I gave birth to my second child, a boy, just four days before Stacey Warnecke’s shocking death in childbirth. Stacey’s baby, also a boy, survived.

It was probably the hormones, or the proximity in birth of our two sons, who arrived under such different circumstances, but I broke down in tears when I heard the news. By all accounts Stacey was a healthy, vibrant young woman – newly married, excited about motherhood, her whole life should have been ahead of her. The tragedy of Stacey’s death wasn’t just that it was likely wholly preventable, but that it could have happened to any number of us.

It might be easy to heap blame on the fringe freebirth movement – in which women choose to give birth completely outside the medical system – or on the growing influence of doulas (birth support workers who are not medically trained). Obstetricians are understandably frustrated by the increasing numbers of women who, in eschewing what they see as the over-medicalisation of birth, are risking both their own health and that of their babies by tapping out of the system altogether.

Regulating doulas and cracking down on dangerous misinformation promoted by birth influencers on platforms like Instagram is a positive start. However, limiting our response to just that risks treating the symptoms and not the cause.

Our maternity system is broken. Until we take steps to meaningfully address the structural problems preventing pregnant women from feeling safe and supported in medical spaces, a small subset will continue to seek alternatives outside the system.

Like many first-time mothers, when I fell pregnant with my daughter back in 2022 I quickly discovered that the continuity of care model, wherein a woman is looked after by a small team of known midwives, is not only the gold standard in public maternity care, but almost impossible to gain access to. For both my pregnancies I asked my GP to refer me to the Royal Women’s midwife-led continuity of care program. Not only did I not receive a place, I never even heard back.

Women birthing in public hospitals today can expect to be attended to by a rotating shift of unknown midwives and doctors, many of whom are compassionate and dedicated but are nonetheless unfamiliar with the medical histories or birth preferences of their revolving door of patients. Many women find this impersonal approach to birth a bewildering and even dehumanising experience.

The Australian College of Midwives notes that women who give birth under the continuity of care model experience less unnecessary medical intervention and are more likely to deliver healthy babies, breastfeed successfully and feel positive about their labour and birth experience.

There is an economic dividend to continuity of care as well. Each time costly interventions such as medically unnecessary caesarean sections are avoided, thousands of taxpayer dollars are saved. Research by the college indicates that extending continuity of care to 50 per cent of a hospital’s maternity caseload could save the hospital up to $3.4 million a year, mostly from a reduction in births by caesarean section.

Rates of caesarean section have risen dramatically in Australia due to a multiplicity of complex reasons, some of which do not appear to be related to medical necessity. As of 2023, 41 per cent of births were by caesarean, up from 29 per cent in 2004. According to the World Health Organisation, caesarean rates above 10 per cent do not correlate with reductions in maternal or infant mortality.

Some of this dramatic increase can be explained by women’s changing birth preferences, growing rates of obesity and trends toward older women giving birth, but there is evidence that indicates that caesareans and other birth interventions, particularly in the private system, are also performed for reasons including scheduling, convenience, hospital culture and financial incentives which determine how a doctor or hospital is paid. A recent NSW parliamentary inquiry into birth trauma profiled numerous examples of such claims involving private and public hospitals. Quoting a submission by the organisation Human Rights in Childbirth, the inquiry’s report noted that “women often feel coerced or misled into having an emergency caesarean, only to later discover the procedures were not genuine emergencies”. The inquiry’s report also cited research from Maternity Choices Australia which stated that at least 15 per cent of inductions are “unnecessary”, with one explanation offered for this being “convenience-driven scheduling due to staff shortages”.

Mums’ groups and pregnancy support forums are replete with stories of women whose babies arrived via an unplanned caesarean or other interventions such as episiotomies, forceps or ventouse delivery, for reasons which were not adequately explained to the mother, who did not feel she gave informed consent. The NSW parliamentary inquiry also noted that “a large number of women shared their personal experiences of procedures being performed without proper consent”, referring to this depressingly common occurrence as a form of “obstetric violence”, one of the key drivers of birth trauma.

It’s estimated that one in three postpartum women in Australia have experienced birth trauma and one in 10 have been subjected to obstetric violence. If it hasn’t happened to you, chances are it has happened to your mum, your sister, a close friend, or someone in your mothers’ group.

There is also a thriving online community catering to expectant mums which fuels an ecosystem of podcasts, substacks, webinars and, yes, questionable mumfluencer content, all dedicated to educating (or promoting misinformation) on pregnancy, birth and parenting. These days the algorithm somehow knows you’re pregnant before even your partner does, and before too long you find yourself absorbing horror stories about birth trauma and obstetric violence while scrolling cures for morning sickness.

This is why the demand for doula services is exploding – women are paying other women to advocate for them during labour when they might not be able to advocate for themselves. The prevalence of obstetric violence and the lottery of rostered doctors and midwives in the hospital system means many pregnant women no longer trust that they will receive the support they need to birth with dignity.

At the extreme end of this sentiment sits the freebirth movement. The risks to mother and baby are in my view unacceptably high. However, it’s possible to understand how a pregnant woman who may have experienced birth trauma or has heard stories of others’ traumatic experiences might be drawn to the idea of birthing within her own home, removed from medical oversight and with it, any unwanted medical interventions.

Both my children entered the world at the hands of an experienced private midwife, someone I had built trust with to guide my labour and advocate for my needs if they were ever to clash with those of the hospital. I had to pay for this service, something I am privileged to have been able to afford.

My private midwife was by my side for my entire pregnancy, birth and early postpartum, checking my baby in utero, facilitating my delivery in a public hospital and monitoring my recovery and my newborn’s development afterwards. All pregnant women deserve this level of personalised medical care. I wish Stacey Warnecke had received it.

If we want to bring scared or traumatised pregnant women back into the medical system and prevent what happened to Stacey from happening to anyone else, we need to tackle the unacceptable prevalence of birth trauma in Australian hospitals. This means prioritising women’s agency over their own bodies, addressing growing rates of medically unnecessary birth interventions, and expanding access to continuity of care models which are proven to deliver better outcomes. We need to ensure that all Australian mothers have the opportunity to birth with safety, dignity and agency.

Kylie Moore-Gilbert is a regular columnist and the author of memoir The Uncaged Sky: My 804 Days in an Iranian Prison.

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