‘No way I was going to call an ambulance’: Doula at fatal free birth defends actions

A doula present at the free birth of Victorian wellness influencer Stacey Warnecke said she did not believe it was her legal obligation to call an ambulance as the new mother lay dying, or to make childbirth safer for women.

On the second day of the inquest into the death of 30-year-old nutritionist Warnecke, who died in September after giving birth to her son at her home in Melbourne’s south-east, Emily Lal told the Victorian Coroners Court she initially believed Warnecke was having a panic attack.

Lal, who has no clinical qualifications, told the court that after passing her placenta, Warnecke’s condition began to rapidly deteriorate and she began bleeding heavily in the early hours of September 29.

When the new mother began hyperventilating and struggling to breathe, Lal said she told Warnecke’s husband it might be a panic attack.

The court heard Warnecke then asked if her level of blood loss was normal.

“She asked me is this amount of blood normal?” Lal said.

“I told her no. I said ‘it’s more than I would consider to be normal’.”

Lal was grilled on Tuesday about the alleged delay in calling an ambulance for Warnecke, who died in hospital hours after giving birth at home.

Lal said over a short period of time she asked three times if Warnecke would like an ambulance to be called, but was refused twice before Warnecke consented the third time.

By the time the Triple Zero call was made, Warnecke was gasping for air and already critically unwell.

“But why did you take no for an answer?” counsel assisting the coroner Rachel Ellyard asked.

“I don’t know how many times I can reiterate this,” Lal responded. “Her autonomy was very important to her. There was no way I was going to call an ambulance against her wishes.”

Asked if she had a responsibility to the women she was assisting with birth, Lal said it was not her role to make a birth safer, saying she saw herself as a friend or big sister rather than a professional, despite being paid for her services.

“I am attending as a supportive friend, essentially,” Lal told the inquest. “I am not clinically trained … it is not my role to assess blood loss.”

When probed further, she said: “How would I keep a woman safe during birth? I don’t think me being there makes her more safe.”

Ellyard asked Lal if there was ever an instance where she would step in and call an ambulance, including where a woman was experiencing serious complications, incapacitated or a medical emergency was escalating.

“It would really depend on what the mother wanted,” Lal replied.

“I would ask if she wanted an ambulance, but if she said no, then that’s the answer. I don’t think I have that obligation … It’s up to the family to make that decision.”

The inquest also heard that Lal – who has since been banned from working as a doula – had refused to be present at births inside hospitals or at home births where a midwife might be present, as she did not want to be exposed to “birth trauma or obstetric violence”.

Asked about her qualifications, Lal told the court she drew heavily on her own experience of giving birth to four children – three of those births being unassisted, with only her husband present.

She also undertook an online course in 2020 and a further short course, the inquest heard.

Lal said that in the months leading up to Warnecke’s birth, she spent between 15 and 20 hours with the first-time mother.

Lal has so far refused to provide a statement to investigators about what happened in the lead-up to Warnecke’s death, but was ordered in March to provide evidence to the inquest.

The court was told Lal agreed to testify if the coroner provided a certificate preventing her evidence being used against her in any future civil, criminal or regulatory proceedings.

On Monday, the court was told Warnecke had paid Lal, who advertised herself as “birth keeper” on social media and her website, to be present at the birth of her son.

A harrowing 12-minute call to Triple Zero made by Stacey’s husband, Nathan Warnecke, and Lal was also aired in court.

By the time the first paramedic arrived at the Seaford home, Warnecke was lying on the floor of a dark room between a couch and a birthing pool. Her skin was yellow and cold and she appeared highly agitated – breathing rapidly and in an altered state of consciousness.

The court heard that Lal was seen by a paramedic stretching the placenta in another room, which she told the court she was doing to try and see if it was intact as a way of determining if it had caused the bleeding.

Warnecke was rushed to Frankston Hospital in a critical condition at 5am, two hours after giving birth.

At a direction hearing in December, the medical examiner proposed Warnecke’s cause of death was a “postpartum haemorrhage in the setting of a home birth”.

Warnecke promoted a healthy and “chemical-free” lifestyle on social media, and the inquest heard her concerns about the healthcare system had intensified during the COVID-19 pandemic.

The inquest also heard she had refused antenatal screening, including routine ultrasounds before the birth, and initially considered having a registered midwife present at the birth but abandoned the idea due to fears interventions would be forced on her.

In a statement submitted to the court, Nathan Warnecke wrote that his wife had “a strong view about the cascade of interventions that can occur within a hospital environment, and a strong wish to avoid them”.

She chose a free birth – sometimes called a “wild” or unassisted birth – because she felt it was the only way to have a baby entirely on her own terms, the inquest was told.

The hearing continues.

Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.