A coronial inquest is this week examining the death of Melbourne wellness influencer Stacey Warnecke after a freebirth at her home in September.
About 25 minutes after her son Axel was born, Warnecke had a postpartum haemorrhage (severe blood loss after birth) and without timely treatment, went into cardiac arrest.
The inquest is trying to determine why Warnecke decided to have a freebirth, in order to prevent similar deaths in future. It heard Warnecke believed a freebirth was the only way to have a baby entirely on her terms.
But what does the research say about other women who seek a freebirth? My colleagues and I have been researching this question for the past decade. Here's what we've found.
What is a freebirth and a birth keeper?
A freebirth is when a woman chooses to have a birth, usually at home, without a registered health professional, such as a midwife or doctor, in attendance. This is different to a homebirth, where women are cared for by a registered midwife.
Freebirths are also referred to as unassisted or wild births .
Sometimes only the partner or a friend or relative are there, but more often women hire an unregulated birth worker such as a " birth keeper " or doula for support.
Unregulated birth workers don't have the formal training , medical equipment or skills to detect and manage any complications.
But our research has shown unregulated birth workers often provide care that is clinical, such as assessing the growth of the baby or listening to the baby's heart during labour.
What are the risks of freebirth?
There are risks with freebirths that a trained midwife at a homebirth could pick up early and manage, or that would prompt a timely transfer to a nearby hospital.
Home births with a registered midlife linked to a responsive health system have a good safety record in Australia .
Midwives now provide more than 20 publicly funded homebirth services linked to public hospitals across Australia as well. But most homebirths are with privately practising midwives that families pay for out of pocket.
Even when a woman's pregnancy and birth is considered low risk, emergencies can occur: postpartum haemorrhages, the newborn baby needing resuscitation, or the mother needing extra medical care.
These emergencies require specialised skills and equipment, and timely transfers to hospital.
Rising popularity but little data about harms
We don't know how the statistical risks of freebirths compare with homebirths that have a private registered midwife or are linked to a hospital, as this data isn't collected.
However the number of coronial findings and media reports of harms from freebirths over the past few years is a cause for concern .
In recent years, and particularly since the COVID pandemic, social media influencers have set up communities of like-minded people to share content about freebirths. These messages have gained momentum and interest, while trust in institutions and experts has declined.
Why women might make this choice
Women who choose to freebirth are more likely to have had a baby before (77%), be white and well-educated.
Freebirths seem more common in regions with higher rates of homebirths, where communities seek a more natural approach to life.
A previous negative birth experience - which may result from a traumatic event, health provider abuse, coercion or care delivered without consent - is a major motivator to have a subsequent freebirth.
A previous negative birth experience may include an unwanted medical intervention such as a caesarean section, or a lack of choice, such not being able to have a homebirth or a vaginal birth after caesarean in mainstream maternity care.
Some women who have a freebirth tried to make the process safer for themselves and their baby. They may have tried to find a midwife to see them at home but couldn't afford the cost or were not able to access a homebirth because it was considered too risky.
Sometimes, a women had a birth that went very well the first time or was very fast, which made a freebirth seem like a safe alternative.
It's not that women who choose a freebirth are unaware of the risks. Women carefully consider the risk but often consider things such as unwanted intervention and birth trauma as a risk in itself that they find unacceptable.
The recent New South Wales Birth Trauma Inquiry received thousands of submissions from women who reported their traumatic experiences. We analysed 1,213 of these publicly available submissions and found over 75% of reported birth trauma was due to disrespect, abuse or health care provided without consent.
What can we do to reduce freebirths?
Our maternity system needs to give women choices and humanise the care it provides.
Sometimes health services unintentionally recreate conditions and memories of a previous traumatic experience or a past birth experience that prompts women to avoid this care in the future.
Health-care providers need to be part of the solution, not part of the problem. Like any skill, they need training in informed consent and trauma-informed care .
A landmark Victorian judgment in March clarified the legal stakes of coercive maternity care. Plaintiff Larissa Gawthrop's birth plan stated: "I decline all vaginal examinations unless there is an urgent medical reason to do so."
When she arrived at Bendigo Health in labour, she was told she would not be admitted unless she agreed to a vaginal examination. After several hours, she relented. Bendigo Health was ordered to pay A$275,000 in damages as consent was not given in a free, informed or voluntary way.
This judgment, alongside the 2024 NSW Birth Trauma Inquiry, represents a significant shift in how women's autonomy and informed choice must be respected.
Addressing systemic changes and behaviours would then reduce the numbers of women choosing to freebirth.
High rates of birth intervention in Australia is also leading to more birth trauma and fear about birth.
Likewise, the lack of birth centres and availability of homebirth without huge private fees needs to be addressed to provide women with safe and acceptable options.
Hannah Dahlen receives funding from NHMRC, ARC and MRFF
