Women who choose home deliveries because of political beliefs or involvement in quasi- religious antimedical groups are problematic because they usually have high expectations. Many believe that by avoiding the medicalization of birth, they will have a unique experience and a perfect baby. Physicians who might otherwise consider supervising a home delivery should be very cautious when working with a patient who has such unrealistic beliefs. The greatest threats posed by such patients are the refusal of necessary hospitalization should an emergency arise and the delay in getting hospital care once the patient agrees.

Even if the physician has discussed this possibility and documented the patient’s agreement to hospitalization in the birth plan, the patient retains the right to refuse a transfer to the hospital. This can put the physician in the ethical and legal bind of a patient’s refusing emergency medical care that is necessary to preserve her and her baby’s health. There is no time for a court order for care, and, unlike the usual situation where the patient is in the emergency room, the patient must be transported against her will to make the care possible.