dr. Rebecca Dekker – 00:33:08:
So kind of, you know, to summarize up all of that data you compiled for us. It sounds that in planned home births with a skilled midwife present, that you’re in general looking at rates, especially in the ideal setting like Ontario, where they have really good risk screening and qualified attendance and the home birth system is integrated into the larger healthcare system. So it’s really easy to get referrals and promptly transfer to the hospital if needed. You’re looking at about a risk of around one per 1,000 of the baby dying. And so what the guardian found was eight women appeared to have experienced stillbirths or newborn deaths in that lighthouse group belonging to the Free Birth Society in a community of about 600 women. So much, much higher rates of stillbirth happening in that group that was pursuing freebirth, at least from what we can tell, because we don’t have actual research on those people. Does that sound correct?

Dr. Sara Ailshire – 00:34:04:
Yeah, that does. And, you know, kind of it reminded me a little bit to like Snowden, right? Like with freebirth, especially if you’re not receiving prenatal care, you might not necessarily have like an accurate sense of, you know, your health, your well-being, like throughout your pregnancy. You might not know like what, you know, risk factors might apply to you. And people who might be risked out, who might no longer be considered low risk, it might be advised to, you know, continue care of their midwife in a hospital are going to continue along sort of like this path with not necessarily like having the knowledge of, you know, what their true risk is in terms of giving birth at home or specifically giving birth at home without a trained attendant present.

Dr. Rebecca Dekker – 00:34:42:
This kind of leads me to talking about, you know, why skilled midwives are able to help keep the outcomes so good at planned home births. In other words, keeping the death rates low. If you’re not hiring a midwife or you’re not having a skilled midwife with you at your birth, this means you lack the presence of someone who’s trained to monitor you throughout labor, to keep an eye on your baby, keep an eye on your temperature, your blood pressure, and other physical signs and symptoms that something might be going wrong. You’re also, if you’re not having prenatal care, then you might not be screened for gestational diabetes, high blood pressure, breach, or transverse position or other conditions that might impact your birth. And licensed midwives have training to identify conditions that warrant transfer to the hospital, such as signs of fetal distress, signs of preeclampsia, preterm birth, a retained placenta, uncontrolled hemorrhage. And one of the things that midwives bring to birth is they can develop a trusting relationship with their client and understand the birthing person, their whole self and their background. And I think these relationships can be really protective. They can allow for more thorough assessment, better informed consent conversations. And then also researchers believe that the social support that midwives provide can help lower the risk of adverse health outcomes. So it’s like not just having them during the birth, but that continuous relationship throughout prenatal care. And then when you talk about labor, I think the Cheney et al study does a really great job of breaking out different complications that might occur during a planned home birth, where a midwife would then recommend and assist with a prompt transfer to the hospital. So about 1% experienced fetal distress during labor that warranted transfer. About 2% needed transfer for pain relief. About 4% labor came to a stop and they needed transfer for help with that. And midwives are also hopefully trained in how to assist with a birth that has issues that the parents might not know how to deal with or might not be prepared for, such as shoulder dystocia or a surprise breech birth. And then when you talk about things that might happen after the birth that might require transfer, Cheney et al found that in their planned home birth study with midwives, 1% required transfer for postpartum hemorrhage or retained placenta.

But about 15% of the sample lost more than 500 milliliters of blood. And about half of these clients were given medications by the midwife to control bleeding. So these, you’re talking about 7% of the sample had a postpartum hemorrhage that needed medical management and the midwife was able to take care of that at home. Then you also have life-threatening complications that might occur for the newborn after birth. So if you have a licensed or registered midwife, they would have the training and skills to intervene. And if you’re choosing a freebirth, you don’t get access to this. So about 5% to 10% of newborns need simple resuscitation measures after birth. And this can include things like drying the baby off and kind of rubbing their skin to stimulate their breathing. About 3% to 6% of newborns are going to need bag and mask resuscitation where the healthcare worker has to provide breath support for the baby. Less than 1% of babies will need advanced resuscitation measures such as chest compressions. There was a review of 20 trials with 1.6 million births in low resource settings. And they found that when you have access to healthcare workers who are trained in newborn resuscitation, it substantially lowers community rates of newborn death across the board. And that’s because if bag and mask resuscitation is needed, it needs to be started within 60 seconds of the birth. After one minute, every 30 second delay in the start of resuscitation increases the risk of death. So trained and licensed midwives are going to be skilled in neonatal resuscitation. They have to regularly keep up their certification. And neonatal resuscitation is a special kind of resuscitation that most parents would never have training or experience in if they were planning a freebirth. In terms of the number of babies that, you know, need to be transferred to the hospital, researchers have found that when midwives are there at a planned community birth, about 0.4 to 0.7% of babies will need to be transferred to the hospital for respiratory support. And I think this is important info because it shows that midwives are identifying and arranging urgent transfers for babies who need more intensive breathing support. And they kind of serve as that bridge to help get the baby safely there. There’s a few other things that you are foregoing access to if you’re freebirthing. If you’re carrying group B strep and you don’t know it, there’s a 1% to 2% chance your baby might have early onset sepsis or a bloodstream infection. Midwives can screen for signs of newborn infection. Midwives also perform whole sock screening, usually about 24 hours of life, which research has shown to decrease the risk of newborn death due to congenital heart disease. There are preventable deaths that midwives can basically save lives with the screening. They’re also trained to screen for newborn jaundice in the days after giving birth. Look for signs of severe pathological jaundice. An early identification of severe jaundice is important because it can prevent brain damage. So, this is not a comprehensive list, but I think it’s important to note that midwives do save lives and there’s a reason why the outcomes in general look pretty good in most of the studies on community birth.

Dr. Sara Ailshire – 00:39:55:
Absolutely. Like midwives who are trained and certified and licensed, they have such a depth of information as well as the practical experience that they have to, you know, they receive throughout their training before they ever start practicing on their own. Being able to assist with things at home as well as know, you know, when it’s time to transfer and sort of help ensure that families are getting, you know, the information they need and the support they need and the care they need to have the best possible outcomes with giving birth at home.

Dr. Rebecca Dekker – 00:40:21:
It’s interesting to share the statistics, you know, on the things that can go wrong in birth. Because from what I’ve seen in the freebirthing community, when you share statistics like these, it might be considered like fear mongering. But I think statistics are helpful.

Dr. Sara Ailshire – 00:40:34:
Absolutely. Yeah. I think sometimes this can be like called like the dead baby card, you know, like you’re threatening, you’re trying to scare me. And, you know, I would hope that if a person is listening to this and they’ve chosen freebirth, they support freebirth, you know, this isn’t necessarily intended to be fear mongering, but more just like this is the evidence that we have. There are researchers who are really passionate about giving people access to choices in birth and also supporting making those choices as safe as possible for people to give birth at home, give birth with a midwife, to have, you know, autonomy and how they give birth safely. So, I just hope that, you know, if you’re hearing this, other things that’s coming from that perspective, you know, that’s definitely the perspective we had when we were preparing this episode.

Dr. Rebecca Dekker – 00:41:14:
It’s just interesting because midwives get a bad reputation in the freebirth community, which I find interesting because midwives not only believe in sharing accurate information, they believe in a bodily autonomy, informed consent, they’re highly trained. And then I also want to recognize that there are some extremely rare situations where minutes count that might not be alleviated by a midwife at a planned home birth, even if one was present. And I can put the statistics for these in the show notes, but placental abruption is quite rare. Placenta accreta, cord prolapse, uterine rupture, amniotic embolism is extremely rare. And with that, we’re talking about like, you know, maybe one in 50,000 cases. But at home and at freestanding birth centers, midwives cannot perform surgery. They cannot provide continuous fetal monitoring. They cannot do a forceps or vacuum assisted birth. They can’t intubate a baby typically or a birthing person. And there’s no NICU at home. So there is a chance that, you know, with the planned home birth with an attendant versus a freebirth, you know, something could go wrong in either case that might not be preventable or savable. But in general, with the more common complications, there are things midwives can look for and do to take action.

Dr. Sara Ailshire – 00:42:26:
Yeah. No, absolutely.

Dr. Rebecca Dekker – 00:42:28:
So we’ve talked a lot about, you know, the research that we’ve been able to find and then kind of looking at the research on home birth and what midwives do provide. Now I want to shift to, you know, why we wanted to talk about this in the first place. And that is everything that’s been in the news about the Free Birth Society.

Dr. Sara Ailshire – 00:42:44:
Yeah. So, you know, I think it would be good for us to talk about the controversy, especially related to the Free Birth Society. And we’ve been talking about it actually a lot behind the scenes at Team EBB for almost the past eight months since late 2025 when this article came out. And I think it’d be interesting to go over the situation of our audience and to look at some of the lessons that, you know, can be learned from this controversy. So again, in late 2025, two reporters from The Guardian published an investigative series. They have a podcast. They have a number of articles they’ve published about a company known as the Free Birth Society. And again, this is one of those things that introduced the concept of freebirth to the general public. So, the Free Birth Society is a business and online community that was all about freebirth. It was founded by Emilee Saldaya. Her and her business partner, Yolanda Norris-Clark, popularized freebirth on social media. And over time, they created a profitable business. Since its inception in the late 2010s, the Free Birth Society has had a variety of both free and paid offerings, including a podcast of over 300 episodes, in-person retreats, paid and free resources for families interested in freebirth, a private directory of freebirth practitioners and other, quote, sovereign, unquote, health professionals, the Radical Birth Keeper Training Program that we mentioned earlier. And in the past, they have also offered what was called the Match Your Birth Midwifery Institute. It’s difficult to tell how influential the Free Birth Society was or is in the freebirth sphere. Before shutting down their Facebook group in 2018, there were over 6,000 members. As of recording, their Instagram, which is still up because they’re still in business, has over 130,000 followers and their YouTube videos have over 27 million views. The Free Birth Society has trained approximately 850 birth keepers around the world, again, according to this investigative series from The Guardian. Over the course of their 331 podcast episodes, as of the time that we’re recording this podcast episode, around 200 of the Free Birth Society podcast episodes featured at least one, if not more people, who had freebirthed or, in some cases, people who had freebirthed multiple times. And we would definitely recommend, you know, that you read the articles and check out The Guardian podcast to learn more about the specifics of this group.

Dr. Rebecca Dekker – 00:44:55:
Okay. So, the Free Birth Society founders, in this investigative report, were alleged to have espoused beliefs and information about pregnancy and childbirth that were not rooted in evidence. So, Yolande Norris-Clark helped popularize the term wild pregnancy and allegedly spread information that ultrasounds are dangerous. And Emilee Saldaya purportedly had a wild pregnancy that she posted about on social media with posts like, quote, wild pregnancy means no ultrasounds, no blood tests, no rectal swabs, no vaginal exams, no technology, no surveillance, no doctor, no midwives. Just you, your baby, and the great mystery, end quote. Last summer, in 2025, her own wild pregnancy did end in a stillbirth at 41 weeks. Although she has since deleted, as far as we can tell, all of her posts mentioning the stillbirth. In other Instagram posts that have not yet been deleted, she said she did not use kit counts, genetic testing, weighing herself, any injections or medications, and she did not believe in pregnancy restrictions of any kind, such as avoiding hot tubs. Emilee Saldaya allegedly would counsel women via text or phone or video calls who were attempting to freebirth and were in distress to not go to the hospital. Or if they did go to the hospital, she allegedly encouraged them to lie about details like when their waters had broken or when they had started to go into labor. She would also allegedly counsel women in her classes to not resuscitate their babies if they were not breathing properly in the first five to 10 minutes after birth. And also has been said to allegedly have told people that if their baby died after the birth to just tell the authorities that it was born still. The Free Birth Society charges money for their services as a business. Costs range from $399 for their complete guide to childbirth online course aimed at mothers who want to freebirth. The Free Birth Society claims this has been taken by more than 10,000 women. It’s still being marketed and sold. $2,000 for a single ticket to their in-person Matriarch Rising Festival, an additional, $1,800 fee if you want to camp on Emily’s property. $6,000 for their Radical Birth Keeper School for, it’s not a doula training, but it’s a quote-unquote birth keeper training aimed at people who want to attend freebirths. And $10,000 for the Matriarch Midwifery Institute has been, the name has changed to the Matriarch Mentor Institute. It’s a 10-month online training program with no hands-on skills training.

