'Birth keeper' would only call ambulance if mother consented, court hears

A court probing the death of a wellness influencer after a freebirth has heard that emergency care was delayed for several minutes because her "birth keeper" would only call an ambulance if she consented.

Melbourne woman Stacey Warnecke died of postpartum haemorrhage shortly after giving birth at home with only her partner, Nathan, and her doula, Emily Lal, present last September.

As well as probing the circumstances of Ms Warnecke's death and the role Ms Lal played during the free birth, a coronial inquest is examining the broader issue of freebirths, which take place without a medical professional present.

These differ from homebirths, which take place in the presence of a midwife.

Ms Lal, who did not profess to have any medical qualifications, was called to give evidence before the Coroners Court of Victoria on Tuesday after being granted a certificate protecting her from self-incrimination.

She relayed how Ms Warnecke's condition quickly deteriorated after she passed her placenta last September, and the young mother asked Ms Lal if her significant blood loss was normal.

"I said: 'It's more than I would consider to be normal',"

Ms Lal said.

Ms Lal said she then asked her client three times over five minutes if she would like an ambulance to be called.

The 30-year-old was said to be gasping and having difficulty breathing by time she consented.

"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," Ms Lal replied.

"Her autonomy was very important to her. There was no way I was going to call an ambulance against her wishes."

While Ms Warnecke's baby survived, the young mother was later pronounced dead at hospital.

Doula refused to provide police statement

The court heard Ms Warnecke agreed to pay Ms Lal $6,000 and spent between 15 and 20 hours preparing the 30-year-old for her birth, providing domestic help and getting to know her.

Ms Warnecke's contractions started on 26 September and Ms Lal was summoned to her Seaford home after they intensified some time later.

Ms Lal recalled finding her "happy and smiling" in a birth pool and supported the 30-year-old until she gave birth early on 29 September.

She initially believed Ms Warnecke was having a panic attack in the deterioration that followed.

After Ms Warnecke's death, Ms Lal returned to the couple's Seaford home to clean up blood that had soaked through towels and the carpet.

Asked if she considered that evidence like blood loss might need to be assessed later, Ms Lal said: "It didn't even cross my mind."

She refused to give a statement when later contacted by police, telling the court she was not legally required to and previous media reporting on a separate case had deterred her.

"One conclusion that might be drawn … from your cleaning up, your taking away the blood-stained carpet and your refusal to give a statement was that you were worried about consequences for you," Ms Ellyard put to Ms Lal.

"Do you see how someone might draw that inference, that you were acting out of self-protection?"

Ms Lal replied: "I think that's really unfair, honestly.

"[Nathan's] wife had just died and I thought the last thing he wants to see is the mess from what's caused her death.

"I thought I was doing something nice by cleaning it up for him," Ms Lal said.

'I'm not clinically trained'

Much of Tuesday's evidence focused on the nature of the guidance Ms Lal would offer her clients over the course of about five years of service.

She told the court she would only offer advice based on her own experiences of giving birth to four children at home, as well as two courses and self-education she undertook afterwards

"I wouldn't say to her, 'I think you've lost too much blood or something like that'. It's not my role," she said.

Ms Ellyard countered that Ms Lal might be the only person in the room with experience of giving birth.

"But I don't know what's too much," she replied.

"I'm not clinically trained. It's not my role to assess blood loss."

Ms Lal is no longer offering her services.

Asked whether freebirth was the safest way for Ms Warnecke to give birth, Ms Lal responded that safety was subjective but conceded that she didn't think freebirth was "the safest option for a lot of women".

She told the court that she remained "sad and distressed to this day over Stacey's death".

A 'vibrant, intelligent and thoughtful woman'

On Monday, Coroner Therese McCarthy said Ms Warnecke was a "vibrant, intelligent and thoughtful woman".

Worried about the potential of cascading medical interventions, Ms Warnecke did not have any antenatal care and was desperate to avoid an induced labour or a Caesarean section, the coroner said.

"She had a deep fear of what might happen to her," the coroner said.

The court heard that Nathan told a triple-0 operator that his wife was having trouble breathing after she decided to have an ambulance called.

When paramedics arrived, the 30-year-old was lying on the floor, breathing rapidly and had an "altered conscious state", Ms Ellyard said.

Ms Warnecke was taken to Frankston Hospital and suffered multiple cardiac arrests. Doctors performed a hysterectomy and heart procedure at the same time in a bid to save her life.

Dual surgeries were conducted to perform a hysterectomy.

A pathologist later found her cause of death to be a postpartum haemorrhage.

Ms Ellyard said hospital staff raised concerns about Ms Lal's involvement, and whether her advice influenced the tragic outcome.

The lawyer said the inquest would examine whether the death was preventable, and if a trained professional could have identified risks or better responded to the major internal bleed Ms Warnecke suffered at home.