Victorian Childbirth Autonomy: New Guidelines Amidst Freebirth Death Inquest

Victorian health authorities have recently issued new guidelines emphasizing support for women's autonomy in childbirth decisions, including the refusal of medical treatment. This development coincides with a coronial inquest probing the death of a woman during an unassisted "freebirth" and growing data on infant deaths and injuries linked to such practices, prompting calls for enhanced regulation and reforms within the state's maternity services.

New Guidelines on Childbirth Choices

Safer Care Victoria, the state's health watchdog, introduced new guidelines in January that mandate doctors and midwives to support women who decline medical treatment during pregnancy and childbirth. This directive applies even when such refusal may carry risks for the unborn baby.

The guidelines aim to address increasing concerns about birth trauma and a reported rise in women opting for "freebirths," which occur outside the hospital system without medical intervention.

The new framework instructs medical staff to:

• Respectfully inform women 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.

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, provided it is made with full understanding. The guidelines also advise against the use of fear-based or coercive language, identifying such practices as potential contributors to gender-based harm and birth trauma.

Dr. Nisha Khot, President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), expressed support, stating it would assist both clinicians and patients in complex situations. Alecia Staines, founder of Maternity Consumer Network, described the guidelines as an essential step toward addressing patient safety and quality, asserting that upholding a woman's autonomy helps prevent birth trauma. A Victorian government spokesperson indicated the framework aims to reduce distress and feelings of being unheard, factors known to contribute to birth trauma.

Coronial Inquest into Maternal Death

A coronial inquest is underway into the September 2025 death of 30-year-old Stacey Warnecke, a wellness influencer who died from a postpartum haemorrhage and experienced multiple cardiac arrests following a "freebirth" at her Seaford home. She had given birth to her son, Axel, in a water bath.

A "birthkeeper" named Emily Lal, known online as The Authentic Birthkeeper, was present during the birth and later involved in contacting emergency services. Ms. Lal initially declined to provide a statement to the investigation, citing privilege against self-incrimination. However, Coroner Therese McCarthy deemed Ms. Lal's evidence "crucial" and has issued a witness summons, indicating the court's authority to compel testimony in the interests of justice, potentially with a certificate to protect against self-incrimination. Police reported that Ms. Lal had extensively cleaned the scene of the birth.

The inquest, scheduled for June 15-19, will examine:

• The cause of Ms. Warnecke's death.
• The regulations surrounding doula advertising.
• The impact of freebirthing on the health system.
• The availability of maternity care for women who opt against hospital births.

Reports indicate Ms. Warnecke received no medical care, ultrasounds, or consultations during her pregnancy and was reportedly affected by COVID-19 vaccine mandates.

Ms. Lal was also referenced in a separate coronial investigation regarding the 2022 death of "Baby E," an infant who died from neonatal pneumonia and complications from a prolonged labour during a home birth. Victoria's Health Complaints Commissioner issued a public warning about Ms. Lal in October and imposed an interim ban, preventing her from offering "any general health services" after allegations of facilitating or participating in freebirths that could endanger mothers and babies.

Rising Trend of Freebirths and Associated Risks

A "freebirth" is defined as giving birth at home without the presence of registered medical or midwifery professionals. This distinguishes it from a planned homebirth that involves a trained midwife after a low-risk pregnancy assessment by a doctor.

Data reveals a concerning trend of adverse outcomes associated with freebirths in Victoria, prompting calls for greater awareness and intervention.

Data on outcomes associated with freebirths in Victoria includes:

• Victorian Coroners Court (2015-August 2025): Six baby deaths following freebirths, four following planned home births with medical staff, two after planned home births without staff, and 15 in unplanned home births.
• High-level health sector sources (past five years): At least 13 baby deaths and 11 potential lifelong brain injuries have been linked to freebirths, along with one maternal death (Stacey Warnecke). This data includes full-term stillbirths during labor, which are not classified as deaths by the Coroner's Court, explaining a discrepancy in figures.
• Medical sources report a significant increase in freebirth-associated deaths since 2021, with many attributed to a lack of oxygen during labor. Health experts suggest most of these deaths and injuries could have been prevented with professional assistance.

Professor Hannah Dahlen, a midwifery expert, attributes the rise in freebirths to various factors, including:

• Increasing rates of medical intervention.
• Distrust in medical institutions.
• Experiences of birth trauma.
• Pandemic-related hospital restrictions.
• A shortage of private midwives.
• The influence of "wellness influencers."

Regulatory and Expert Responses

The Australian Health Practitioner Regulation Agency (AHPRA) is developing guidelines for midwives who work alongside unregulated birth workers, as well as public resources to inform individuals about the benefits of clinical care from registered midwives. However, the Nursing and Midwifery Board of Australia is not proposing regulatory changes specifically targeting unregulated birth workers.

The Victorian government is reviewing South Australia's regulatory model for birth-workers, which includes fines for doulas performing restricted birthing practices. Health Minister Mary-Anne Thomas is seeking advice from the Health Department on protective measures for Victorian families.

Experts have called for further action:

• Dr. Nisha Khot of RANZCOG has urged the government to regularly release freebirth death and injury data to inform expectant mothers.
• RANZCOG and the Australian College of Midwives advocate for laws that restrict labor and birth management to appropriately trained, registered practitioners, similar to regulations in South Australia and Britain.
• Professor Hannah Dahlen cautioned that strict legislation against doulas could further alienate women from health services, suggesting that improving access to private midwives, expanding hospital home birth programs, and "humanizing" birth experiences could be safer alternatives.
• Associate Professor Gino Pecoraro, a senior obstetrician, expressed concern over outcomes and called for an overhaul of the maternity sector to improve access, choice, and continuity of care, noting that only 5% of Victorian women received continuous midwifery care in 2023.