Op-Ed: When Women Die in Childbirth, Blame Fails Us. Listening Might Save Lives.

The recent tragic deaths of several Australian women and babies following freebirths have rightly ignited grief and concern across the nation. Any maternal or neonatal death is heartbreaking, and communities affected by these losses deserve compassion and support.

However, calls to criminalise doulas or restrict freebirth represent a deeply troubling response. They threaten to undermine women’s reproductive autonomy, fail to address the systemic drivers pushing some women away from mainstream maternity care, and risk repeating a historic pattern: when women suffer, the instinct is to police them rather than listen to them.

Women’s Autonomy Is Not Optional

Whether one agrees with freebirth or not is immaterial. At the heart of this issue lies a fundamental principle: women have the right to bodily autonomy. This includes the right to decide where, how, and with whom they give birth. Restricting this right leads us onto dangerous ground, eroding sexual and reproductive health and rights enshrined in international law, including the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the International Covenant on Economic, Social and Cultural Rights (ICESCR).

Attempts to limit women’s legal rights around childbirth should alarm us all. History teaches that reproductive control rarely stops at one point of intervention.

The Difficult Question Too Few Are Asking: Why?

Critics have rushed to blame social media influencers and so-called “birth keepers” for these deaths. This simplistic narrative dismisses the real motivations driving women’s decisions and insults their intelligence. Women do not reject the healthcare system on a whim; they do so because, in their experiences or in the experiences of those they trust, it has already rejected them.

Each year about 300,000 women give birth in Australia. Approximately 97 percent do so in hospital; around 1.8 percent in birth centres; and 0.3 percent at home, mostly through regulated midwifery models. Freebirth accounts for a tiny fraction of births. There is no evidence of a sudden surge; what has increased is public attention.

What also continues to rise is birth trauma. One in three women in Australia report their birth as traumatic, and around 10 percent develop symptoms consistent with post-traumatic stress disorder. This is not fringe rhetoric. These figures come from large-scale Australian research and government-commissioned reports.

We also operate in a highly medicalised maternity environment. Induction rates for first-time mothers are close to 50 percent, and caesarean births approach 40 percent. This escalation in intervention has not corresponded with improved clinical outcomes, but it has contributed to increasing morbidity and psychological distress.

Associate Professor Vinay Rane recently noted that hospitals “can feel quite clinical and too bright, too busy,” and must work to become more inclusive and accessible. This understatement gestures toward a far deeper truth: women are telling us they do not always feel safe, respected, or seen in our maternity system. Dismissing that reality drives them further away.

Doulas Are Not the Problem

Doulas have become convenient scapegoats in this debate. In reality, they are trained providers of emotional, physical, and informational support. They do not perform clinical tasks or replace midwives or doctors. Decades of international and Australian evidence show that continuous non-clinical labour support reduces intervention rates, caesarean births, instrumental delivery, epidural use, and improves maternal emotional outcomes.

In a system where fewer than 10 percent of Australian women receive continuity of midwifery care, doulas fill a vital gap. Restricting them would remove one of the few evidence-based supports women can reliably access.

What Women Are Telling Us

Women are not turning away from maternity services because they are naïve or reckless. They are turning away because they are frightened of being silenced, coerced, disrespected, or traumatised.

Women tell us this in surveys, inquiries, patient complaints, advocacy forums, and public submissions. Silencing them will not make them safer. Listening to them might.

The Real Work Ahead

If we want to prevent further tragedies, we must move beyond regulation and toward reform:

• Expand access to continuity-of-midwifery-care models
• Embed trauma-informed, culturally safe care across all services
• Strengthen community-based childbirth education
• Protect and integrate doulas into collaborative maternity care pathways
• Address systemic obstetric violence, coercion, and racism
• Centre women’s experiences in policy, practice, and evaluation

The Bottom Line

Doulas are not to blame. Women are not to blame. The system has been broken for decades and women are simply doing whatever they can to ensure that they birth surrounded by people who will protect them and care for them throughout one of life’s most vulnerable moments. It is time to turn the spotlight on the real culprit: our maternity care system. Fixing it is not optional; it is overdue. Women deserve safety, dignity, and respect in childbirth, and they will keep seeking it wherever they can find it.

 References

Australian Institute of Health and Welfare (AIHW). (2023). Australia’s mothers and babies 2021. AIHW.

Australian Birth Trauma Association. (2022). Birth Trauma in Australia Survey Report.

Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews.

Commonwealth of Australia. (2023). Better, Safer Care: National Maternity Services Review.

International Covenant on Economic, Social and Cultural Rights, opened for signature 16 December 1966.

Lamaze International. (2023). Evidence-based Labor Support Model.

Wiltshire, A., et al. (2023). PTSD following childbirth in Australia: A prevalence study. Australian and New Zealand Journal of Psychiatry.

World Health Organization. (2018). Intrapartum care for a positive childbirth experience.

For more information, please contact:

Tanya Cawthorne

Co-Founder, Lamaze Australia

Email: tanya@lamazeaustralia.com

www.lamazeaustralia.com.au

Book review: The Complete Australian Guide to Pregnancy and Birth

The Complete Australian Guide to Pregnancy and Birth
By Sophie Walker and Jodi Wilson

Book review by Tanya Cawthorne LCCE, FACCE

While Sophie Walker’s name might be somewhat unfamiliar, you have probably heard of her hugely popular podcast, Australian Birth Stories. Since the podcast launched in 2017, the podcast has featured over 350 Australian women’s birth stories and has had 11 million downloads and counting

Walker and co-author, Jodi Wilson have collaborated to write a new book, The Complete Australian Guide to Pregnancy and Birth – a book that I hope will soon become a must-read for every Australian woman either planning a pregnancy or currently expecting.

There’s certainly no shortage of pregnancy books out there – if anything, it’s information overload. How do you wade through the almost infinite list of titles, and determine what’s worth reading and what’s not worth the paper it’s printed on?

A clue that this book might be a bit different are the many glowing endorsements it received. From Professor Hannah Dahlen to renowned childbirth educator and author, Rhea Dempsey, to prominent Melbourne-based obstetrician Dr Lionel Steinberg – many leading birth professionals from across Australia are singing Walker and Wilson’s praises.

And rightly so. This book, while chunky (it’s close to 400 pages!) is incredibly accessible and very readable. Five large chapters take the reader through each of the three trimesters of pregnancy, labour and birth and finally, early postpartum.

Each chapter is thorough, comprehensive, and importantly – evidence-based. The book’s title is a bit of a giveaway, but I particularly love the fact that this book has been written with an Australian audience in mind. This is important, because our maternity care system is unique to us, and therefore the information is relevant to people birthing here. I was thrilled to see that models of care such as midwifery group practice, private midwives and homebirth were all included – as is Birthing on Country, acknowledging the ancient birthing wisdom of our First Nations people.

The book is good balance of factual information on antenatal care, labour and birth and postpartum recovery, while also incorporating a holistic approach, acknowledging the hugely transformational nature of pregnancy, birth and becoming a parent, and the psychological impact that can have on a person. I was also very glad to see that the authors included vital information on pregnancy loss, perinatal anxiety and depression and birth trauma.

The podcast also provides an additional element, by featuring a number of women’s birth stories throughout the book. Readers can opt to take a break from the book and have a listen to a birth story, which brings a real depth and multidimensional quality to the book.

’I wish I had known’ is a phrase uttered by countless women after they give birth for the first time. It’s often closely followed by, ‘I wish someone had told me’. We hope this book gives you everything you need to know about pregnancy, labour, birth and early postpartum so you’re not left wondering what could have been.”

The old saying, knowledge is power could not be more true or more important when it comes to preparing for birth and parenting. It is my sincere hope that every Australian woman reads this book (ideally)at the preconception stage, or at the very least in early in pregnancy so that she can make thoroughly informed decisions about the best model of care for her, that she understands the benefit of quality, independent evidence-based childbirth education and makes wise decisions about her chosen circle of support.

The Complete Australian Guide to Pregnancy and Birth is published by Murdoch Books and available here or wherever you buy your books.

The Australian Birth Stories podcast is available wherever you get your podcasts!

 About the Reviewer

Tanya Cawthorne LCCE, FACCE is the Immediate Past President of Lamaze International and the co-founder of Lamaze Australia. She is a Lamaze educator, a program director and birth doula. 

Tanya is a passionate advocate for equitable and person-centered maternity care and her articles have appeared in The Journal of Perinatal Education, Australian Midwifery News, Connecting the Dots, Interaction – the journal of Childbirth and Parenting Educators Association of Australia (CAPEA) and International Doula (DONA International). Last, but absolutely not least, she is also the mother of two beautiful children, her son Liev and daughter Amalia.