When Protection Turns Into Control
What Australia’s new debate about doulas and “freebirth” really reveals about trust, choice, and care.
In recent weeks, Australia’s peak maternity bodies, RANZCOG and ACM, have called on health ministers to introduce laws that would make it illegal for anyone who isn’t a registered practitioner to “manage labour or birth.”
On the surface, it sounds like a sensible safeguard.
But beneath that language lies a deeper problem: when we focus on who is in the room instead of why women are leaving the system in the first place, we risk turning protection into control.
The current landscape
Childbirth in Australia is overwhelmingly hospital-based. Around 97% of births occur in hospitals, 0.6% at home with a registered midwife, and fewer than 1% entirely outside the system, the so-called “freebirths.”
Australia’s intervention rates are among the highest in the developed world. Yet outcomes haven’t improved; instead, what has risen sharply is birth trauma.
1 in 3 women describe their birth as traumatic.
1 in 10 experience what researchers and the NSW Birth Trauma Inquiry define as obstetric violence, non-consensual procedures, coercion, or dehumanising treatment.
1 in 25 develop post-traumatic stress disorder (PTSD) as a direct result of their birth experience. (Australasian Birth Trauma Association, 2024; NSW Parliament Select Committee, 2024.)
This is not a small, fringe issue. It is a widespread public health crisis hidden behind words like “routine” and “protocol.”
If safety is the goal, then the question must be asked: Why are so many women feeling unsafe inside the system designed to protect them?
What the research shows: Dr Melanie Jackson’s Birthing Outside the System
Dr Melanie Jackson’s PhD, Birthing Outside the System (Western Sydney University, 2023), offers an unflinching look at why women choose to birth outside institutional care, and what those decisions reveal about trust, autonomy, and respect.
Her findings expose what statistics alone cannot:
These women are not reckless. They are deeply informed, weighing risk and autonomy in systems that often silence them.
Loss of trust is the common thread. Many turned away after coercion, disrespect, or trauma in previous births.
Fear of intervention outweighs fear of birth. For many, hospital protocols felt more dangerous than the birth itself.
They sought emotional safety, not defiance. Choosing to birth outside the system was, in many cases, a final act of self-preservation.
Jackson’s conclusion is stark:
“The rise in births outside the system is not a failure of women, it’s a failure of the system to make them feel safe enough to stay within it.”
What’s being proposed
The new RANZCOG–ACM proposal calls for laws modelled on South Australia’s Restricted Birthing Practices Act, which makes it illegal for anyone other than a registered midwife or doctor to “manage labour or birth.”
The intent, they say, is to reduce risk after a handful of tragic freebirth cases. But the implications extend far beyond those rare (very unfortunate and potentially preventable) events, particularly for doulas, midwives, and the women they support.
Defining “management”: the heart of the issue
What does it mean to “manage labour and birth”?
If “management” is defined too broadly, doulas and birth companions could be criminalised simply for offering emotional and physical support, for helping a woman breathe, offering touch, or reminding her she’s safe.
This blurring of lines between medical management and human support threatens to remove one of the few things proven to make birth safer: continuous, trusted support.
As Dr Bashi Kumar-Hazard of Human Rights in Childbirth put it:
“Women aren’t stupid. They know doulas are not doctors or midwives. They hire them because doulas offer the emotional and physical support women are denied in hospitals.”
When options shrink, equity suffers
If homebirth or freebirth options are restricted without expanding relationship-based care, we don’t increase safety, we reduce choice.
Women who already feel unsafe in hospitals won’t return because the law tells them to. They’ll retreat further from visibility and support.
Safety doesn’t come from fewer options. It comes from better ones, continuity models, publicly funded homebirth programs, and maternity care that honours consent, respect, and dignity.
The unintended consequence
History shows that prohibition doesn’t prevent behaviour; it drives it underground.
When women fear reporting, judgement, or legal penalty, they avoid the system altogether, seeking help later, if at all. That silence costs lives.
If we truly care about outcomes, we need policies that invite women into care, not laws that push them further away.
What we should be doing instead
Define roles clearly. Protect doulas by distinguishing emotional support from clinical management.
Fund relationship-based models. Expand continuity-of-carer programs and publicly funded homebirths so every woman has access to known, trusted providers.
Measure safety differently. Move beyond mortality rates to include emotional wellbeing, informed consent, and the absence of trauma.
Hold systems accountable. Birth trauma, not freebirth, is the real epidemic, and it begins in environments where women are silenced.
Global Case Studies: What Happens When Birth Becomes Regulated
Across the world, laws defining who can “manage labour or birth” have produced vastly different outcomes, from clarity and collaboration to fear and criminalisation.
