Safer Care Victoria has introduced new guidelines that mandate doctors and midwives to support women who decline medical treatment during pregnancy and childbirth. This applies even when such refusal carries risks for the unborn baby. The guidelines, which took effect this month, address increasing concerns about birth trauma and a reported rise in women choosing "freebirths" outside the hospital system to avoid medical interventions.## Key Directives for Medical StaffThe new framework details how medical staff should respond when a pregnant woman declines medical advice or treatment despite potential health deterioration for herself or her unborn baby. Staff are instructed to:
- Respectfully inform the woman that permanent harm may not be avoidable.
- Continue providing support without intervention.
- Reduce the number of staff in the room.
- Keep an emergency team on standby.
- Appoint a scribe to document all conversations.The guidelines also clarify that under Australian law, a fetus does not hold separate legal rights from the mother. Clinicians are reminded of their legal and ethical duty to respect a woman's informed choice, even if it diverges from medical advice.## Expert PerspectivesDr. Nisha Khot, President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, expressed support for the new guidance. She noted that it would assist both clinicians and patients in navigating complex situations, especially as more women question the necessity of interventions during pregnancy and childbirth. Dr. Khot observed a growing 'friction' in maternity services regarding differing expectations.Alecia Staines, founder of Maternity Consumer Network, described the guidelines as an essential step toward addressing a 'patient safety and quality issue' that has resulted in birth trauma for a significant number of women. She emphasized that upholding a woman's autonomy helps prevent birth trauma. Staines also suggested that the rise in freebirths indicates a maternity system that is not adequately serving women, often stemming from previous trauma or concerns about disrespect.## Context and Legal BackgroundThe guidelines advise clinicians to communicate respectfully, provide evidence-based information, and avoid fear-based or coercive language, stating that such practices can contribute to gender-based harm.Victorian Coroners Court data from 2015 to August 2025 indicates six baby deaths following freebirth, four following planned home births with medical staff, two after planned home births without staff present, and 15 in unplanned home births. The Coroner's Court is currently investigating the death of Stacey Warnecke, who died from complications after a freebirth.An individual recounted a personal experience in 2022 where she felt 'coerced' into an epidural and emergency caesarean despite her preference for a vaginal birth, citing staff statements about risks to her and the baby. This experience led her to become a maternity advocate.A Victorian government spokesperson stated that the framework aims to reduce distress and feelings of being unheard, which are known contributors to birth trauma. The framework was developed by Safer Care Victoria with input from various stakeholders, including women with lived experience, and aligns with recommendations from the Victorian Maternity Taskforce to improve maternity services.