“Planned home birth: the professional responsibility response”
Frank A. Chervenak, MD, et al
Presented at European Congress of Perinatal Medicine, Paris, France, June 13, 2012
Conclusion
“Advocacy of planned home birth is a compelling example of what happens when ideology replaces professionally disciplined clinical judgment and policy.
We urge obstetricians, other concerned physicians, midwives, and other obstetric providers, and their professional associations to eschew rights-based reductionism [i.e. current ideas of patient autonomy and a woman’s right to be fully informed and subsequently make reproductive healthcare decisions] in the ethics of planned home birth and replace rights-based reductionism with an ethics based on professional responsibility.
An editorial in Lancet succinctly summarized this point: “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.”
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Editor ~ FG.org: This lengthy academic paper written by American obstetricians in conjunction with a professor of medical ethics argues that unconstrained rights of pregnant women to control the birth location is an ethical error and therefore has no place in professional perinatal medicine.
These author assert that it is inappropriate and unfair to “subjugate the physician’s integrity” by permitting childbearing women to make this kind of a decision — that is, one that can potentially affect her baby — and therefore physicians are justified in limiting the woman’s rights by limiting her choice to only the clinically reasonable alternatives as identified by the obstetrical profession.
This is startling position, and so my web article includes the original ethics-based statements (copied at the end of part 2) that were used in this unusual paper to arrive at those extraordinary conclusions.
Personally I put this position statement in the same general category (admittedly not as extreme) as the 1984 NJM’s paper promoting the ‘prophylactic’ use of Cesarean as the standard of care for healthy women. In that case, two obstetricians argues that Cesarean delivery was safer for the baby, therefore this better way should become new standard of care. They admitted that carrying out such a policy would result in a few ‘excess’ maternal deaths but since Cesarean delivery would save so many babies, the small additional number of maternal mortality was be a price worth paying.
I can’t help but mention that the obstetrical profession’s supreme focus on the fetus and well-born neonate apparently doesn’t extend to assisting the many low-income families and single women who are struggling alone and unaided by society to feed, house and raise these fetuses-turned-newborns -turned-children who (G*D willing!) eventually become adult citizens.
The idea that an ultra-medicalized system is ‘price worth paying’ has for several decades made hospital-based obstetrical care the single most costly item of our healthcare budget, while Cesarean section has become the single most frequently perform surgical procedure AND the most frequently performed operating room procedure.
This latter category is most remarkable, as it refers to diagnostic procedures like cardiac catheterizations, angiograms and other sterile radiology procedures performed on the ill and elderly. This means more healthy women as maternity patients see the inside of an operating room (and get billed for a major OR procedure) than patients who are ill or injured. This extraordinary level of spending and the unproductive nature of it does nothing to make society work for families or to educate those newborn after they get out of diapers.
We are told that childbearing women in American get the best of the best when it comes to obstetrical care. However, the system currently comes with an increasing risk of morbidity and mortality due to the many interventions, most especially the high rate of Cesareans. One of the reasons for the liberal use of Cesarean surgery was to reduce malpractice suits. Everyone hoped that reduced litigation would result in reduced fear on the part of obstetricians and everyone would benefit.
Unfortunately the record does not support this beneficial view of professional liability. According to the Childbirth Connection’s Fact sheet #2 in the series on how professional liability insurance impacts maternity care, physicians pay a lot in med-mal rpemiums, and it protocols ultimately control everything about how and where maternity care is provided, patients, their family or society’s interest in a safe, fair and cost-effective system. Here is what they have to say and it is as shocking as our C-section rate and its increasing association with maternal mortality
One of the two widely accepted objectives of the liability system is to attend to the needs of those who are injured as a result of negligence. Available evidence, not separately available for maternity care, suggests that the present liability system fails in about 99% of cases to compensate people who are injured as a result of medical error.
The report found that in the practice of an average obstetrician-gynecologist, negligent injury of mothers and newborns appears to occur more frequently than any claim (warranted or not, obstetric or gynecologic), and far more frequently than any payout or trial.
After repeated carefully reading of this material, here is my “deconstruction”, which is to say, to actually lay out what they are specifically saying and how they explain and justify the position they have taken. I don’t know what kind of reception this paper had when presented in Paris last summer but since i never heard a word of it in the press, I must assume that the obstetrical profession world wide is sympathetic to the idea that doctors (and only doctors) should made all the crucial decisions about childbirth practices.
Continue to part 2 -My comments (link immediately below:
