FREEBIRTH – VALFRIHET ELLER TVÅNG? En systematisk litteraturöversikt om kvinnors motiv till freebirth

Abstract

Background: Freebirth refers to the intentional act of giving birth outside the conventional healthcare system without the presence of medically trained personnel, such as a midwife or obstetrician. The phenomenon occurs primarily in high-income countries where access to maternity and obstetric care is generally good. For midwives, it is essential to safeguard women’s autonomy and right to self-determination, and a deeper understanding of freebirth and the motives behind this choice may contribute to strengthening respectful and individualized care. Aim: To synthesize and highlight women’s motives for choosing freebirth in high-income countries through a systematic qualitative literature review. Method: A systematic literature review with qualitative data. The database search was conducted in November 2025, using PubMed, CINAHL, Scopus, and PsycINFO. The collected data were analyzed according to the nine steps recommended by Bettany-Saltikov (2016) for qualitative research. Results: The results identified four main categories. Women’s choice to freebirth was motivated by a critical view of a medically dominated and inflexible healthcare system, a risk assessment that differed from that of healthcare professionals, previous healthcare-related trauma and experiences of obstetric violence, as well as a strong trust in the body’s capacity and a need for autonomy and emotional safety. Overall, the findings indicate that women’s motivations for choosing freebirth are multifaceted. Conclusion: Women’s motivations for choosing freebirth in high-income countries are complex and multidimensional. The choice is shaped by an interplay between healthcare organization, women’s risk assessments, previous life experiences, and their fundamental understanding of childbirth. From a lifeworld perspective, childbirth emerges as an existential and embodied life event in which autonomy, safety, and meaning are central. When healthcare structures and risk assessments do not align with women’s lifeworlds, freebirth may be perceived as the safest available option. The findings indicate that choosing freebirth should not primarily be understood as an ideological rejection of healthcare, but rather as a consequence of limited access to individualized and acceptable care options.