Tuesday, January 31, 2012

Why your doctor probably won't support your choice to birth at home

The scenario is familiar... Woman tells doctor that she's considering a home birth. Doctor says that it's not safe and that she should have a hospital birth. Woman says that home birth is a safe option for low-risk pregnancy, and doctor says... "you should really have a hospital birth."

Coming from a midwifery model of care perspective, client autonomy is put on a pedestal. After all, a woman's right to make an informed choice about where she chooses to birth is paramount. Yes, there are other factors that are sometimes at odds with this (e.g., midwife determines through careful assessment that a home birth may not be safe for someone, given their risk factors), but the woman's autonomy is always considered in this model. It begs the question, under what model are doctors working when they advise against home birth for all of their patients (note: of course, some doctors are supportive of home birth. Here we address those who are uniformly against it).

An article published in Obstetrics and Gynecology last year (Obstet Gynecol. 2011 May;117(5):1183-7)  allows us to peek into the window of medical model thinking. In the article's abstract, the authors write:

"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."

This seems to suggest that the doctors' responsibilities (beneficence) trump women's autonomy (as may be the case with midwifery as well). Perhaps a more nuanced and thoughtful approach from physicians would be to consider each woman's unique circumstances and collaborate to make healthy, informed choices, rather than a categorical refusal to support home birth as an option.

Your thoughts?

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