Planned home birth in the United States and professionalism: a critical assessment.

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one's training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a "professional." Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth.The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients' concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility.

Seeking an alternative baseline for birth.

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.

"We wanted a birth experience, not a medical experience": exploring Canadian women's use of midwifery.

In this study I explore Canadian women's use of midwifery to examine whether their choice represents a resistance to the medicalization of pregnancy/childbirth. Through my analysis of the data I identified eight ways the women's deliberate decision to pursue midwifery care represented resistance to medicalization. In so doing, I demonstrate how women actively assert their agency over reproduction thus shaping their own reproductive health experiences. The outcome of their resistance and resultant use of midwifery was empowerment. Theoretically the research contributes to understanding the intentionality of resistance and a continuum of resistant behavior.

Childbirth in modern Athens: the transition from homebirth to hospital birth.

The transition of birthing practices in Greece from a homebirth culture, in which women deliver at home surrounded by family and under the supervision of a typically female birth attendant, to a biomedical birth model, in which women deliver in a hospital with numerous forms of medical intervention and under the control of a physician, has been unusually rapid. Today, Western biomedicine not only dominates the health care system in Greece but has an essential hegemony on women's health care. My research examines whether the pervasive utilization of biomedical environments for birthing can be explained by a lack of alternatives or by women's satisfaction with the technology and care available in hospitals. I also examine how women retain control over their experience of pregnancy and childbirth within the biomedical context and attempt to explain the emerging construction of a "natural" discourse on pregnancy and childbirth in Athens. Major themes that emerged from interviews with Athenian women were the lack of consent for medical intervention during birth, limited infrastructure to support women who seek non-medical alternatives, and limited emotional support and collective education for mothers in the urban environment of Athens. Also, women described choosing the right caregiver as essential to maintaining a sense of control over their pregnancy and, more generally, over their life. In light of women's apparent interest in improving women's experience of pregnancy and childbirth in Athens, it is recommended that researchers further explore the interaction of medical and non-medical discourses on pregnancy and childbirth.

Postmodern midwives in Japan: the offspring of modern hospital birth.

Although childbirth is fundamentally involved with the issue of women's bodies, it is also involved with such social values as politics, economics, medicine, and other phenomena characteristic of a particular time and culture. In this article I divide Japanese society and childbirth into pre-modern, modern, and postmodern phases, with special emphasis on the postmodern phase. I use the word "postmodern" to denote visible changes in childbirth and midwifery that began to occur around 1990 - changes that distinguish it from modern hospital birth. I conclude that postmodern midwifery is a reaction to and a consequence of modern hospital birth, which failed to satisfy a large number of women's needs. In this sense, postmodern midwifery could rightly be said to be the offspring of modern hospital birth.