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J Clin Ethics [journal]
- Legal briefing: home birth and midwifery. [Journal Article]
- J Clin Ethics 2013; 24(3):293-308.
This issue's "Legal Briefing" column covers recent legal developments involving home birth and midwifery in the United States. Specifically, we focus on new legislative, regulatory, and judicial acts that impact women's' access to direct entry (non-nurse) midwives. We categorize these legal developments into the following 12 categories. 1. Background and History 2. Certified Nurse-Midwives 3. Direct Entry Midwives 4. Prohibition of Direct Entry Midwives 5. Enforcement of Prohibition 6. Challenges to Prohibition 7. Forbearance without License 8. Voluntary Licensure 9. Unclear and Uncertain Status 10. Growth of DEM Licensure 11. Licensure Restrictions 12. Medicaid Coverage
- On the need for a real choice. [Journal Article]
- J Clin Ethics 2013; 24(3):291-2.
For low-risk mothers who do not wish to give birth in a hospital, a nearby birth center led by midwives is an excellent option.
- The industry take-over of home birth and death. [Journal Article]
- J Clin Ethics 2013; 24(3):289-90.
The generation in the United States who renewed interest in home birth is also returning to the tradition of funeral care at home. Caring for your own dead at home is legal in all 50 U.S. states.
- Individual versus professional preferences. [Journal Article]
- J Clin Ethics 2013; 24(3):287-8.
The author, the mother of two children in Amsterdam, describes her birth experiences, the first in the hospital, the second at home.
- Seeking an alternative baseline for birth. [Journal Article]
- J Clin Ethics 2013; 24(3):285-6.
Birth is a spiritual experience for mother and baby. Women need information and psychological preparation before birth, and a knowledgeable companion during birth. Unless medical intervention is needed, medical personnel should step back and stay out of the way.
- One obstetrician's look at a polarizing birth arena. [Journal Article]
- J Clin Ethics 2013; 24(3):283-4.
Birth, whether at home or in the hospital, should involve shared decision making that empowers women to choose or decline the interventions that are best for the woman and her baby. Obstetricians and home birth midwives must share important information with their patients.
- Facilitating women's choice in maternity care. [Journal Article]
- J Clin Ethics 2013; 24(3):276-82.
Maternity careproviders often have strong views concerning a woman's choice of where to give birth.These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should "counts' instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.
- Being safe: making the decision to have a planned home birth in the United States. [Journal Article]
- J Clin Ethics 2013; 24(3):266-75.
Although there is evidence that supports the safety of planned home birth for healthy women, less than 1 percent of women in the United States choose to have their baby at home. An ethnographic study of the experience of planned home birth provided rich descriptions of women's experiences planning, preparing for, and having a home birth.This article describes findings related to how women make the decision to have a planned home birth. For these women, being safe emerged as central in making the decision. For them, being safe included four factors: avoiding technological birth interventions, knowing the midwife and the midwife knowing them, feeling comfortable and protected at home, and knowing that backup hospital medical care was accessible if needed.
- Exceptional deliveries: home births as ethical anomalies in American obstetrics. [Journal Article]
- J Clin Ethics 2013; 24(3):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 nonpunitive.
- Women's perceptions of childbirth risk and place of birth. [Journal Article]
- J Clin Ethics 2013; 24(3):239-52.
In the United States, clinical interventions such as epidurals, intravenous infusions, oxytocin, and intrauterine pressure catheters are used almost routinely in births in the hospital setting, despite evidence that the overutilization of such interventions likely plays a key role in increasing the need for cesarean section (CS).' In 2010, according to the U.S. Centers for Disease Control and Prevention, approximately 32.8 percent of births in the U.S. were by CS.2 The U.S. National Institutes of Health has reported that CS increases avoidable maternal and neonatal morbidity and mortality.3To increase understanding of what might motivate the overuse of CS in the U.S., we investigated the factors that influenced women's decision making around childbirth, because women's conscious and unconscious choices about giving birth could influence whether they would choose or allow delivery by CS. In this article, we report findings about women's decisions related to place of birth-at home or in a hospital. We found that choosing a place of birth was significant in how women in our study attempted to mitigate their perceptions of the risks of childbirth for themselves and their infant. Concern for the safety of the infant was a central, driving factor in the decisions women made about giving birth, and this concern heightened their perceptions of the risks of childbirth. Heightened perceptions of risk about the safety of the fetus during childbirth were found to affect women's ability to accurately assess the risk of using clinical interventions such as the time of admission, epidural anesthesia, oxytocin, or cesarean birth, which has important implications for clinical practice, prenatal education, perinatal research, medical decision making, and informed consent.