The Guardian Journalist spoke to women who were harmed or their babies were harmed or died as a result of misinformation they learned through the Free Birth Society. And although you might suspect that the Free Birth Society would be brought to an end by the founder’s own stillbirth, it is still in existence. They are still posting reels promoting freebirth to their 133,000 followers on Instagram. They still claim on their posts that hospital birth is dangerous and freebirth is the ideal. But there have been additional headlines also related to maternal deaths. There have been several maternal deaths linked with the Free Birth Society. I mentioned the one with Stephanie Warnke, who died in Australia in the year 2025, of preventable causes related to a postpartum hemorrhage. Stephanie paid a birthkeeper who was trained through the Free Birth Society $6,000 to attend Stephanie’s birth as a non-medical, quote-unquote, birthkeeper attendant. Stephanie ended up dying of a massive postpartum hemorrhage. There was a whole medical inquest into her death, which is still not finished. But the testimony revealed that Stephanie had an early stage of labor that lasted three days. Her uterus was exhausted, unable to contract, and unable to stop the bleeding following the birth of the placenta. And medical experts testified that Stephanie’s death was preventable if she had been attended by a qualified attendant who would have recognized clear signs of abnormality and that that abnormality required intervention. Instead, evidence shared in the inquest indicated that the birthkeeper, Emily Lal, told Stephanie that Stephanie was having a panic attack when Stephanie was dying of internal bleeding. The Guardian News Organization also reported that this terminology of radical birthkeeper is being used to help their students get around laws that restrict practicing midwifery without a license. They allegedly teach their birthkeeper students to refer to themselves as a friend, albeit a friend who might be paid $6,000 to support you in birth. And interestingly, at the inquest into Stephanie’s death, her birthkeeper, Emily Lal, referred to herself as a friend eight times. They’re not calling themselves a doula or midwife, but they call themselves a friend or a birthkeeper.

And interestingly as well, because it kind of keeps getting more fascinating, is that quite a few of the former participants of the Free Birth Society organization have referred to it as a cult. They’ve identified potential cult-like factors, including policing language. So you’re not allowed to use certain words or phrases. Like you’re not allowed to say empowerment. You have to always use the word sovereign instead. There’s rigid ideas about how to give birth and make parenting decisions. Shame is used as a method of control. You might shame people for asking questions or for seeking prenatal care or care during labor. It’s difficult or you’re unable to criticize the leaders. You might be kicked out for offering any kind of feedback or criticism. Or you might be labeled as a jealous, angry woman if you issue a complaint. The inner circle was under even higher control. So some people were living on Emilee Saldaya’s land and were dependent on the owners for their homes. They were isolated from the outer world. They left everything to live in this remote location in North Carolina. And they even depended on the owner to provide a school for their children, which was called the Yurt School. And there’s a strong emphasis on either-or thinking. Like you can see on social media, you know, something either evil or perfect. And ultrasounds are described as evil. Alternative beliefs are evil. Any medical intervention is a failure. Giving birth in a hospital means you’ll be abused. Meanwhile, freebirthing at home might be presented as risk-free. And in fact, you can still go on their social media page and see captions stating things like, and these are direct quotes, midwifery care is betrayal disguised as care. Midwives are only loyal to the government. Registered midwives serve the government, not you. Birth centers are medical facilities in disguise. Sheep in wolf’s clothing. And one of my favorites, they refer to providers as “so-called providers.” So, you know, they shouldn’t even be distinguished with the name as a healthcare provider. And now, you know, they still continue to share misinformation or disinformation, but there’s a disclaimer, you know, very posted everywhere that this information is just for educational and informational purposes. But at the same time, they’re sharing, you know, inaccurate information. Another place, if you want to dig deeper to go to learn more about what happened with this company is there is a group of people on Reddit who claim they have been harmed by practices of the Free Birth Society, or they’re trying to expose the actions of the founders. And you can read lots of stories about ethics, manipulation, financial harm, physical and mental harm. And we’ll link to that in the show notes. But it’s kind of a place where you can go to read firsthand accounts of what happened. So, Sara, what are your thoughts about this?

Dr. Sara Ailshire – 00:52:09:
Yeah, you know, I mean, the story was troubling, like reading the articles. And it actually took me a while to want to sit down and listen to the podcast from The Guardian. Shereen Kale and Lucy Osborne were the journalists. And if you do, I definitely would recommend listening to it. It’s really well done. I actually couldn’t bring myself to listen to much of the Free Birth Society’s podcast. So we did check out a few episodes. And of course, one threader social media. I sometimes would rely on the transcripts, you know, because it was… It was just, it was really disheartening sort of the disdain they had for midwives, for people who chose to birth differently, as well as the sort of misinformation that they would share. But I also just wanted to note too that, you know, the Free Birth Society is not the end all and be all of freebirth. People have been pursuing freebirth before the Free Birth Society ever existed. During the time that it was active, there were other supporters of freebirth who were, you know, even though they were, again, like, you know, supporters of freebirth, they were critical of the Free Birth Society. They warned against them to other people who were interested in freebirth. And of course, there are people who have nothing to do with Free Birth Society or any organization that promotes freebirth. And they continue to pursue it on their own. And even now, after these issues have come to light through this new story, this organization just seems like it was kind of like a perfect storm. A perfect example of how easy it is to be drawn into a toxic situation, even in something as seemingly peaceful as the birth world. Even an organization that claims it’s about reclaiming motherhood and supporting people as they, you know, pursue their births. And they also had such an incredible amount of influence in popularizing the term birth keeper and training so many, you know, birth workers in their ideology. And that’s something that’s also kind of really stuck with me.

