Duke Medical Ethics Journal
Birth Observed and Yet Undisturbed: A Case Study from 1624 to 2014 to 2024
Note: Discussion of stillbirths and death in infancy
by Morgan Biele
“People who choose to give birth should also get to choose how they are the agent of the birthing process, not objectified or a subject of birth.”
Since 2017, British photographer Natalie Lennard has been creating “Birth Undisturbed”, a fictional staged photography series depicting women in childbirth. The final piece was recently completed in 2022. The series reclaims the act of birthing—as viewership is chosen by those giving birth—rendering the public-facing display of birthing “undisturbed”. Lennard’s series empowers those giving birth. Their autonomy, both in giving birth and choosing to confront and reveal their experience, makes it impossible for them to be “disturbed”.
“Birth Undisturbed” comes after the stillbirth of Lennard’s first child, Evan, who died in 2014, after receiving a diagnosis of bilateral renal agenesis (being born without kidneys) and Potter’s Syndrome at a 32 week scan when he was deemed “incompatible with life”. As we approach the ten-year anniversary of Lennard’s experience, we also near the 400th anniversary of the 1624 British “Concealment Act”, formally known as the “Act to Prevent the Destroying and Murdering of Bastard Children”. This law convicted unmarried women as murderers, responsible for infanticide, if they had concealed stillbirths. The punishment was execution. The Concealment Act was deeply rooted in a “guilty until proven innocent” framework targeting unmarried women. Despite being hundreds of years apart, the Concealment Act and “Birth Undisturbed”—united by their notable anniversaries coinciding at 2024—reveal many implications for births surveilled over time. They elucidate what reinforces stigma or breaks it, what a "Birth Undisturbed" can look like, and what we want to make of this in 2024 as representative of the potential for change in the future.
The Concealment Act strongly stigmatizes unmarried pregnancies. It begins with “Whereas many lewd women” to target women pregnant out of marriage, and goes on to argue that women pregnant out of wedlock would receive so much societal shame and ostracization that she would ultimately cause the death of her child [1-2]. In merely these first few words, the Act perpetuates the stigma of marriage out of wedlock with its use of “lewd”. The law’s language pinpoints its motive as a response to societal stigma directly, when it reads: “to avoid their Shame, and to escape Punishment, [women] do secretly bury or conceal the Death of their Children”, and that it exists, “For the Preventing therefore of this great Mischief” .
Notably, throughout the 18th century, 70% of the women indicted for this crime of infanticide were servants under the age of 16 years old . The law ultimately resulted in 200 women tried for this crime between 1674 and 1803, when the law was repealed, as noted in the Old Bailey records which encompassed London’s main criminal court information from the time . This Act recognized the concealment of the birth to be the basis for a murder charge, so the women could be found not guilty if proof could be given that the woman was actually married, or that the baby was witnessed to be dead prior or during the original birth. Between 1720 and 1800, the Northern Circuit Courts executed only two women as a result of the Concealment Act. This appeared to be the trend for the law throughout its existence: one which indiscriminately accused women based on presupposition, but did not create meaningful societal change .
Criminologist Leon Radzinowicz noted that the “statute was one of the few in English criminal law which were framed contrary to the principle of presumption of innocence” . Ultimately, these women were guilty until they could prove their innocence, implicitly requiring them to either be married, or have their birth witnessed in case it was a stillbirth. The act ends with: “In every such Case the said Mother so offending shall suffer Death as in Case of Murther, except such Mother can make proof by one Witness at the least, that the Child (whose Death was by her so intended to be concealed) was born dead” [1, 2, 8].
Records show that 22 women were acquitted from the charge just for having a witness attest that they were married . Women who were known to be married at the time of concealing their stillborn were charged with a different crime, with only eight indictments in the same period as the 200 Concealment Act charges, with three women being acquitted for accidental deaths, and two for being deemed “out of their senses” and not responsible .
