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Participating in Home Deliveries

As long as a home delivery is successful, the physician is not at any special legal risk. If the mother or the baby is injured because of a complication that could have been successfully managed in the hospital, the physician must convince a jury that home deliveries constitute proper medical care. At this point the woman's attorney will pose the argument that the physician endorsed the safety of home deliveries by consenting to perform one. The woman's assumption of risk will evaporate if the jury agrees. Very few jurors are sympathetic to physicians who claim that the patient bullied them into agreeing to provide unsafe care. The defense that the woman could not afford to go to the hospital can be countered with the availability of emergency admissions. If the woman is in active labor and the physician is willing to fight with the hospital administrator, the woman will be admitted because of the laws governing emergency care of women in labor. The hospital may punish the physician for holding it to its legal duty, but that is not the pregnant woman's problem.

Legally, there is little to recommend participation in home deliveries. Analogies to the successful use of home deliveries in Europe have limited persuasion. The European countries have a structurally different medical and legal system that does not encourage a patient to sue her physician for any complications of a home birth. The ethics of home deliveries are more ambiguous. A woman in good health, without risk factors for birth complications, and with realistic expectations could reasonably consent to a home delivery. While the physician's legal risk might be great if any complications arose, it would not be unethical to participate in such a delivery.

Ethical problems arise when any of these preconditions is not met. If there are medical contraindications to a home delivery, the physician should hesitate before implicitly minimizing those risks by agreeing to deliver the woman at home. If the woman has unreasonable expectations, the physician should consider the possibility of not being able to render needed care in a crisis. A woman has a legal right to refuse necessary care, but physicians have an ethical duty not to encourage or support unreasonable medical care decisions. Physicians who choose to participate in home deliveries should carefully document the circumstances that make a home delivery necessary or appropriate. The informed consent must recite the added risks of the home delivery and why delivery in a hospital is undesirable or impossible.

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