The state’s health watchdog has ordered doctors and midwives to support women who refuse medical treatment during pregnancy and childbirth, even if it risks permanently harming their unborn babies.
The Safer Care Victoria guidelines, which quietly came into effect this month and is the first document of its kind in the state, coincide with growing concerns about the prevalence of birth trauma and an anecdotal rise in the number of women choosing “freebirths” outside the hospital system to avoid unwanted interventions.
The road map details how medical staff should respond to cases where a mother declines medical advice and treatment despite her own health, or that of her unborn baby, deteriorating.
In these high-stakes moments, staff are instructed to “respectfully inform the woman … that permanent harm may not be avoidable”, while continuing to provide support without intervention.
In cases where women refuse medical treatment, the watchdog advises hospitals to reduce the number of staff in the room, keep an emergency team on standby in case the mother changes her mind, and appoint a scribe to document all conversations.
It also reminds hospitals and health workers that under Australian law, a fetus does not hold separate legal rights from the mother.
“When a woman makes an informed choice about her pregnancy or newborn care that doesn’t follow medical advice – even if there are concerns about the baby’s health – clinicians still have a legal and ethical duty to respect her decision,” note the guidelines.
“This can be emotionally or ethically difficult for health professionals, but Australian law is clear: a fetus does not have separate legal rights, and the woman’s choices must be respected.”
Dr Nisha Khot, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, welcomed the new guidance, and said it would help clinicians and patients navigate complex situations during pregnancy and childbirth.
Khot said maternity services were increasingly treating women who were concerned about the rationale for interventions during pregnancy and childbirth and wanted something different to the standard model of care.
“There is more and more of this friction,” she said. “Women are struggling with it, and clinicians are struggling with it.”
Khot said she had seen clinicians cite hospital policy as the primary justification for interventions, and fail to explain the actual medical necessity to their patients.
“It happens because there isn’t a consistent framework,” she said.
Under the new Safer Care Victoria guidance, clinicians are advised to communicate respectfully, provide evidence-based information and steer clear of fear-based language. They should not use “coercive approaches” to enforce hospital protocols.
“These practices can contribute to gender-based harm,” the 34-page document states.
Alecia Staines, the founder of Maternity Consumer Network, said the guidelines were a vital step in addressing a “patient safety and quality issue” that had left one-third of women with birth trauma. But she questioned how the guidelines would be implemented, and said staff needed support to roll them out.
“It should never be a trade-off between the woman’s experience and the clinical outcome,” Staines said. “If a woman’s autonomy is upheld, you’ve actually insulated her against the vast majority of birth trauma.”
The mother of six said situations where women refuse recommended treatments, despite their health deteriorating, were distressing but rare.
“The baby actually doesn’t have any rights until it’s detached from the mother,” Staines said. “The woman gets to make decisions for her and the baby. That is bodily autonomy and human rights because ultimately, she bears the outcome.”
The anecdotal rise in freebirths was a symptom of a maternity system that was not serving women, Staines said.
“For the vast majority of women, [freebirthing] is due to not feeling safe – previous trauma and concerns about being disrespected and abused.”
Victorian Coroners Court statistics show that in the decade between 2015 and August 20, 2025, six babies died following freebirth, four died following planned home births with medical staff present, two died after planned home births where medical staff were unable to attend, and 15 died in unplanned home births (often due to premature arrivals).
The Coroners Court is currently examining the death of wellness influencer Stacey Warnecke, who suffered catastrophic bleeding following a freebirth in September.
Warnecke, 30, is believed to have died from complications of a postpartum haemorrhage after giving birth to her son, Axel, in a water bath at her Seaford home on September 29.
Dr Ishita Akhter said that after labouring for hours at a Melbourne hospital in 2022, she was “coerced” into an unwanted epidural and emergency caesarean despite her repeated requests for a vaginal birth. She said doctors told her the surgery was necessary because the epidural was causing a persistent drop in the heart rates of the first-time mother and her son.
“They brought in doctors and other midwives who said, ‘You have to go for a C-section, not having one could endanger you and the baby’,” the academic recalled. “The situation was so stressful, I had to say yes.”
Akhter said that moments before being placed under general anaesthesia, she overheard a doctor saying she was fully dilated.
She said the surgery robbed her of the “golden hour” with her newborn son, whom she was not permitted to hold for 20 hours while he was kept in the nursery. She said staff told her that her son was being treated for respiratory distress – despite the baby recording a reassuring APGAR score of 7 and 9 at birth. Akhter underwent therapy for a year following the traumatic birth and now works as a maternity advocate for other pregnant women.
A Victorian government spokeswoman said the framework aimed to reduce distress and the sense of being unheard, which are both contributors to birth trauma.
“The framework was developed by Safer Care Victoria with input from midwives, obstetricians, maternity care teams and women with lived experience of the maternity system,” she said.
The guidelines were a response to the Victorian Maternity Taskforce’s call to strengthen respectful, equitable and culturally safe maternity and newborn care, the spokeswoman said.
The taskforce, a government initiative to improve maternity services, made a number of recommendations in a report tabled in November, including the creation of a Chief Midwife for Victoria.
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Henrietta Cook is a senior reporter covering health for The Age. Henrietta joined The Age in 2012 and has previously covered state politics, education and consumer affairs.Connect via Twitter, Facebook or email.
