In the US and UK Births in obstetric units vastly outnumber births that take place outside of an obstetric unit. Still non-obstetric births are increasing in both countries. Is it professionally responsible to support a non-obstetric birth? It is morally responsible to choose to give birth at home? This debate has become heated with those on both sides finding empirical support for their positions. Indeed this moral debate is often carried out in terms of empirical evidence. While to some this (...) debate over the evidence is a distraction from what is genuinely at stake, namely different non-epistemic values, I will argue in this paper that the way forward is to take a closer and more fine grained look at the evidence. This closer look will first require that we distinguish between evidence of risk acceptability and evidence of safety and then focus carefully on evidence of the safety of non-obstetric births compared to obstetric births. (shrink)

Approaches to supporting autonomy in medicine need to be able to support complex and sensitive decision-making, incorporating reflection on the patient's values and goals. This should involve deliberation in partnership between physician and patient, allowing the patient to take responsibility for her decision. Nowhere is this truer than in decisions around pregnancy and Caesarean section where maternal autonomy can seem to directly conflict with foetal interests. Medical and societal expectations and norms such as the expectations of a ‘mother’, constraints of (...) making decisions in an emergency, and the role of technology in viewing the foetus as a separate patient and surgery as a guarantor of results can all act to limit a woman's autonomy. In considering decisions about Caesarean section, maternal interests in bodily integrity can be dismissed as being less important than the foetus's own interests and the mother's duties to it, despite the inherent risks and impacts of such a major surgical procedure... (shrink)

Within the context of global debates about safety and ethics of supporting women to give birth at home, it is important to analyse documents governing midwifery and obstetric practice and influence decision‐making around place of birth. In Australia, the United States and the United Kingdom, relatively small numbers of women choose to give birth at home despite their midwifery colleges' support. In the United States and Australia, the obstetric colleges do not support homebirth and these countries have lower numbers of (...) women who birth at home, compared with the United Kingdom. There are numerous regulatory and industry challenges for midwives attending homebirths. This paper reports on a Foucauldian analysis of Australian obstetric and midwifery colleges' position statements about homebirth, who have conflicting views, with the view to understanding their arguments and underlying assumptions. The documents highlighted tensions between competing discourses of risk and autonomy and differences in academic argument. Opportunities for strengthening their statements are highlighted. The methodology is applicable for future analysis of similar documents governing practice in other countries. (shrink)