Safer Care Victoria’s new birth rules for Victorian hospitals
The state’s health watchdog has instructed doctors and midwives to support women who refuse medical treatment during pregnancy and birth, even if it risks permanent harm to their unborn babies.
Safe Care Victoria’s guidelines, which were quietly introduced this month and are the first document of their kind in the state, coincide with growing concerns about the prevalence of birth trauma and an anecdotal rise in the number of women choosing “free birth” outside the hospital system to avoid unwanted interventions.
The roadmap details how medical staff should respond when a mother refuses medical advice and treatment despite her or her unborn baby’s health deteriorating.
During these risky moments, staff are instructed to “respectfully inform the woman that permanent harm cannot be prevented,” while continuing to provide support without intervention.
In cases where women refuse medical treatment, the watchdog recommends hospitals reduce the number of staff in the room, keep an emergency team on hand in case the mother changes her mind, and assign a scribe to document all conversations.
It also reminds hospitals and healthcare professionals that under Australian law the fetus does not have legal rights separate from the mother.
Note the guidelines: “When a woman makes an informed choice about her pregnancy or newborn care that does not follow medical advice—even if there are concerns about the baby’s health—clinicians still have a legal and ethical duty to respect the woman’s decision.”
“This may be emotionally and ethically difficult for healthcare professionals, but Australian law is clear: the fetus has no separate legal rights and the woman’s choices must be respected.”
President of the Royal Australian and New Zealand College of Obstetricians and Gynecologists, Dr. Nisha Khot welcomed the new guidance and said it would help clinicians and patients deal with complex situations during pregnancy and birth.
Khot said maternity services are increasingly treating women who are concerned about the rationale for interventions during pregnancy and birth and who want something different from the standard model of care.
“There is more and more of this friction,” he said. “Women struggle with this, and clinicians struggle with this, too.”
Khot said he has seen clinicians cite hospital policy as the primary justification for interventions and fail to explain the true medical necessity to their patients.
“It happens because there is no consistent framework,” he said.
Under new Safer Care Victoria guidance, clinicians are advised to communicate respectfully, provide evidence-based information and avoid fear-based language. They should not use “coercive approaches” to enforce hospital protocols.
“These practices may contribute to gender-based harm,” the 34-page document says.
Alecia Staines, founder of the Maternity Consumer Network, said the guidelines were a vital step in addressing the “patient safety and quality issue” that leaves a third of women exposed to birth trauma. But he questioned how the rules would be enforced and said staff needed support to implement them.
“This should never be a trade-off between the woman’s experience and the clinical outcome,” Staines said. “If a woman’s autonomy is supported, you actually insulate her from the vast majority of birth traumas.”
The mother of six said cases where women refuse recommended treatments despite their health deteriorating are sad but rare.
“The baby doesn’t actually have any rights until it’s separated from the mother,” Staines said. “The woman makes decisions for herself and her baby. This is bodily autonomy and human rights, because ultimately she bears the consequences.”
Staines said the anecdotal increase in free births is a symptom of a birthing system that doesn’t serve women.
“For the vast majority of women [freebirthing] “It stems from feeling unsafe, previous traumas, and anxiety about being disrespected and abused.”
Victorian Coroner’s Court statistics show that in the ten years between 2015 and 20 August 2025, six babies died following free birth, four died following planned home births where medical staff were present, two died following planned home births where medical staff were unable to attend, and a further 15 babies died in unplanned home births (usually due to early arrivals).
The Coroner’s Court is currently examining the death of wellness influencer Stacey Warnecke, who suffered catastrophic bleeding following free birth in September.
Warnecke, 30, is believed to have died from complications of post-natal haemorrhage after giving birth to her son Axel in a water bath at her Seaford home on September 29.
Dr Ishita Akhter said she was “forced” into an unwanted epidural and emergency caesarean section after working for hours at a Melbourne hospital in 2022, despite repeatedly requesting a vaginal birth. She said doctors told the first-time mother that surgery was necessary because the epidural caused a permanent drop in her son’s heart rate.
“They brought in doctors and other midwives who said, ‘You need to have a caesarean section, not having a caesarean could endanger you and the baby,'” the academic recalled. “The situation was so stressful that I had to say yes.”
Akhter said that a few minutes before he was put under general anesthesia, he heard a doctor say that his pupil was fully dilated.
She said the surgery robbed her of the “golden hour” of her newborn son, who was not allowed to hold him for 20 hours while he was kept in nursery. She said that although the baby’s APGAR score at birth was a reassuring 7 and 9, staff told her her son was being treated for respiratory distress. Akhter underwent therapy for a year following the traumatic birth and now works as a birth advocate for other pregnant women.
A Victorian government spokesperson said the framework aims to reduce the distress and feeling of not being heard that contributes to birth trauma.
“The framework was developed by Safer Care Victoria with input from midwives, obstetricians, maternity care teams and women experienced in the birthing system,” she said.
The spokesperson 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 taskforce, a government initiative to improve maternity services, made a number of recommendations in a report presented in November, including the creation of a Chief Midwife for Victoria.
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Henrietta Cook is a senior health correspondent for The Age. Henrietta joined The Age in 2012 and has previously covered state politics, education and consumer affairs.Connect with: excitement, Facebook or email.
