The Old Catholic Church affirms the virgin birth of Jesus Christ as a historical and theologically significant doctrine. Jesus was born of the Virgin Mary through the direct action of the Holy Spirit, without conception by a human father. This doctrine is attested in Matthew 1:18-25 and Luke 1:26-38 and was universally affirmed in the early church.

Mary is honored as Theotokos (God-bearer), the mother of the one person, Jesus, who is God. This title, affirmed by the Council of Ephesus (431 AD), both honors Mary and protects the doctrine of the incarnation. The virgin birth demonstrates God's direct action in redemptive history and establishes the unique mode of Christ's entry into human existence.

Perpetual virginity of Mary is affirmed by many Old Catholic branches, reflecting Catholic tradition, though some branches do not strictly require this doctrine. The virginal conception is universally affirmed; perpetual virginity is a matter of theological tradition and pious devotion rather than essential doctrine. Mary is venerated as the preeminent saint and intercessor, though worship (latria) is reserved to God alone.