Standing in Truth: Autonomy, Choice & the Storm in Maternity Care
I feel it. The wind is rising. I lie awake at night mulling it over, feeling it in my bones.
In recent weeks, the media has turned its gaze sharply towards “natural birth”, “home birth”, “choice”, “midwives who support physiological birth”. The framing is loud: “ideology”, “fanaticism”, “obsession”. The message is clear: women who choose differently, midwives who support differently — beware.
As an independent midwife in East Sussex, I stand here with the families I walk beside, and I feel both the grounding and the tremor. Because this isn’t simply about birth preferences. This is about autonomy. This is about rights. This is about a system under strain that is seeking control — and the women, babies and midwives caught in the middle.
Autonomy & Human Rights in Maternity Care
Let’s be clear: a woman’s right to make decisions about her own body and maternity care is not optional. It is fundamental. Under UK law, the Birthrights charity emphasises that human rights laws give you the right to make your own choices about your maternity care — and public bodies must treat you with dignity, consult you about decisions and respect your autonomy. Birthrights+1
To label women as “fanatical” for wanting physiological birth or an informed homebirth pathway is to deny that autonomy — to frame choice as extremism rather than as a right.
And yet, as we see, that choice is shrinking.
The Storm of Control: Structure, Fear & Compliance
The narrative being spun is seductive in its simplicity: “Natural birth = dangerous → We must regulate → You must choose hospital, you must conform.”
But this external storm of rhetoric hides an internal storm of system collapse:
The latest MBRRACE‑UK data (2020-22) show the maternal mortality rate in the UK rose to 13.56 per 100,000 maternities — significantly higher than the 8.79 per 100,000 recorded in 2017-19. NPEU+1
At the same time, homebirth services are being restricted: a recent investigation found that 66% of NHS Trusts had suspended or severely limited home birth services between October 2023 – November 2024. Maternity & Midwifery Forum
A survey by Birthrights found only 68% of women were given a choice about place of birth and 31% said they didn’t feel in control of their birth experience. Birthrights
Here is the truth: It is easier to direct fear at individuals (women choosing homebirth, midwives supporting autonomy) than to face the large, difficult truth of under-funding, understaffing, loss of continuity care, collapsing birth centres. The system wants compliance. The system does not deeply encourage connection.
Autonomy as Safety — Not Ideology
When we speak of physiological birth, home birth, or midwife-led continuity care, we are not speaking of ideology. We speak of evidence. We speak of safety.
For low-risk women, the evidence shows that planned home birth attended by experienced midwives produces comparable perinatal outcomes and lower intervention rates. While home birth isn’t suitable for every pregnancy, the framing that it is inherently reckless is misleading.
Choice is not opposite safety — it can be the pathway to safety. Autonomy is not opposite care — it is care.
The Weight of Responsibility
As an independent midwife I carry the weight of this storm. I know each time I say “yes, I will walk with you” that I am not just taking on a client: I am pledging commitment to relationship, to continuity, to holding thresholds.
And I know the cost. If something goes wrong — even with the best preparation, most evidence-based care, deepest continuity — I will be held accountable in ways that the larger system often refuses to be. That knowledge is deeply humbling. And yet it does not stop me from standing. Because to walk with women through this storm is sacred work.
Midwifery, Continuity & the Threshold of Becoming
Birth is liminal. It is not simply arrival. It is passage. It is transformation.
When care is continuous — when you know your midwife, when she knows you — you enter that threshold with trust. The research is clear: continuity models are the gold standard. They reduce interventions, improve satisfaction and reduce trauma.
Yet these models are being squeezed. The system draws inwards. Women are given fewer options, fewer meaningful choices, fewer relationships.
And still: we centre autonomy, we centre care, we voice truth.
A Feminist Issue, A Midwifery Issue, A Rights Issue
Framed rightly, birth choice is a feminist issue. It is about gendered power, bodily autonomy, the intersection of health, identity and culture.
The framing of this debate as “ideology” is a strategy of control: control of women, control of bodies, control of birth. It masks the real crisis: collapse of choice, collapse of continuity, collapse of trust.
When women are silenced, when midwives are constrained, when choices vanish — no amount of regulation will substitute for dignity.
Emotional & Practical Realities for Families
For families choosing autonomy: you are brave. You are choosing to trust. You are choosing to climb a hill where the view is less travelled.
For families not choosing home birth: your choice is equally valid. My stand is not judgement — it is freedom. Freedom for you to choose what aligns, what feels safe, what you believe.
For you, I offer relationship. I offer presence. I offer continuity. I offer transparent discussion about risk, about emergent decisions, about physiology, about system limitations.
And I hold this: that for many women, the greatest risk is feeling unheard, unseen, coerced, diminished. That is the storm we cannot ignore.
A Reality Check: Where Are We Now?
Homebirth services: shrinking, restricted.
Birthcentre availability: under pressure.
Continuity midwifery: less invested than ever.
Maternal death rate: rising.
Autonomy: increasingly spoken of as a threat rather than a right.
This is the crux. This is what we are resisting. This is why we name it.
Standing in Courage — For Midwives, For Families
Midwives who walk this path need courage. We need courage to say “I will stand with your choices.”
We need courage to walk the unknown, to practice relational care when systems incentivise speed.
We need courage to bear accountability, to step into discomfort, to hold space.
And mothers who choose differently need courage. To trust their bodies. To ask questions. To hold unwavering to what they believe in.
Together, we break the cycle of compliance. Together, we re-centre autonomy. Together, we reclaim the sacred.
Invitation: If You Seek Continuity, Care, and Choice …
I am Rachel of Birth Song Midwifery, based in East Sussex. I walk with families who yearn for relational care, for continuity, for autonomy, for birth crafted around you, not the system. Whether you are seeking a home birth, or a hospital birth with the same relational framework — I would be honoured to walk with you.
My spring 2026 diary is filling; now is the time to explore what your care can look like.
📚 Resource & Reading List
Birthrights UK – birthrights.org.uk
Essential reading on your legal rights in maternity care and the intersection of birth and human rights.The Politics of Birth – Sheila Kitzinger
A foundational text on how birth has become medicalised — and how we reclaim it.Women Who Run With the Wolves – Clarissa Pinkola Estés
Myth, psychology, and story woven into the reclamation of the wild feminine.Radical Wholeness – Philip Shepherd
A fascinating look at how the modern world has disconnected us from body intelligence — relevant far beyond midwifery.The Positive Birth Movement – Milli Hill
Explores how language, story and collective voice can reclaim power in birth narratives.Birthrights – Factsheet: Human Rights in Maternity Care Birthrights
MBRRACE‑UK – Maternal Mortality Data Briefs NPEU+1
