A senior clinician reported a birthkeeper to police on the same day one of her clients died after giving birth at home - a move the doctor said was a first for him, which really says something about the state of unregulated birth support.
The evidence emerged during the third day of the inquest into the death of 30-year-old wellness influencer Stacey Warnecke, who died on 29 September at Frankston Hospital in Melbourne. She had paid Emily Lal $6,000 to support her in having a freebirth at home, entirely without clinically trained staff. Lal described her role at the time as a “birthkeeper” - a profession that, conveniently, has no medical training, operates outside the medical system, and apparently doesn’t believe in involving trained clinical staff at any point during pregnancy.
On Tuesday, Lal told the inquest her role was not a medical one, nor was it to keep Warnecke safe. Instead, she was acting primarily as a friend when hired and attended the birth. She also said it wasn’t her job to call an ambulance unless specifically asked by any mother she was hired by - a policy that seems to have backfired spectacularly.
Warnecke gave birth to her son shortly after 3am, and delivered the placenta about 20-25 minutes later, when she suffered a bleed. At that point she said she needed to lie down. She became short of breath and panicked, and Lal told her she might be having a panic attack. The inquest heard that Warnecke had actually suffered a massive postpartum haemorrhage - a condition that Frankston Hospital’s director of obstetrics and gynaecology, Nisha Khot, described as treatable and “very rare” for women to die from when they give birth in hospital, or with a midwife present at a home birth.
After struggling to breathe for a while, Warnecke told Lal “I’m bleeding”, but Lal looked between her legs and told her she wasn’t bleeding anymore. Khot explained that internal bleeding can follow a haemorrhage, and visible blood is just one of many signs clinicians are trained to look for - none of which, one presumes, were in Lal’s job description.
The executive director of medical services and clinical governance at Bayside Health Peninsula, associate professor Shyaman Menon, described the efforts of clinical staff as they tried to save Warnecke’s life. By the time she arrived at hospital approximately two hours after giving birth, her heart was struggling and she had suffered numerous cardiac arrests. Lal had asked Warnecke three times if she wanted an ambulance, but only called on the third time, after Warnecke said “yes” - a level of customer service that probably won’t make it into any testimonials.
A paramedic who gave a statement to the coroner described Warnecke as agitated, breathing rapidly, and in an altered state of consciousness by the time she arrived. Surgeons needed to perform both a hysterectomy to stop the bleeding and a procedure to drain fluid from her heart. Lal told the inquest she only attended the hospital because Warnecke’s husband, Nathan, had accidentally taken her phone instead of his own.
Menon said clinical staff were concerned by what Lal told them because, despite presenting herself as a friend, she was using language that suggested she may have been responsible for treatment or care. “The feeling was the language used was probably more than what a general public member would actually understand … and which raised a concern whether there was someone who actually had an element of knowledge provided during that care,” he said.
Concerns were raised at a review meeting held in the hours after Warnecke’s death, prompting Menon to go to Frankston police station the same day to make a statement - something he told the coroner he had not done before. “The basis of why I went to the police on behalf of Bayside Health Peninsula was to make a report from a public health and safety perspective.” Lal was approached by police to give a statement, but told the inquest on Tuesday she did not do so. “I wasn’t legally required to,” she said - which, in fairness, is a pretty solid defence when your legal obligations apparently didn’t include calling an ambulance.