Women and babies have died and been left at risk of life-threatening complications from a rise in “free births” – when women choose births without medical supervision – the country’s directors of midwifery have said. In an unprecedented move, directors of midwifery at the country’s 19 maternity units – the most senior midwives in the State – have signed a policy paper that linked free births in Ireland with “perinatal and maternal mortality and severe morbidity”. The 19 medical professionals, who adopted the new policy amid major concerns about the risks to women and babies, have warned that more women are choosing free births because they don’t trust the health service and may have had difficult experiences in maternity hospitals. The number of free births taking place are understood to be small but rising. A free birth is different from a HSE home birth where strict guidelines have to be met, including requiring a midwife to be present and an ambulance to be on standby. Social media influencers and birth activists often promote free birth as an ideologically driven choice.In June 2024, 38-year-old mother of four Naomi James died after delivering her son at her home in Drogheda, Co Louth. She suffered a postpartum haemorrhage shortly after his birth. Her brother, Adam Boyle, said his sister had chosen to birth at home because she wanted to deliver her baby by vaginal birth but had been advised against it by doctors. In October 2024, four months after her death, the country’s 19 directors of midwifery came together to agree that it was “crucial” to address the rise in deliberately unassisted births in Ireland.“In recent years in Ireland there has been a notable rise in the number of women who express interest in and who undertake a deliberate unassisted birth,” their 2024 policy paper said. “Regrettably, this has resulted in cases of perinatal and maternal mortality and severe morbidity. While we know that the numbers are rising, we do not know the actual number being planned, taking place and their birth outcomes.” While midwives stressed the need to respect women’s autonomy and their right to choose a free birth, the paper all 19 directors signed said: “Supporting autonomy does not equate to supporting all choices without reservation.”Dr Rhona Mahony, a consultant obstetrician and gynaecologist – and former master of the National Maternity Hospital – said: “Many of us have had direct experience, very sadly, of cases of perinatal mortality and maternal morbidity from free births.” She said in many cases women who choose free births can be “vulnerable”, possibly because of a previous negative experience with birth or maternity services.“That’s the problem with these free birth influencers. They are peddling the myth that free birth is a wonderful thing, that it promotes autonomy and in fact you have patients who have had very difficult experiences who need good information and care.” Mahony said the rates of interventions, such as inductions and Caesarean sections, can be high in Ireland.“I can understand why that would worry women,” she said.“But at the end of the day we have an obligation to try to deliver everyone safely. And it’s something we have to challenge ourselves on: are our interventions worthy and are they doing good?”