This Shared Insights forum took place on 15 July 2025.

This session focused on how to support staff to provide safe clinical care to birthing people who choose ‘birthing outside of guidance’.

This is also sometimes described as 'birthing off pathway' or 'birthing choices', meaning that they opt for a birth that falls outside of the current recommendations or clinical guidelines. This includes 'free birthing'.

We appreciate that however described, ‘birthing outside of guidance’ can be a highly emotive topic for both birthing individuals and healthcare providers. We know birthing people may have strong preferences for how they want to give birth, sometimes diverging from recommended guidelines or care pathways. We acknowledge the challenges, which can lead to tension between the desire for patient autonomy and healthcare professionals' responsibilities to ensure safety according to established protocols.

In this session, we heard legal, patient and clinician perspectives and discussed a range of issues including:

• The legal risks associated with ‘birthing outside of guidance’.
• Common pitfalls.
• Best practices during planning and supported decision-making processes.

The session was chaired by Browne Jacobson’s Kelly Buckley. Rachael Bose of Browne Jacobson covered the legal framework and potential issues arising from decisions to ‘birth outside guidance’.

We were delighted to be joined by Heather Simmonds-Copete, who shared her powerful personal story of birth trauma and the work she now does to support others through the Birth Trauma Association and Floretta Cox and Elizabeth Swift of University Hospitals of Leicester NHS Trust who gave an account of their tailored support for patients in these circumstances. They shared their practical experience of providing a dedicated service for these patients and how to keep communication open to support achieving the best outcome for all.

Given the time limitations, our session did not deal with emergency situations when ‘birthing outside of guidance’ or the issue of capacity.

We would like to thank our speakers for enriching our understanding with their diverse experiences and knowledge.

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