BACKGROUND:
In Belgium, most births occur in obstetric-led units where midwives’ autonomy is restricted and their full professional competencies, as legally defined, cannot always be exercised (Vermeulen, 2021). Some midwives choose to work autonomously in extra-hospital settings, attending births at home, in freestanding or alongside midwife-led units.

OBJECTIVES:
This study explores how midwives practising autonomously in birth centres make room for women’s autonomy and how decision-making is negotiated.

METHODS:
This ongoing qualitative research is based on semi-structured interviews conducted between May and August 2025, in-person or via Teams. To date, seven autonomous midwives working in extra-hospital settings have participated. A grounded theory approach is used for analysis.

RESULTS:
These midwives usually accompany the entire labour and childbirth process. They observe that most women do not require them to "deliver" the baby, but rather to be present in a supportive and reassuring way. This continuity of care builds trust in the physiological process of childbirth and confidence in women’s capacities. Moving away from a risk-averse medical paradigm, internalised during training, requires experience and repeated observation of physiological birth. This trust also helps build therapeutic alliances. It relies on equality and open dialogue where both the midwife’s professional boundaries and the woman’s preferences are clearly expressed. Decision-making emerges through clear, complete information, dialogue and negotiations. When women’s requests fall outside the midwife’s safety limits, referral to another healthcare professional is discussed: this also supports autonomy while ensuring professional integrity, in a spirit of mutual respect.

CONCLUSIONS:
Autonomous midwifery practice in birth centres fosters women’s autonomy through relational care, informed dialogue, and mutual trust. This autonomy is co-constructed and negotiated, as respect for women’s choices must be balanced with respect for the midwife’s professional boundaries and sense of safety.

KEY MESSAGE:
In Belgian birth centres, therapeutic alliances are based on mutual trust and negotiated autonomy, aiming an equal partnership. Poster session 1 (Group A)