Freebirth and professional responsibility: Respect for autonomy does not justify clinical neutrality on preventable fetal and neonatal harm

The freebirth movement, planned birth without any qualified professional attendant, is expanding internationally, including in Scandinavia, where rising rates and incomplete outcome reporting have raised clinical and ethical concerns. A recent editorial in this journal emphasizes respectful engagement with women considering out-of-hospital birth and the importance of rebuilding trust through less coercive models of care. We argue that insufficient distinction between professionally attended home birth and planned unassisted birth risks conflating two distinct professional obligations: respecting patient autonomy and maintaining clinical neutrality in the face of preventable fetal and neonatal harm. These are not equivalent obligations. Respect for autonomy requires accurate, complete, evidence-based counseling and a clear professional recommendation when the evidence warrants one, while preserving the patient's right to decline. After viability, the fetus acquires patient status with corresponding beneficence-based obligations that planned unassisted birth forecloses entirely. Directive counseling against a practice associated with increased risk of preventable fetal and neonatal death is not coercion. It is what informed consent requires of the clinician. Professional responsibility does not ask clinicians to choose between compassion and clarity. It requires both.