Over the past few days, in the wake of the UK decision to promote homebirth, I’ve looked at several reasons why the effort to promote homebirth over hospital birth is unethical.
First, in a system struggling with staff shortages, lack of supervision of midwives, poor outcomes, and exorbitant insurance expenditures, it is defies logic to promote type of birth that will only exacerbate staff shortages, further limit supervision of midwives, and increase the risk of poor outcomes and additional insurance expenditures.
Second, it is nothing short of cruel to force women to choose between personalized care and pain relief in labor.
Today, I’d like to address the third reason why promotion of homebirth is unethical: a national government has no business encouraging ANY form of birth over another. In doing so, it restricts women’s reproductive autonomy.
Imagine, if you will, that the UK government had decided to encourage “natural family planning” (NFP) over other forms of contraception, claiming that NFP is the most “natural” method and the way that women have controlled their fertility for most of human existence, and that it costs the government far less in contraceptive funds than the birth control pill or IUDs.
Women’s rights groups would, quite appropriately, decry such a plan. They would be angry because NFP is not as effective as other forms of birth control, it is far more onerous to use than other forms of birth control, and the government is overstepping its bounds by involving itself in the highly personal decision of fertility control.
They would not be mollified by government claims that the ideal effectiveness rate of NFP is high. They would likely point out that the real world effectiveness of NFP is rather low, and that is the rate that counts.
They would likely point out that women should not be “encouraged” to sacrifice convenience of a birth control method to save money for the government. The greatest portion of the burden of contraceptive failure falls on the individual woman and therefore, she is the one, and the ONLY one, who should choose among safe, effective methods of birth control.
They would almost certainly point out that choice of fertility control is a personal decision in which the government ought to have no role. Women are not truly free to control their own bodies when the government is “encouraging” a less effective, less convenient method of contraception over others.
Women’s groups would be correct on all three counts.
Let’s take another example:
How about if a government decided to promote induction of labor over conventional surgical pregnancy termination? For most first trimester and early second trimester terminations, minor surgery is used to evacuate the uterus, thereby ending the pregnancy. Surgical termination is a safe method, takes only a short time, and involves a relatively easy physical recovery.
But imagine instead that a government decided to “encourage” medical abortion, using various types of medication that induce uterine contractions to force out the products of conception, reasoning that it is the most “natural” method, one that women have used to end pregnancies for hundreds of thousands of years, and costs the government less than surgical terminations. The government might point out that pharmaceutical manufacturers have been recommending medical termination over surgical termination for years.
Women’s rights groups would, quite appropriately, decry such a plan. They would be angry because medical termination is far more painful, more onerous, and takes longer than a surgical termination. They would point out that government is overstepping its bounds by involving itself in the highly personal decision of which method of termination to use. That is both a medical decision and a personal decision and there is simply no justification for government involvement.
They would not be mollified by government claims that medical termination is cheaper and they would likely point out that women should not be “encouraged” to endure the hours of pain of a medical termination to save money for the government. The greatest portion of the burden of the procedure falls on the individual woman and therefore, she is the one, and the ONLY one, who should choose among safe, effective methods of pregnancy termination.
They would almost certainly point out that pregnancy termination is a personal decision in which the government ought to have no role. Women are not truly free to control their own bodies when the government is “encouraging” a more painful, less convenient method of pregnancy termination over others.
Women’s groups would be correct on all three counts.
The government in the UK does not privilege one form of birth control over another, and does not privilege one form pregnancy termination over another, but it has decided to encourage one form of birth over another.
The government has decided to promote homebirth reasoning that it is more “natural”: it’s the way women have given birth for millions of years; and it costs less than hospital birth. The government notes that midwives have been recommending homebirth for years.
Women’s rights group, indeed anyone concerned with medical ethics, should decry such a plan.
They should not be mollified by government claims that homebirth is relatively safe for some women under ideal conditions (i.e. The Birthplace Study). No one has bothered to look at the safety of homebirth in the UK under real world conditions, and that is the only standard of safety that counts.
They should highlight the fact that women should not be “encouraged” to sacrifice safe, effective pain relief for the agonizing pain of childbirth to save money for the government. The burden of childbirth (pain, risk of death, risk of the baby’s death) falls on the individual woman and therefore, she is the one, and the ONLY one, who should choose among safe places to give birth.
They should emphasize that place of birth is a personal decision in which the government ought to have no role. Women are not truly free to control their own bodies when the government is “encouraging” a more painful, arguably less safe place of birth over others.
The decision by the UK government to “encourage” homebirth is fundamentally unethical. It interferes with a woman’s right to control her reproductive decisions. It makes no sense from a healthcare perspective. It represents political pandering to midwives and a vain hope that reducing upfront costs for childbirth won’t be totally obliterated by massive downstream costs for care of children injured at birth and lawsuit payouts for infants who died.
It’s not healthcare; it’s politics. And, above all, it’s unethical.
