Safety of homebirth has focused on risk of death; moms-to-be poorly informed of other issues

The risk of future long term disability to the child should "weigh heavily" in decisions about whether to give birth at home or in hospital, argue leading ethicists in the Journal of Medical Ethics.

Women should, of course, be free to choose where they want to give birth, insist Oxford University ethicist Professor Julian Savulescu and obstetrician and gynaecologist Associate Professor Lachlan de Crespigny of the University of Melbourne.

But to date, the arguments around the safety of homebirth have focused on the risk of death, ignoring the possibility of long term disability to the future child--an equally relevant consideration, they argue.

As a result, women and their partners may be poorly informed of all the potential risks they could be taking by choosing a homebirth, they say.

There is comparatively little evidence on the long term outcomes of children born at home. And this is a deficit that needs to be addressed, to ensure that both women and their doctors are better informed, argue both authors in an accompanying podcast.

But the available research indicates that there are "a number of reasons to be concerned," they say in the podcast, as they point to increased risks of death, disability, and admission to neonatal intensive care compared with hospital births.

If complications arise during birth, it is vital that mother and baby can access immediate medical expertise to ensure the long term wellbeing of both, they say.

Even small delays can be crucial and have lifelong implications. And inevitably, there will be few resources available to pick up and manage these complications at home, they point out.

"When a baby is injured during childbirth, the full extent of the harm is often not obvious until years later," they warn, adding: "Actions taken today that cause harm in the future are as wrong as if that harm were realised today."

The authors acknowledge that hospital births are not without their own risks, and that homebirth is often seen as a more natural and less interventionist alternative.

"However, labour and delivery is a time of high risk, and homebirth may expose the future child to unreasonable risk of potentially life-changing disability for benefits that may be comparatively small," they argue.

In the podcast, Professor Savulescu argues strongly that hospitals need to do far more to make their environments more attractive and acceptable to women, while healthcare professionals should ensure that mums to be are fully informed of the potential risks of a homebirth.

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