title: Ethics and professional responsibility: Essential dimensions of planned home birth.
abstract: Planned home birth is a paradigmatic case study of the importance of ethics and professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the professional responsibility model of obstetric ethics, which is based on the professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist's ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman's rights. We then identify the implications of the professional responsibility model for the perinatologist's role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the professional responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth.
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.
authors.forename: Amos
authors.initials: A
authors.lastname: Grünebaum
authors.affiliation: Center for Mother and Child, Philipps University, Marburg, Germany; Clara Angela Foundation, Berlin, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Arabin
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY; Louis and Bess Stein Professor of Pediatrics, Sidney Kimmell College of Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Brent
authors.affiliation: Division of Pediatrics & Child Health, University of Leeds, Leeds, United Kingdom.
authors.forename: Malcolm I
authors.initials: MI
authors.lastname: Levene
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY. Electronic address: fac2001@med.cornell.edu.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Chervenak
mesh_terms: D001034:Apgar Score; D036861:Delivery, Obstetric / Q000941:ethics* / Q000592:standards; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth / Q000009:adverse effects / Q000941:ethics / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000941:ethics* / Q000592:standards; D028681:Moral Obligations; D009321:Natural Childbirth / Q000009:adverse effects / Q000941:ethics / Q000592:standards; D061214:Patient Safety / Q000592:standards*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D024382:Professional Role; D014481:United States
keywords: Midwife; Planned home birth; Professional responsibility model of obstetric ethics