Dr. Rebecca Dekker – 00:53:49:
You know, we see the controversy, but we’ve also been talking amongst our team, like what are some lessons we can learn or that we can share with others based on the research that we’ve looked at, but then also based on this controversy, like how can people safeguard themselves from organizations like this?

Dr. Sara Ailshire – 00:54:07:
Yeah, sure. So, you know, Evidence Based Birth®, we’re evidence-based in our approach to pregnancy and childbirth. You know, and we’re also supporters of the human right to bodily autonomy. You know, we know that home birth is an option for families and that many births can proceed safely and healthily with few interventions under the care of a professional. We also know that complications can arise at any point during your pregnancy and that for some people, only a hospital might be able to offer the level of care they need to give themselves and their baby the best possible outcome during a birth and postpartum. We also know in many cases that birth can unfold physiologically with good outcomes. There are people who have given birth at home without an attendant present, either by choice in the case of a freebirth or by accident due to precipitous labor at home or in the car or the side of the highway. You know, those are examples of how birth can sometimes go well without a skilled birth attendant present. And we talk about this actually one of our other podcast episodes, episode 292, Confronting the Unkowns of Childbirth with Liesel Teen of Mommy Labor Nurse. And we’ve linked that in our show notes. However, that being said, we also know that decades of research and science has demonstrated that nature doesn’t always care about each and every outcome, that a totally natural approach to birth with no interventions and no trained birth attendant would result in unnecessary deaths and lifelong medical problems. We believe that anybody who claims to be able to guarantee exactly how you will give birth or to guarantee that you will have a perfect birth is not being truthful. There are many ways to have a birth where you are respected, cared for, and treated with dignity. But there’s no crystal ball that’s going to tell you exactly how that birth is going to play out.

Dr. Rebecca Dekker – 00:55:44:
Yeah, I think one of a couple of the lessons I’ve learned and I’ve, you know, having been in the birth world since 2012, which, you know, I keep learning things, but one of my lessons learned is that when it comes to social media influencers, and I’ve seen lots of them come and go, you want to be wary of anyone who claims they have the secret answer to something like a happy marriage, a sense of fulfillment, a perfect birth, a foolproof way of avoiding birth trauma or the best way to parent. If they want to sell something like that to you and it sounds too good to be true, it almost always is. I also think we all need like a refresher on culty warning signs. There are some excellent podcasts on how to avoid cults. There’s also work by Dr. Steven Hassan, a licensed mental health professional and author who developed the BITE model to identify warning signs of authoritarian or cult-like groups. And you can have a spectrum of behaviors from mild to severe. B stands for behavioral control. I stands for information control. T stands for thought control. And E stands for emotional control. You know, if you go look at stories of people, survivors and people who have left the Free Birth Society group, you can hear stories about how some of these types of control they claim they experience. And however, I want to say that many people who join groups like the Free Birth Society and then ultimately left, these are people who are curious, intelligent, thoughtful people. They want to learn more about birth and their options and they want to affirm their bodily autonomy. But, you know, if you’re seeing a lot of red flags and one of the red flags is that they don’t allow dissent. If they’re led by a charismatic leader who uses some of the influencer tactics I’m going to talk about next, that would be a sign you want to have caution engaging with a group because, you know, birth workers and birthing people, it’s quite common to have a history of trauma. I think sometimes different influencers and organizations can try to use that to sway you to pay many thousands of dollars to them. Influencers, no matter how they get their start, are business people. But… In contrast to most businesses, they’re selling their lifestyle and their personality and their choices and themselves. So by the time you see someone as an influencer posting a reel or a story, there’s a lot of thought and scripting and editing that’s gone into that. For example, if you see a video of someone crying, they had to set up their phone or their tripod, push record and then cry. But I think it’s really important to look for signs of ethical businesses and also look for signs that people might be leaning more heavily into manipulation tactics or other irresponsible strategies to kind of manipulate their following, to generate attention, to feed their ego, to gain followers or to pursue their own professional or personal aims. So, here are the ways.

