In the Spotlight
Featuring news from the members of the WAPM
Planned Home Birth
Intervention of WAPM and IAPM International Study Group to the European Court of Human Rights Concerning Planned Home Birth
The members of the WAPM and IAPM International Study Group for Planned Home Birth are Frank A. Chervenak, M.D., Weill Medical College of Cornell University, New York, New York, United States; Brigit Arabin, M.D., Philipps University, Marburg, Germany; Malcolm I. Levene, M.D., University of Leeds, United Kingdom; Robert L. Brent, M.D., Ph.D., Thomas Jefferson University, Philadelphia, Pennsylvania, United States; Amos Grünebaum, M.D., Weill Medical College of Cornell University, New York, New York, United States; and Laurence B. McCullough, Ph.D., Baylor College of Medicine, Houston, Texas, United States.
Scholarly Work of the International Study Group
The International Study Group began its scientific work on planned home birth at a 2013 scientific meeting at the National Academy of Medicine of the U.S. National Academies of Science, Engineering, and Medicine. The International Study Group has, to date, published scientific papers in the international peer-reviewed literature on the outcomes of planned home birth in the United States, as well as ethics papers in the international peer-reviewed literature on the professional responsibilities of physicians regarding planned home birth. These papers represent the most clinically comprehensive and ethically rigorous analysis of the clinical and ethical dimensions of planned home birth. In addition, the International Study Group has made scientific and ethics presentations at international medical congresses, the majority of which have met in Europe.
The Intervention
The International Study Group was invited to submit an intervention (also known as an amicus curiae, or friend-of-the-court statement) in the case Re: Dubská and Krejzová v The Czech Republic, Applications nos. 28859/11 and 28473/12 in the Grand Chamber of the European Court of Human Rights. The intervention has two main parts.
The first presents the results of the International Study Group’s scientific studies of planned home birth in the United States. The data that presented in this section support the conclusion that planned home birth has higher risks of neonatal mortality and serious morbidity that can be prevented by planned hospital birth.
The second presents the results of the International Study Group’s ethical studies of planned home birth in the United States and European countries. The ethical analysis of this section supports the conclusion that planned home birth is not consistent with professional integrity because its increased risks are preventable by planned hospital birth. Pregnant women do not have absolute freedom to control the place of birth because they have an ethical obligation to the soon-to-be-birth child to protect its health-related interests. This obligation cannot be fulfilled by planned home birth but can be fulfilled by planned hospital birth. The precautionary principle justifies reducing risks of the vulnerable when the burdens of doing so are minimal. Consider the mandated use of infant care seats. These prevent the known risks of vehicular accidents from which risks the infant cannot protect himself or herself. The burden on parents of using an infant car seat are minimal. Planned hospital birth protects fetal and neonatal patients from the risks of planned home birth, from which risks they cannot protect themselves. The burdens on pregnant women of planned hospital birth are minimal. Planned home birth is therefore not compatible with the precautionary principle.
Outcome
The case was heard by the Court in November, 2015. The intervention is being seriously considered by the seventeen judges of the Court in their ongoing deliberations. The decision of the Court is expected in 2016.
Submitted by
Frank A. Chervenak, M.D.
Past President, WAPM