Because the law ultimately then does not look at the cause of death so much as the act of Concealment, one of the defenses most frequently used is known as “The Preparation Defense” which said that women could attest to preparing for the birth with witnesses or proof, like in having baby clothes, or having a room prepared for the birth [7, 8]. On the other hand, the hiding of a pregnancy was largely viewed to be an intention for murder if the baby was later found to be dead, regardless of whether there was actually proof of cause . Scholars have interpreted the Act to highlight the apparent moral contradiction, as the death of a child could be “justified” if the mother was married, but “unjustified” and fundamentally insidious if the birth was illegitimate.
I turn to this act as a case study to think about how birth was observed. This law was made in response to a societal shame believed to be so strong that it could be driving women to kill their children and therefore needed legal intervention so as to avoid it. Ultimately, the law became one of criminalizing “Concealment”, criminalizing those who were the subjects of imposed shame, and was about whether the birth was viewed within norms observed, regardless of what happened during the birth or after. Women were being driven to give birth in private but then also did not have the privilege of privacy.
Long after the end of this law in 1803, Lennard’s photo series openly invites observation into the act of birthing, reclaiming women’s choice in where and how observation of their experience is possible . The women have blood on their hands in these photos, evidence as the agents of creation and the autonomous agents of their observation. As Lennard writes in her artist’s statement, the photos juxtapose “undisturbed amongst varying palettes of chaotic, cinematic disturbed” . She explained that “upon conceiving the series [she] quickly became focused by the idea of creating images we have never seen” and bringing the act of birthing itself back into the spotlight, as opposed to the stigma associated with it . For her, she is not forced into witness, but invites it: “I wanted to picture that which we have lacked the opportunity to witness, either because the nature of the scene is taboo, unusual, or simply obscured by the focus on an overly dramatic or exclusively-medicalised depiction of birth we see in mainstream TV, movies etc.” .
The series includes historical figures in the act of childbirth, demonstrates spaces that have shaped childbirth, and even displays birth phenomena like the “fetal ejection reflex”, or the water birth, that all together create a nuanced, layered look at birth. The series does not require a specific lens for understanding the pieces. Rather, the series focuses on the power and autonomy of the person giving birth. There are photos from a hospital room just as there are photos inspired by The Farm, a community where births happened in school buses employing the midwifery principles of Ina May Gaskin.
One of the most controversial images is called “The Creation of Man” (2017) and depicts biblical Mary giving birth to Jesus in a standing position in the manger of the Western depiction of the nativity scene. Lennard describes her as the “Omniscient image” of the Virgin Mary but one who has never been depicted in birth, an omniscient image about birth without the actual birth .
Lennard even included a scene from English history. In her piece entitled “Royal Blood” (2018), she depicts Queen Elizabeth II during her final home birth in 1964 (50 years before Lennard gets her idea for the series from her own home birth). Lennard describes: “This photo recreates and spotlights the elusive revelation that the Queen broke several traditions in Royal birthing history: to be unobserved, and to have her husband, Prince Philip at her bedside, the first male Royal partner in modern history to be present at a delivery” . She is unobserved by the public, when Lennard notes that previously there was a tradition of more observance, and yet she has her husband observe when traditionally he would not have been there . It encapsulates a “birth observed and yet undisturbed”, because she gets to choose the conditions of observance, so as not to be disturbed by them. This birth became in part remarkable for the Queen’s autonomy: choosing to stay conscious, choosing to have her husband there, refusing to switch to a different room, and refusing to have more observers.
Finally, we turn to Lennard’s own story, the one that
inspired the photo series . At the time, Lennard had
been told a doctor would need to be there to certify
death or in order to conduct a postmortem, yet Lennard
chose to not have the doctor there to certify death at
the moment . Lennard had given birth feeling
empowered because she had planned it the way she
had wanted. Even with Evan’s diagnosis, she made
decisions about the birth itself that would optimize the
experience for her and for him, that would allow her to
grieve but to celebrate the birth. She uses items from the
births of her children (two more after Evan), in her pieces
in this series about the “birth undisturbed” . Of course
Evan’s fatal condition was non-negotiable, but at the stark
other side of the spectrum from the Concealment Act,
Lennard’s stillbirth was for her, an opportunity to be proud
of his birth and what she could provide for him.