I’ve done research on this. I’ve looked at the research on psychological strategies that some people may use to manipulate you on social media. So creating a false sense of intimacy. So mentioning or showing glimpses of their relationship with their spouses or their children or their friends. Frequent posting of candid posts. Pseudo intimacy is a really big deal. I always am very wary of someone who’s always sharing close-up videos, a strong eye contact, or if they share videos from their bed, their bathroom, or another intimate space, they’re trying to hijack your brain possibly to gain more influence over you. If someone’s always showing off how successful or strong or influential they are, like showing a beautiful home, a project they finished, their talents, their beauty, their strength, makes you feel like you’re best friends with someone who’s really cool. Also showing how they can influence others in the comments section. So if the comments seem very parasocial and it’s almost like there’s a mob of people constantly replying about how much they love someone and how amazing that person is, that’s a red flag. This is a weird one, but I’ve seen it in the birth world. Like I said, I’ve been in the birth world for a long time. If someone’s always showcasing their attractiveness, like videos that they post on social media of themselves in their underwear, their lingerie, bikini, or they’re dancing in a way or looking at the camera in a way that’s meant to like kind of seduce the person who’s watching, you know, people are more likely to trust people people who are attractive and also creates this form of energetic supply to the influencer because they get so many compliments about how gorgeous they are underneath the video.

So to me, it’s often a sign that somebody is, if they’re in the birth space, that they’re in this more for themselves and not so much to educate other people. And then the last warning sign, but I think one of the clearest ones is inappropriately evoking pity from the audience constantly. So sharing dark or ugly truths about themselves, cosplaying humility. See, I make mistakes too. I’m clumsy just like you. But then expressing a lot of negative emotions. We’re in this together because I’ve experienced this horrible thing. Someone’s evoking your pity, not just once. People can go through tragedies and need to share bad things that happen. But if they’re over and over asking for your pity, that’s a big red flag. Because emotions sell. And just be mindful if somebody’s being very emotional online, they might be trying to either sell you something today or gain more influence over you so they can sell something later on. So those are kind of my red flags. Did you find that helpful, Sara?

Dr. Sara Ailshire – 01:00:58:
Yeah, I did. You know, I mean, influencers are business people. They’re working. Not every influencer is doing all of these things. But it’s nice to have kind of like a handy guide just to also just check into your own relationship with these people who live in your phone. You know, if you find yourself being overly attached or you can catch yourself being really sucked in, this can be really helpful. Be like, hey, wait. And you just like take up.

Dr. Rebecca Dekker – 01:01:19:
Right. Am I feeling pity for them? Am I, you know, feeling like I know this person really well?

Dr. Sara Ailshire – 01:01:25:
Yeah. You know, I think it’s normal, you know, if you follow people who share an interest or share a hobby to be, you know, you enjoy their content. If you’re getting overly invested and it’s kind of sucking you in, it’s important to be able to sort of pump the brakes and be like, I don’t know this person. You know, what are, what’s, what’s actually happening here? I kind of have that sort of like bird’s eye view of like the content you consume and where you give your attention.

Dr. Rebecca Dekker – 01:01:50:
Yeah, exactly. Because, you know, if you’re giving someone your attention, you’re giving them like a piece of yourself. So ask yourself, are they worthy of my energy right now? And so today we’ve gone over a lot. We talked about what freebirth is, the different paths people might take with a freebirth, how it’s different than a planned home birth. We also went over the research on why people might choose this option, which by far shows that it’s typically fear-driven. We also went over the statistics of the types of medical emergencies that can happen in birth, how common they are and how a trained licensed midwife might be able to help. And then we spent some time talking about the controversies and tragedies that happened in relation to the company known as the Free Birth Society and some, some lessons that our community can learn about, you know, who they’re choosing to engage with online. So we did a ton of research preparing for our podcast today. Thank you, Sara, for doing a lot of the heavy lifting. Our bibliography for this episode includes more than 40 research and news articles. So if you want to learn more or read some of the articles for yourself, we highly encourage you to do so. We’re also going to include some resources on stillbirth prevention. So much of what we talked about today had to do with stillbirth. And there are ways to prevent or lower the chances of stillbirth that are evidence-based, including getting adequate prenatal care and having a trusting relationship with a healthcare provider. So, you know, finding someone you can trust is a great takeaway point if that’s possible for you. So, Sara, what’s your number one takeaway from diving into this and talking about it for the last eight months with Team EBB?

