"The right of women to choose whether they have home births is being questioned by a top medical journal. The Lancet said mothers-to-be should not be able to opt for them if they put their babies at risk - under UK law women can override medical advice. It comes after research suggested home births were more risky than hospital delivery. But doctors said it was rare for women to ignore their wishes in high-risk, complicated cases. The editorial was written following the publication of a study in the American Journal of Obstetrics and Gynaecology. The review of 500,000 births across the world found the death rate for home births at 0.2% was twice as high as in hospitals. In the UK, a total of 3% of births take place at home - three times more than in the US but far fewer than in the Netherlands, where home births make up a third of the total. The relevance of the US study to the UK was questioned by medical bodies as midwives in the NHS are said to have better training in resuscitating babies in home birth situations. The Lancet said: "Women have the right to chose how and where to give birth, but they do not have the right to put their baby at risk." The journal went on to say that in high-risk, complicated pregnancies hospital delivery should be favoured. This chimes with guidance in the UK, but women still have the right to insist on giving birth where they want to as court cases have established the baby only gets equal rights to the mother after birth." - Anne Bouey from Bookmarklet

Does this seem at odds with an abortion culture? It just seems that more and more one's real choices are being taken away and being replaced with some kind of program that has a very odd morality. This in itself just reminds me of Dune's Axlotl tanks: females who were housed and monitored before during and after birth. - Melanie Reed

I don't think there's any "abortion culture", but I see both sides of the issue. It's really very stupid to not have medical care available when knowing entering into a dangerous birth, but it should be a choice how and where you have your baby. Perhaps this shows a need for more medical training in midwives and training for the couple to recognize signs of complications. - <3Heather<3

I have to agree with Heza, I don't think there's an "abortion culture" present in this article or, frankly, anywhere. Additional training for midwives (which can sometimes be atrociously lacking) seems highly necessary. However I think it's ridiculous for women to not be able to decide how they wish to deliver their child. - Soup in a TARDIS

Regarding "abortion culture" are you up on the latest stats? While stats vary depending on who is gathering and compiling them, they generally agree they are in the millions each year. http://www.emedicinehealth.com/abortio... - Melanie Reed

My comment was meant to point out the disparity of the same political element that espouses Pro-choice on abortions are the same political element behind taking away choice when it comes to whether a doctor gets to decide or the woman gets to decide. - Melanie Reed

I think the difference is safety. - <3Heather<3

But isn't it a selfish safety in the first instance when it over-rides the baby which depends on the mother for protection and an intrusive one in the second when a doctor is not part of that family but only has the right to offer his/her services. But then I am not here looking at morality in terms of ever-changing modernity and technology. - Melanie Reed

@Melanie, I am indeed up on the latest stats, yes. However I personally feel "abortion culture" is little more than a buzz word used by the anti-choice movement to inaccurately characterize the pro-choice movement. While abortion is certainly a possible resulting option of societies that permit abortion it should always be remembered that it is an OPTION. There are other options in a pro-choice culture/community and even using your statistics the majority of abort/not-abort choices result in the continued life (something less than 60% of women with the linked figures). Given the underlying theme of choice and options in the pro-choice movement (there is no pro-abortion movement, no one on the pro-choice side is sitting around wishing for dead babies) I would think most pro-choicers would find the above legislation repellent as it actually reduces the number of options a woman has over the care and treatment of her own body (and any other unborn bodies that may reside within it). You yourself have already pointed out this disparity. However it's important to remember this opinion is being forwarded by The Lancet, a medical journal written for and by physicians who aren't likely to be keen, whatever their politics, to hand over their authority, real and otherwise, to anyone else (but particularly not to midwives who have historically had a combative relationship with the more traditional, more established medical community). - Soup in a TARDIS

While they do cite a paper that concludes that home birth is riskier than hospital birth, this should be taken with a grain of salt because it's a meta-analysis. But I think the author is mainly concerned with high-risk cases--where there's already a known risk for high morbidity and mortality complications. If you run into a situation where you need a crash C-section or neonatal resuscitation, it doesn't matter how well-trained you are if you don't have the appropriate equipment or facilities. An argument could be made that a mother who opts for home birth when there's a high probability of bad things happening is being negligent. http://www.thelancet.com/journal... - Victor Ganata

:O - Rochelle

My mother had 4 children at home (on the same couch). I was born at the hospital, two months early, and was higher risk. Most births at home are close enough to a hospital should issues arise. - Louis Gray

"Close enough" is highly dependent on the complication. Time is tissue, and most tissues don't deal very well with more than eight minutes of not being supplied with oxygenated blood. But if it's a normal pregnancy, I don't dispute that likelihood that there's no difference between home and hospital birth. - Victor Ganata

I really think the author is talking more about women who have known chronic diseases--like, say, an inherited bleeding disorder--or fetuses who have known structural anomalies from prenatal testing--like a complex congenital heart defect--where we know there's a high likelihood that things may go wrong. But the editorial suggests that most women in those situations typically don't opt for home birth. - Victor Ganata

Next I suppose one should be denied the right to have your child at the hospital with the highest death rate. And so on. - Sue - Friendfeed is best

Midwives (at least, in this state) are required to be trained in neonatal resuscitation and carry resuscitation equipment and oxygen. - Rochelle

Rochelle, I have to admit, I'm not that familiar with home births. So midwives are trained to intubate? - Victor Ganata

Victor, I'm not sure what all is included in "neonatal resuscitation", honestly. - Rochelle

Looking at the course descriptions for the midwifery school in Seattle, it says it includes a "full-day neonatal resuscitation program (NRP) certification". So, whatever that includes. - Rochelle

Suezanne, there isn't anything that is free of risk. But I think you have to look at it on a case-by-case basis. What level of risk is acceptable to all people involved? Is everyone involved truly aware of exactly how much risk there is? If there's a 100% chance that you're going to need an emergency invasive procedure during the delivery, but you deliberately decide not to do it anywhere near a hospital, I can see how someone might make the argument that that's negligent. - Victor Ganata

Rochelle, yeah, NRP includes intubation. Now I'm curious about is how often that ends up actually happening. - Victor Ganata

Jasmine, there is such criteria already. Again, I can only speak for my state, but midwives can't legally deliver high risk cases outside of a hospital setting and there are specific state-regulated guidelines about what makes a woman "high risk" in that sense. - Rochelle

Personally, I've found pro-choice advocates (not sure if that's the right phrase) to be extremely supportive of home birth. I've not found them very supportive of choosing elective c-section, though. - Melly Botts

Is this really a problem in the UK, though? Are there any high-profile cases there where a mother was deemed high-risk by health care providers, and she opted to have a home birth anyway, and things went bad? - Victor Ganata

@Victor, No, there isn't to my knowledge. Remember this isn't a law that has been passed. It's not even a law that is being debated. It's an opinion in an article in a medical professionals journal based on studies from an entirely different country. The general media obviously picked up a choice phrase and ran with it. I think if it ever did come up for a vote it would get slapped back before any sort of real (legal) debate was stirred up on a national level. - Soup in a TARDIS

Soup, yeah, I'd definitely be hesitant about applying conclusions from data from another country, particularly when those conclusions are from a meta-analysis and not a single study. But, yeah, ultimately, it's the legislators and the courts that decide these things, not physicians. - Victor Ganata

In the UK it is midwives who routinely deliver babies, whatever setting. Obstetricians are only usually involved for cases where there are likely to be problems. - WoH: Minding her Botts