Now that the photo series has ended, and we come upon this anniversary year of 2024, ten years for Lennard and 400 years for the Concealment Act, what should we do next? The near future grants us the time to raise the ethical questions of what we could and should do. Lennard notes in a video that she uses birthing metaphors for her creative work, a “labour of love” in her artist’s statement, but also the birth of the idea and others [3, 5]. With a vocabulary for a “birth observed and undisturbed”, I believe future directions do turn to creative processes that can be generative and productive to reinforce the empowerment of an autonomy-granting “bringing into the world”. Lennard writes about the benefits of her narrativizing her birth stories as an advocate for narrative medicine .
In addition, we look to these examples as not only interesting evidence for these ideas, but as ethical questions for the future. With immense disparities in healthcare by race, socioeconomic status, gender, and more, no sweeping claims about what a birth should look like seem fitting or even possible. There are privileges to certain elements of privacy and observation that are not equally available as resources to people giving birth. These examples need to be modified to include people giving birth from more backgrounds, but the hope is that in these very specific examples, people who choose to give birth should also get to choose how they are the agent of the birthing process, not objectified or a subject of birth. We are at a confusing and pivotal moment for these ideas, whether it be because abortion laws are changing across the United States—increasing the scope of “concealment” to abortion—but also more subtle changes, such as the creation of birthing videos for social media, and more vocal stories about postpartum life in blogs, advice, or even news stories. If observation and disturbance can be attended to as vehicles to help improve access to the infrastructure and resources necessary for more people, especially people more at-risk in birth, to give birth safely, then that is what this should aim to accomplish. If the recognition of observation can decrease stigmas, empower, and create a more inclusive lens on birth-giving, then it is important to consider.
Review Editor: Eric Lee
Design Editor: Shanzeh Sheikh
 1623: 21 James 1 c.27: To prevent the destroying and Murthering of Bastard Children. The Statutes Project. (2022, May 20). Retrieved April 8, 2023, from https://statutes.org.uk/site/the-statutes/seventeenth-century/1623-21-james-1-c-27-to-prevent-the-destroying-and-murthering-of-bastard-children/
 Cambridge, Printed by J. Bentham. (1762, January 1). The statutes at large from the magna charta, to the end of the eleventh parliament of Great Britain, Anno 1761 [continued to 1806]. by Danby Pickering : Great Britain : Free Download, borrow, and streaming. Internet Archive. Retrieved April 8, 2023, from https://archive.org/details/statutesatlarge50britgoog/page/298/mode/2up
 Framed Show. (2018). The Story Behind Artist Natalie Lennard's Birth Undisturbed Series. YouTube. Retrieved April 8, 2023, from https://youtu.be/lZoSXFF4SSE
 "Infanticide Trial Transcript from the Old Bailey of Elizabeth Taylor of Clerkenwell, London, June 1734 [Trial Record]," in Children and Youth in History, Item #162, https://cyh.rrchnm.org/items/show/162 Retrieved April 8, 2023, from https://chnm.gmu.edu/cyh/primary-sources/162.html
 Lennard, N. (n.d.). Artist's statement. Birth Undisturbed. Retrieved April 8, 2023, from https://www.birthundisturbed.com/artist-statement
 Lennard, N. (2018, March 28). Victory voyage: The story of evan. Positive Birth Movement. Retrieved April 8, 2023, from https://www.positivebirthmovement.org/victory-voyage-the-story-of-evan/
 McDonagh, J. (2003). Child murder and British culture, 1720-1900. Cambridge University Press.
 "She was out of her senses when she did it": Narratives of infanticide defense in eighteenth-century London. | Prized Writing. (n.d.). Retrieved April 8, 2023, from https://prizedwriting.ucdavis.edu/%E2%80%9Cshe-was-out-her-senses-when-she-did-it%E2%80%9D-narratives-infanticide-defense-eighteenth-century-london