🇦🇺 South Australia
Since 2014, South Australia’s Restricted Birthing Practices Act has made it illegal for anyone other than a registered midwife or doctor to “manage labour, childbirth, or delivery of the placenta.” While intended to protect, it’s been used to prosecute and silence birth attendants, even in cases where no harm occurred. It remains the model RANZCOG and ACM are now proposing for national rollout.
Lesson: When definitions are vague, doulas and support people can be penalised for simply being present.
🇨🇦 Ontario, Canada
Ontario’s Midwifery Act makes “managing labour or conducting the delivery of a baby” a controlled act, reserved for licensed professionals. Doulas thrive here, but only because the boundaries are crystal clear: emotional and physical comfort = ✅; any clinical act = ❌.
Lesson: Clarity protects everyone — mothers, doulas, and clinicians.
🇬🇧 United Kingdom
Practising midwifery while unregistered is a criminal offence, but doulas are recognised as non-clinical companions. Advocacy groups like Birthrights UK have warned that criminalising language risks isolating women and silencing witnesses to mistreatment.
Lesson: Even in a regulated environment, language must protect support, not police it.
🇳🇿 New Zealand
New Zealand strikes a better balance. Midwifery is publicly funded and community-based, meaning women have access to known midwives, and doulas can work freely alongside them. Because women have genuine access to safe, relationship-based care, there’s little need to birth “outside the system.”
Lesson: Accessibility, not punishment, is what reduces risk.
🇺🇸 United States
Some states criminalise unlicensed midwifery; others don’t. In states where prosecutions have occurred, most followed poor outcomes. The result: fear and secrecy, not safety. Communities without supportive midwives see more underground births, not fewer.
Lesson: When regulation is used punitively, women disappear from care entirely.
FAQs: What People Are Asking
Q: Can a doula be charged for “managing labour”?
Only if they perform or appear to perform clinical acts (vaginal exams, fetal monitoring, delivering the placenta). Without clear language, though, this boundary blurs, which is exactly the concern.
Q: Why is this being discussed now?
RANZCOG and ACM are responding to a few tragic freebirth cases, but their proposed solution (replicating the SA model) risks criminalising many who’ve potentially done nothing wrong.
Q: What’s a better path forward?
Global examples show the answer is not tighter control, but clearer definitions, accessible continuity care, and rights-based practice that women actually trust.
In Short
Around the world, when care is accessible, respectful, and relationship-based, fewer women leave the system. When it’s punitive or coercive, they leave in greater numbers, often at greater risk.
Safety isn’t achieved by narrowing the circle of who can support women. It’s achieved by expanding the circle of care around them.
How this conversation should be handled
If RANZCOG and ACM genuinely want to improve safety, the answer isn’t more control, it’s more connection.
Spend the money differently - Instead of funding fear-based PR campaigns, direct resources toward:
Expanding continuity-of-care models where women know and trust their midwives.
Funding public homebirth programs across all states, particularly rural and regional areas.
Training clinicians in trauma-informed and rights-based care.
Launching public education campaigns about informed consent and respectful care, not about policing women’s choices.
Real safety grows from access and respect, not restriction.
Change the language, change the message
The RANZCOG/ACM joint statement could have sounded radically different if it began with empathy and evidence:
“Every woman deserves safe, respectful, and supported care — wherever she births, and whoever she chooses to have beside her. We are committed to learning from women’s experiences and strengthening the system to meet their needs.”
That’s the language of care, not control.
Address the real issue: obstetric violence and trust
Before legislating who can “manage” birth, we must confront what’s happening inside the system:
Non-consensual vaginal exams, episiotomies, and interventions without explanation.
Disrespect and coercion documented by state inquiries.
Postpartum trauma that’s normalised, dismissed, or entirely unreported.
If we fixed that, the demand for birth outside the system would all but disappear.
The way forward
We can’t protect women by restricting them. We protect them by creating care they can trust.
That means investing in relationship-based models, defining support roles clearly, and confronting obstetric violence as the systemic issue it is.
Because safety isn’t just about survival, it’s about dignity, autonomy, and trust.
As Dr Melanie Jackson’s research reminds us:
“The future of maternity care lies not in tighter control, but in rebuilding the kind of care women feel safe to stay within.”
Sources
Jackson, M. (2023). Birthing Outside the System: Women’s Experiences of Autonomy, Risk and Resistance in Australian Maternity Care. Western Sydney University.
RANZCOG & ACM (2025). Call on Health Ministers to End Freebirth Deaths.
Human Rights in Childbirth (2025). Consumers Call on Health Ministers to Protect Women’s Rights.
NSW Parliament Select Committee (2024). Inquiry into Birth Trauma.
Australasian Birth Trauma Association (2024). Your Birth, Your Voice Survey.
AIHW (2023). Australia’s Mothers and Babies.
Birthrights UK, Criminalising Support: The Risks of Restrictive Birth Law.
Flo to Grow stands with the maternity consumers, doulas, and families calling for protection of women’s rights, not restriction of them.