Bioethics for Breakfast: Mother, Midwife, Doctor, State: What to Do About Place of Birth?

bioethics-for-breakfastDeborah Fisch, JD, and Nancy Herta, MD, presented at Thursday morning’s Bioethics for Breakfast event, offering opposing views on the topic, “Mother, Midwife, Doctor, State: What to Do About Place of Birth?”

The topic of childbirth has recaptured national attention, with questions emerging about high maternal and infant mortality rates, persistent racial disparities in outcomes, high cesarean section rate, necessity of routine interventions, prevalence of childbirth-related trauma, and more. Home births increased markedly between 2004 and 2012 and now account for 1.36% of all births. Together these two phenomena have reignited the debate on whether home birth is to be prohibited, tolerated, advised, or preferred.

Who decides? Legislatures possess a right – and in some states a duty – to enact laws for the protection of the public’s health, but must weigh these protections against accompanying constraints on personal liberties. Medical providers and institutions are bound by both professional ethics and medico-legal standards of care. State medical societies seek to preserve providers’ economic and political survival and to support their members in maintaining scientific and ethical best practices. Women claim both consumer and human rights in deciding their place of birth. Everyone wants what is best for mothers and babies. What bioethical stance can bring these disparate views into proximity, if not into harmony?

Presentations highlighted expanding national conversations concerning US childbirth management. Ms. Fisch and Dr. Herta engaged the audience in considering how these combined phenomena contribute to the debate on whether home birth is to be prohibited, tolerated, advised, or preferred.

Deborah Fisch, JD
Deborah Fisch is affiliated with the University of Michigan Program for Sexual Rights and Reproductive Justice, the Friends of Michigan Midwives and Coalition to License CPMs, and the Birth Rights Bar Association. Her research interests include the role of malpractice liability in determination of standard of care; the legal maternal-fetal relationship in pregnancy, labor and childbirth; demographic outcome disparities in childbirth and the criminalization of pregnancy; regulation of out-of-hospital birth attendants and protocols for their interaction with in-hospital providers; and evolving access to maternity care under the Affordable Care Act. She earned an undergraduate degree in Linguistics from the University of Michigan and a JD from Wayne State University Law School.

Nancy Herta, MD
Nancy Herta is an Assistant Professor of OB/GYN at Michigan State University. She has had a clinical OB/GYN practice in the Lansing area for the last 18 years and has been the Associate Residency Director of the Sparrow OG/GYN residency for the last 12 years. In addition she has been a consultant for the Greenhouse Birth Center, and works with many local midwives as a consultant. She will be addressing the concerns local OB/GYN physicians express over home birth and the barriers to moving toward a more cooperative, mother/baby centered model of care.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.

New article from Libby Bogdan-Lovis published in ATRIUM issue “Bad Girls”

bogdanlovis-crop-facElizabeth (Libby) Bogdan-Lovis and Raymond De Vries co-authored the article “The Baddest Births in Town” in Issue 12 (Winter 2014) of ATRIUM, the Report of the Northwestern Medical Humanities and Bioethics Program.

“… [W]hile all pregnant women walk the line between “good girls” (those who eat right, exercise, and put speakers on their bellies to let their future children listen to classical music) and “bad girls” (those smoking, drinking, soft cheese-eating ne’er-do-wells), the ultimate bad pregnant girls—the baddest of the bad—are those who decide to birth their babies at home, turning their backs on the “benefits” offered by hospital-based obstetric technology.”

Read “The Baddest Births in Town” in Issue 12: Bad Girls.

For more information on Bogdan-Lovis’ work in the areas of medicalized childbirth and evidence-based medicine, see her faculty profile.

Center’s Libby Bogdan-Lovis co-edits a special JCE issue on “Place of Birth”

bogdanlovis-crop-facElizabeth (Libby) Bogdan-Lovis and collaborators Charlotte de Vries and Raymond de Vries co-edited a special issue of the Journal of Clinical Ethics on “Place of Birth” (Vol. 24, No. 3, Fall 2013). Her co-authored contribution with Raymond de Vries, “Ethics and the Architecture of Choice for Home and Hospital Birth” identifies competing considerations in the professional tensions surrounding women’s choice of birthplace. Such tensions extend beyond the immediate and direct provider-patient encounter to encompass relationships with colleagues, as well as affiliations with professional organizations, hospitals and third party payors. Place of birth is a contentious issue involving value-driven selection and interpretation of the evidence, perceptions of risk and consequent management, providers’ fiduciary responsibilities and, finally and importantly, patient values. Invited contributors reflect multiple perspectives and vantage points.

See more of Bogdan-Lovis’ work in the areas of birth medicalization and evidence-based medicine at her page at

Book chapter announcement

A chapter coauthored by Elizabeth Bogdan-Lovis, Assistant Director of the Center for Ethics and Humanities in the Life Sciences, was recently published in a new volume: Readings in Health Care Ethics, 2nd edition.

The chapter, Choosing Surgical Birth: Desire and the Nature of Bioethical Advice, discusses the rise in births by cesarean section due to a growing public perception that it is a convenient and equally safe option to natural birth.

To learn more about Bogdan-Lovis’ research interests in medicalized childbirth as well as evidence-based medicine, visit her page on