A new clinical opinion paper, "Planned Home Birth: The Professional Responsibility Response" determines how a caregiver should respond to a request for a planned home birth. Published in the American Journal of Obstetrics and Gynecology, this paper critically evaluates the claims that planned home births offer benefits for patient safety, patient satisfaction, cost effectiveness, and respect for women's rights.

Home births have been increasing in popularity throughout North America and Europe. Lead author of the paper, Frank A. Chervenak, MD, (chairman of the Department of Obstetrics and Gynecology at Weill Cornell Medical College, obstetrician and gynecologist-in-chief and director of maternal-fetal medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center) says that statements about the safety and cost effectiveness of home births should not go unchallenged.

"Positions taken about planned home birth, in our view, are not compatible with professional responsibility for patients...We call on obstetricians, other concerned physicians, midwives, and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital."

Dr. Chervenak and fellow authors examined evidence of obstetric outcomes, claims of patient satisfaction and analysed cost effectiveness of planned home births and found that a planned home birth does not meet current standards for patient safety. Patient satisfaction was also undermined by necessary emergency transport, intervention and risks to the baby. Home births also resulted in a three-fold increase in costs.

Finally, the team examined the relationship between planned home births and women's rights. It argues that medical professionals should not allow unconstrained rights of pregnant women to control the birth location, allowing them to demand home births when it is clearly not within their best interests. According to the report, to do so would be unethical.

The debate over a home versus hospital birth remains a contentious one and the response over this paper is sure to be a fiery one. Yes, there are certainly downsides to hospital births. Hospitals cannot replicate the same kind of environment home birth supporters are looking for, and even obstetricians feel that there are probably too many interventions: ­ forceps, cesareans sections, etc. But it is precisely the immediate availability of these interventions that has led to the current safety of modern birth. (You can read my previous post on this matter).

However, as an obstetrician who sees pregnancy and labour complications on a daily basis, I firmly believe that it is not within a patient's best interests to plan a home birth. Safety is our major concern, for both mother and baby, and the safest place a women can give birth is in the hospital.