Birth is often seen as a clinical event, a moment to be managed and monitored by medical systems. But at its core, childbirth is an experience shaped by identity, culture, safety, and personal values. The place where someone gives birth isn’t just a location. It’s a symbol of autonomy, representing both a choice and a right.
Yet around the world, including here in Canada, the right to choose where and how to give birth remains inconsistently protected. Home birth is accessible for some and discouraged for others, while it remains out of reach for many. This article discusses why this disparity matters and why questions about birth setting are a crucial part of conversations on human rights and reproductive freedom.
Childbirth is more than just a medical procedure; it is a moment of autonomy. Restricting the ability to choose one’s birthplace raises a fundamental ethical question about bodily autonomy.
Choice in Childbirth as a Fundamental Freedom
International human rights frameworks have long recognized reproductive autonomy as essential to equality. Documents such as the Universal Declaration of Human Rights and the Convention on the Elimination of All Forms of Discrimination Against Women affirm women’s right to make decisions about their own bodies. Many countries reinforce these principles through national charters that recognize informed consent and free choice in reproductive health as essential to respecting individual freedom.
Home birth aligns with this principle. Choosing to give birth at home, surrounded by trusted midwives and/or loved ones, reflects personal choices, whether it’s for safety, familiarity, cultural continuity, or control over one’s environment. This decision is deeply connected to identity and lived experience. Ethically, it can’t be separated from the broader issue of who holds power during childbirth: the system or the individual?
When health systems restrict or compromise access to home birth, they do more than limit a birthing location option: they are restricting the right to self-determination.
A Québec and Canadian Context Marked by Struggle
Québec’s history reflects this tension. Before the legalization of the midwifery profession in 1999, home births existed in a legal gray area. Families depended on networks of so-called illegal midwives, who risked stigmatization and prosecution without any public funding. Today, midwifery services are available within the healthcare system: they are provided by healthcare facilities and are free for those covered by RAMQ (Quebec Health Insurance Plan). However, access still varies greatly from one region to another.
Many families still face:
- Long waitlists
- No midwives in their area
- Limited home birth availability
- Policies that prioritize institutional care over personal choice
This creates an ethical contradiction: while the rights to the best possible state of health and to make decisions are recognized in principle, they are not always respected in practice. When families want a home birth but no midwife is available, or they’re told they “don’t meet the criteria” despite being healthy, this isn’t just the denial of a preference. It is the fundamental freedom to make choices that is being violated.
For marginalized communities, including racialized families and rural residents, these barriers are even more significant. Autonomy depends on access, but access requires structural commitment.
The Power of Informed Choice (and What Happens When It’s Absent)
Around the world, organizations like the World Health Organization highlight that informed consent isn’t optional; it’s essential for respectful perinatal care. But informed consent only matters when people have genuine choices to agree to.
A home birth attended by a midwife offers:
- Continuity of care
- Personalized support
- Greater control over the birth environment
- Reduced unnecessary interventions
- An experience centered around the birthing person’s voice
When these options are unavailable or discouraged, families feel disempowered and anxious. They may disconnect from their own experiences. Often, the message becomes: You can choose, but only within the limits the system allows.
Systems Can Protect Autonomy or Undermine It
Whether medical, legal, cultural, or other systems, all influence childbirth norms. In some countries, home birth is criminalized. In others, midwives are prevented from attending out-of-hospital births. Even where home birth is legal, negative attitudes can undermine choice through fear-based messaging or misinformation. A lack of investment in midwifery services can have a similar impact.
A rights-based approach asks different questions:
- Does the system trust families to make informed decisions?
- Are midwives supported and empowered to provide safe out-of-hospital care?
- Are marginalized communities equally able to access home birth?
- Is the individual at the center of decision-making?
If the answer to any of these is no, autonomy is compromised.
This year, The Movement’s work has reaffirmed what communities have said for decades: birth culture in Québec needs to change. As we saw during our regional tour earlier this year, families repeatedly voiced concerns about access, informed choice, and the need for more equitable perinatal services, especially home birth.
The ethics of childbirth are simple. They show up every day in the lives of parents who can’t access a midwife, families pressured into hospital births, communities whose cultural traditions are dismissed, and individuals who view childbirth as a deeply personal act, not just as a simple medical procedure.
For Québec, the question isn’t whether home birth is safe. Decades of research already confirm that it is safe for low-risk pregnancies. The real question is whether our system will respect the rights and dignity of those giving birth. Our Great Gathering on February 7 and 8 at the Maison d’Haïti in Montreal, these conversations will be highlighted, creating a space for our entire community to help shape the future of perinatal rights. We are working toward a Quebec where home birth is not only legal but truly accessible and recognized. We invite you to join the Movement.