Dr. Sara Ailshire – 01:03:19:
Oh man, it’d be so hard to take just one. I’ll do my best. Maybe I’ll pick two. I think one is that it’s really important to try to understand where people are coming from, even if it doesn’t make sense to you or if it’s, you know, it’s not a choice you would make. Understanding why people might choose something like freebirth, I think is really important just to kind of like be able to better address this topic and maybe also help, you know, build bridges of trust and communication for people who feel like they can’t, you know, be in the sort of mainstream birth sphere. And I think the other thing too, I was going to take away I have is, is you can always change your mind. You know, you get new information, you take in new evidence and it’s, you know, it’s always okay to change your mind. You can go down a path and you can say, you know, I thought this and then I learned something and now I don’t. And I think that’s one of the most admirable things you can do, you know, to take in the new, take in something and use it to inform yourself and don’t be afraid, you know, to say like, this doesn’t work for me anymore.

Dr. Rebecca Dekker – 01:04:17:
I would have to say, I really like your point about looking at things from somebody else’s perspective. Like if you can put yourself in their shoes, like for me, I would personally. For me, I would personally not choose to freebirth, but I think it’s important that I can put myself in the perspective of someone who would so I can better understand their situation. And I think it kind of goes back to a root of a lot of this is, you know, trauma and people react in different ways to the trauma they may or may not have processed in the past. And a lot of the fear-based decision-making, and yeah, we don’t want to contribute to that. We want to share the actual numbers. We’re not trying to scare anyone. We’re just sharing the numbers. To me, it’s actually kind of inspiring to see. How research has developed ways to identify and treat and prevent postpartum hemorrhage, for example, which so many of us, our ancestors might have died from. And the fact that midwives have those skills is just, I think, super valuable. And I’m so grateful to the midwives around the world and nurses and doctors who regularly train and drill and keep up their knowledge on the latest research on the prevention and treatment of postpartum hemorrhage is just one example of ways that they make a difference. And I remember when my sister got her start in attending births as a family doctor, one of the things that she said that really struck a chord with me is like, you know, I am a lifeguard. I’m there to support you and be a supportive presence and advise you if you want information. But, you know, I’m only going to jump in if I really need to jump in the water. And then they still talk with you about what they’re doing. It’s not like they’re violating informed consent. But I just, I love meeting providers like that. And I know some people feel maybe traumatized by their previous interactions with the providers. So I would, you know, for me, a lesson learned is identify that you experienced trauma and then work on processing it.

Dr. Sara Ailshire – 01:06:14:
Absolutely. Yeah. Yeah. Because, you know, it sounds like if it doesn’t get addressed, it can, you know, continue to rear its head. At different points throughout your life.

Dr. Rebecca Dekker – 01:06:24:
Exactly. Thank you so much, Sara. This was an interesting conversation, and I hope our listeners found it fascinating as well.

Dr. Sara Ailshire – 01:06:30:
Well, thank you, Rebecca, for making the space on EBB Podcast for us to have this conversation. Thank you to all the members of the team who’ve been sustaining such a lively and thoughtful conversation about this behind the scenes, all 2026.

Dr. Rebecca Dekker – 01:06:44:
Thanks everyone for listening. We hope you learned something new and we’ll see you next week. Bye.

Dr. Sara Ailshire – 01:06:47:
Bye.

Dr. Rebecca Dekker – 01:06:49:
Today’s podcast was brought to you by the Signature Articles at Evidence Based Birth®. Did you know that we have more than 20 peer-reviewed articles summarizing the evidence on childbirth topics available for free at evidencebasedbirth.com? It takes six to nine months on average for our research team to write an article from start to finish. And we then make those articles freely available to the public on our blog. Check out our topics ranging from advanced maternal age to circumcision, due dates, big babies, Pitocin, vitamin K, and more. Our mission is to get research evidence on childbirth into the hands of families and communities around the world. Just go to evidencebasedbirth.com, click on blog, and click on the filter to look at just the EBB Signature Articles.