The Journal of Clinical Ethics
Claire L. Wendland, “Exceptional Deliveries: Home Births as Ethical Anomalies in American Obstetrics,” The Journal of Clinical Ethics 24, no. 3 (Fall 2013): 253-65.
Interest in home birth appears to be growing among American women, and most obstetricians can expect to encounter patients who are considering home birth. In 2011, the American College of Obstetricians and Gynecologists (ACOG) issued an opinion statement intended to guide obstetricians in responding to such patients.
In this article, I examine the ACOG statement in light of the historical and contemporary clinical realities surrounding home birth in the United States, an examination guided in part by my own experiences as an obstetrician in home-birth-friendly and home-birth-unfriendly medical milieus. Comparison with other guidelines indicates that ACOG treats home birth as an ethical exception: comparable evidence leads to strikingly different recommendations in the case of home birth and the case of trial of labor following a prior cesarean; and ACOG treats other controversial issues that involve similar ethical questions quite differently.
By casting the provision of information as not just the
primary but the sole ethical responsibility of the obstetrician, ACOG
statement obviates obstetricians’ responsibilities to provide appropriate
clinical care and to make the safest possible clinical environment for those
mothers who choose home birth and for their newborns. What, on its face,
seems to be a statement of respect for women’s autonomy, implicitly
authorizes behaviors that unethically restrain truly autonomous choices.
Obstetricians need not attend home births, I argue. Our ethical duties do,
however, oblige us (1) to refer clients to skilled clinicians who will
attend home birth, (2) to continue respectful antenatal care for those women
choosing home birth, (3) to provide appropriate consultation to home birth
attendants, and (4) to ensure that transfers of care are smooth and
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