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Planned home birth: the professional responsibility response–a midwifery response

      To the Editors:
      The clinical opinion related to planned home birth by Chervenak et al
      • Chervenak F.A.
      • McCullough L.B.
      • Brent R.L.
      • Levene M.I.
      • Arabin B.
      Planned home birth: the professional responsibility response.
      requires a midwifery response.
      Home birth is a complex choice that includes the rights of women over their bodies; these rights do not go away because health professionals or governments ban them. The authors suggest that women’s rights should be superseded by the clinician’s obligation to protect the pregnant woman and the “fetal, neonatal patient.” This paternalistic discourse privileges the baby’s rights over that of the woman’s. Any risk to the baby’s health dominates with woman’s rights and risks to the woman’s health subjugated. A civilized society considers women to be more than just vessels to grow babies. To postulate that women’s opinions, concerns, and intelligent consideration for their own health and their baby’s health should be superseded by an obstetrician is unacceptable. The argument by Chervenak et al
      • Chervenak F.A.
      • McCullough L.B.
      • Brent R.L.
      • Levene M.I.
      • Arabin B.
      Planned home birth: the professional responsibility response.
      that a woman’s right to make decisions and control what happens to her body is a “purely contractual model” and “rights reductionism” is contrary to the human rights movement. The United States, as a signatory to the Convention for Elimination of Discrimination against Women, recognizes this important principle.

      United Nations Treaty Collection, Convention on the Elimination of all forms of Discrimination against Women, 1995: New York. Available at: http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm. Accessed May 31, 2013.

      The authors assume that hospital birth and obstetric intervention will confer improved safety and better outcomes but the US cesarean section rate has increased far more than its rate of decreasing perinatal mortality and the United States is one of the few developed countries with increasing maternal mortality, yet <1% of the maternity population birth at home.
      • Bingham D.
      • Strauss N.
      • Coeytaux F.
      Maternal mortality in the United States: a human rights failure.
      • Amnesty International Publications
      Deadly delivery: the maternal health care crisis in the USA.
      Caution needs to be taken when discussing safety and safer care; until such a time as there is no mortality or morbidity associated with childbirth, no one can promise complete safety regardless of birth setting.
      Women worldwide cite the loss of personal autonomy and increasing use of interventions in hospital birth as unsafe for both them and their babies and see this as an unacceptable risk. When this is put in the context of comparable perinatal outcomes for the baby many women consider that hospital birth provides an increased risk with few benefits for them.
      If women are supported, listened to, and provided with information they will make decisions based on the best outcome for them and their baby. Health professionals providing maternity services should be seeking to provide safe, woman-centered care for all women regardless of where they choose to birth.

      References

        • Chervenak F.A.
        • McCullough L.B.
        • Brent R.L.
        • Levene M.I.
        • Arabin B.
        Planned home birth: the professional responsibility response.
        Am J Obstet Gynecol. 2013; 208: 31-38
      1. United Nations Treaty Collection, Convention on the Elimination of all forms of Discrimination against Women, 1995: New York. Available at: http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm. Accessed May 31, 2013.

        • Bingham D.
        • Strauss N.
        • Coeytaux F.
        Maternal mortality in the United States: a human rights failure.
        Contraception. 2011; 83: 189-193
        • Amnesty International Publications
        Deadly delivery: the maternal health care crisis in the USA.
        Amnesty International Publications, London2010

      Linked Article

      • Planned home birth: the professional responsibility response
        American Journal of Obstetrics & GynecologyVol. 208Issue 1
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          This article addresses the recrudescence of and new support for midwife-supervised planned home birth in the United States and the other developed countries in the context of professional responsibility. Advocates of planned home birth have emphasized patient safety, patient satisfaction, cost effectiveness, and respect for women's rights. We provide a critical evaluation of each of these claims and identify professionally appropriate responses of obstetricians and other concerned physicians to planned home birth.
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        American Journal of Obstetrics & GynecologyVol. 209Issue 3
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          We thank Dr Dixon for her letter in response to our article.1 According to the New Zealand College of Midwives World Wide Web site ( http://www.midwife.org.nz/home/personnel , accessed April 13, 2013), Dr Dixon is “Midwifery Advisor–Practice Advice and Research” for the college. Inasmuch as she does not appear to be an officer of the college, we assume that she speaks only for herself and not also for the college.
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