Natalie Krueger lives in Osmond, Nebraska, a town with a hospital that has no labor and delivery unit at all. When she went into labor with her first child in 2020, she had to drive across state lines to Yankton, South Dakota, laboring in a Walmart and a restaurant along the way before finally reaching a hospital, where she received an epidural and delivered her son, Sawyer. For her next two children, she didn't go to a hospital at all.
Krueger, a doula, gave birth to her son Callahan in 2023 at home without a midwife present, and to her daughter Aurora in April 2026 in what she describes as her second free birth, according to reporting by KCUR. Free birth means intentionally giving birth without any medical professional, qualified midwife or physician present, a definition distinct from an attended homebirth, as Today's Parent explains. During Aurora's labor, Krueger signed an against-medical-advice form before leaving the hospital, and the baby was ultimately born with her umbilical cord wrapped around her neck, per the KCUR report.
Krueger's situation reflects a broader gap in rural maternity access. Pierce County, Nebraska, where she lives, is classified as a maternity care desert — a county without a birthing facility or obstetrician — and only two midwives served her area at the time of her birth, KCUR reports. Nationally, one in three U.S. counties lacks access to maternity care, according to the March of Dimes.
Nebraska's Strict Midwifery Laws Complicate Access
Nebraska has some of the strictest midwifery laws in the country. State law classifies attendance at home births by certified nurse midwives as a felony in some instances, making legal home birth with a midwife illegal for many families, according to the same KCUR reporting. The Nebraska Supreme Court closed a midwifery licensing loophole in 2024, though that decision was reversed in 2025. Certified nurse midwives are registered nurses with additional nursing and nurse-midwifery education, while certified professional midwives are not required to hold a nursing degree — a distinction that shapes who can legally attend a birth in the state.
Elsewhere in the region, families describe barriers that can drive them toward unassisted birth.
Elsewhere in the region, the article discusses barriers to attended home birth and the potential complications of unassisted birth.
Serious Complications Have Followed Some Unassisted Births
Serious complications have followed some unassisted births, including postpartum hemorrhage, KCUR reports. Kansas City-area OB-GYN Caitlin Linscheid identified shoulder dystocia and postpartum hemorrhage as common birth emergencies, noting that postpartum hemorrhage can cause liters of blood loss within minutes — complications that Today's Parent notes can arise even in healthy, low-risk pregnancies. In a hospital, medical staff can respond immediately with medication, bleeding control or emergency surgery, options that are not readily available at home.
Home births across Iowa, Kansas and Missouri have increased in recent years, mirroring a national pattern. Freebirths are believed to represent only a tiny proportion of those home births, most of which are planned and attended by midwives, according to The New York Times. Health officials do not track free births specifically, according to the KCUR reporting.
A Movement Amplified by Social Media, and Its Deadly Cases
Free birth has been popularized in part by social media influencers, and interest in the practice has trended upward online over the past year, per the Times, which cited data from ViralMoment. Abbey Khopesh, who gave birth to both of her children unassisted and did not receive prenatal care, said she does not recommend free birth for other women, according to KCUR. People who choose free birth say the practice is often misunderstood, per the same report, even as experts quoted in the article maintain it is dangerous and potentially deadly.
That danger has proven fatal in at least one high-profile case. Stacey Warnecke died after giving birth at home without medical assistance in September 2025, hemorrhaging after the birth, according to KCUR. A pathologist later found her cause of death to be a postpartum hemorrhage, per the ABC. Accounts differ on how quickly emergency help was sought: the Guardian reported an ambulance was called around half an hour after the bleed began, after Warnecke gave permission, while the ABC reported her birthkeeper asked her three times over five minutes whether she wanted an ambulance called before it was summoned. Medical experts told the inquest into her death that it was preventable had medical staff been involved, according to the Guardian.
Warnecke's death is one of the cases the Guardian examined in connection with the Free Birth Society, a North Carolina-based business founded in 2017 by birth advocate Emilee Saldaya that promotes birth without midwives or doctors present. The Guardian's investigation examined cases of stillbirth, neonatal death or other serious harm apparently involving mothers or birth attendants linked to the organization, and found evidence suggesting the group played a significant role in decisions that contributed to potentially avoidable tragedies. The organization is described as multimillion-dollar, according to KCUR reports.
The reporting examines the broader maternal-health context surrounding these choices.
