"Place of Birth: Evidence and Ethics" Leah McClimans (University of South Carolina)

In the UK and US Births in obstetric units vastly outnumber births that take place outside of an obstetric unit. Still non-obstetric births are increasing in both countries. For example, in 2004 only .87% of US births occurred in non-obstetric units (home or midwifery units), but by 2012 1.36% babies were born in a non-obstetric unit. In the UK they have seen an even steeper increase, with only .9% of births occurring at home between 1985-8 rising to 2.4% in 2011. Is it professionally responsible to support a non-obstetric birth? It is morally permissible to support women in choosing where to give birth? These are the kinds of questions that shape the debate over place of birth, and for those who answer no to these questions, the increase in non-obstetric births is alarming. Given the emphasis on evidence-based policy and evidence-based medicine it may not be surprising that the current discussion of place of birth takes the shape of empirical studies investigating the relative riskiness of different birth place choices. This debate has become heated with those on both sides finding empirical support for their positions—sometimes within the same study. While to some this debate over the evidence is a distraction from what is genuinely at stake, namely different non-epistemic values, I will argue in this paper that the way forward is to take a closer and more fine grained look at the evidence. I am interested here in how the debate over place of birth is most fruitfully conducted; I will not attempt to answer the morally loaded questions that shape the debate itself.