Emily Lal, a birthkeeper hired by a woman who died after giving birth at home, has told a coroner that she was “not there to make a birth safer”.
Lal gave evidence on Tuesday at the inquest into the death of 30-year-old Stacey Warnecke, who died on 29 September in Frankston hospital after giving birth at home with her husband and Lal present.
Warnecke had chosen a freebirth, meaning no trained medical professionals were involved with the majority of the pregnancy, and hired Lal as her birthkeeper. Lal said Warnecke had already decided on a freebirth before contacting her.
Birthkeepers have no medical training and operate outside the medical system.
Evidence on blood loss and ambulance calls
During earlier evidence, the court heard that Lal asked Warnecke three times whether she wanted an ambulance called after she gave birth to the placenta, lost up to 1.5 litres of blood, and began struggling to breathe. Lal said Warnecke sounded panicked and said: “I don’t want you to leave me.”
Warnecke agreed the third time, but by the time paramedics arrived she was seriously unwell, having suffered a massive postpartum haemorrhage. Lal said she asked three times within a five-minute period.
Warnecke died in hospital several hours later from related complications.
Role of a birthkeeper
Lal told the coroner, under questioning by counsel assisting Rachel Ellyard, that although Warnecke paid her $6,000 for the full freebirth support package, her role was primarily as a friend and the money was for her time.
She said her role was not medical, nor was it to override the wishes of the mother and her family.
Ellyard asked Lal about her website, which offered services including education, antenatal support, birth attendance and postpartum support, and whether she saw her role as helping to keep mothers safe.
“How would I help people stay safe during birth?” Lal replied. “I don’t think me being there makes the birth more safe.”
Asked what the purpose of her birthkeeper role was, she responded: “I’m attending as a friend in a support role.”
Communication with paramedics
During a call to paramedics played to the court, Lal told them Warnecke had difficulty breathing but that the bleeding had stopped.
She told Ellyard that while she thought Warnecke lost more blood than normal, it wasn’t her role to share this information with a mother unless asked: “I wouldn’t say to her, ‘I think you’ve lost too much blood.’ That’s not my role.”
“But you’re being paid to be there,” Ellyard said.
Lal responded: “I’m attending as a supportive friend. I’m not there to make a birth safer. I can’t do that. I’m not clinically trained. It’s not my role to assess blood loss.”
Free Birth Society course
Lal said she undertook a course offered online by the Free Birth Society, a multimillion-dollar online business that promotes giving birth with no medical assistance. It has been criticised by medical professionals for sharing dangerous information about excessive bleeding, blue babies and placenta care.
Lal said at one point Warnecke asked if her blood loss was normal, and she responded: “It’s more than I would consider to be normal.” Lal told the court: “If it was me, I would have been concerned.”
But she said she would not decide for a mother whether and when to call an ambulance, and respecting autonomy was central to the support she provided.
With hindsight, she said, she might have pushed harder for Warnecke’s agreement to call an ambulance but still would not have made the final decision.
Rarity of death in hospital
On Monday, the inquest heard that it is rare for women to die from a postpartum haemorrhage when giving birth in hospital or with medical professionals present, as it is treatable with fast access to care.
Asked if with hindsight Warnecke would have benefited from faster access to medical professionals, Lal said: “I can’t say what would have happened.” But she agreed that suffering a postpartum haemorrhage is more dangerous at home than in hospital.
Aftermath and suspension
Lal stopped working as a birthkeeper immediately after Warnecke’s death, saying she believed she would bring trauma from the death to any future births she attended.
The health complaints commissioner then suspended Lal from providing or advertising health services while investigating concerns about her services. That investigation is ongoing.
The court heard that while Warnecke was in surgery, Lal returned to the home, cleaned up and took the bloodied carpet to her own bin to dispose of it because it would not fit in Warnecke’s. She refused to give a statement to police.
Asked if her actions could be viewed as worrying about consequences to herself, Lal said: “I think that’s really unfair.” She said her concern was ensuring Warnecke’s husband wasn’t confronted by the scene on his return.
She said she sought legal advice after Warnecke’s death because of her experience following a death during a previous freebirth, when she felt blamed by the media.
“I wasn’t legally required to [make a statement to police] so I opted not to do that,” she said. “I am so sad and distressed to this day over Stacey’s death.”
The inquest continues.
