Contribution of the UK Midwives and Freebirth study to the National Maternal and Neonatal Investigation call for evidence.

An apparent rise in births without professional attendance (freebirth) has been reported in the UK. The UK Midwives and Freebirth study explored the perspectives of 432 UK clinical midwives between 2022 and 2025, offering midwives' perceptions of trends and motivations driving this practice in the UK, as well as evidence on how midwives deliver care in the context of freebirth decisions. Key preliminary findings indicate: 1) Freebirth may be increasing in the UK in response to unreliable, inflexible and sometimes harmful maternity care provision, reflecting growing distrust in maternity services; 2) When maternity services are unable to meet women's needs, alternative forms of unregulated birth attendance may be increasing in the UK; 3) A risk-averse culture, unclear guidance and lack of support constrain midwives' professional agency and capacity to provide personalised, compassionate, safe care. This report was provided as evidence to the National Maternity and Neonatal Investigation, which aims to develop one set of national recommendations to drive improvements in maternity and neonatal care across England, and is part of a wider package of actions to boost accountability and safety in the NHS.