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Obstetric Ethics: An Essential Dimension of Planned Home Birth

Chervenak, Frank A. MD; McCullough, Laurence B. PhD; Arabin, Birgit MD

doi: 10.1097/AOG.0b013e3182172a97
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The American College of Obstetricians and Gynecologists (the College) Committee Opinion, “Planned Home Birth,” invokes two core concepts of obstetric ethics, the right of a woman to make a medically informed decision about delivery and the informed consent process. We set out a framework for obstetric ethics that empowers the autonomy of pregnant women by focusing on when, in beneficence-based clinical judgment, clinical management should be offered, should be recommended, and should be recommended against in the informed consent process. Using this ethical framework, we show that the College statement does not provide adequate guidance to obstetricians in fulfilling their ethical obligations in the informed consent process with pregnant women who express an interest in, or preference for planned home birth. Obstetricians have an ethical obligation to disclose the increased risks of perinatal and neonatal mortality and morbidity from planned home birth in the context of American healthcare and should recommend against it. Obstetricians should recommend hospital-based delivery and respond to refusal of these recommendations with respectful persuasion. As a matter of beneficence-based professional integrity, obstetricians should not participate in planned home birth. At the same time, obstetricians have a beneficence-based obligation to continue to provide prenatal and emergency obstetric care. The obstetric profession should continuously strive to make hospital births more humane and support home-birth-like environments in the hospital as well as continuously improve safety for both pregnant and fetal patients.

Obstetricians should provide adequate disclosure about the risks of planned home birth, recommend against it, recommend hospital-based delivery, and not participate in planned home birth.

From the Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York; the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and the Center for Mother and Child, Marburg University Hospital, Marburg, Germany.

See related articles on pages 1179 and 1188.

The authors thank Amos Grunebaum, MD, and Daniel Skupski, MD, of Weill Cornell Medical Center, for editorial assistance.

Corresponding author: Laurence B. McCullough, PhD, Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030-3411; e-mail: mccullou@bcm.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.