Is high risk homebirth a form of medical neglect?

Despite counseling about the risk of a fatal outcome, a mother elects to attempt a VBA3C at home, her uterus ruptures and her baby dies.

A woman with a breech baby is advised that birth at home carries higher than average risk. The woman ignores the medical advice, the baby’s head is trapped during birth and the baby dies.

A women is told that her twins are in an unfavorable position for successful vaginal birth. The woman elects to have a homebirth and, as she was warned might happen, the second baby dies.

The women in these cases, didn’t simply choose to have a homebirth. They chose to ignore the guidelines for homebirth safety by attempting a high risk homebirth. They may argue about their right to choose and their actions may be legally protected, but that doesn’t change the fact that, morally, they have committed medical neglect.

What is pediatric medical neglect?

According to the American Academy of Pediatrics position paper Recognizing and Responding to Medical Neglect, written by Carol Jenny of the AAP Committee on Child Abuse and Neglect:

Several factors are considered necessary for the diagnosis of medical neglect:

1. a child is harmed or is at risk of harm because of lack of health care;
2. the recommended health care offers significant net benefit to the child;
3. the anticipated benefit of the treatment is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over nontreatment;
4. it can be demonstrated that access to health care is available and not used; and
5. the [mother] understands the medical advice given.

In each of the cases above, a child died because of lack of appropriate healthcare. The recommended treatment (C-section) offers significant net benefit to the child. Access to healthcare was available, and the mother did understand the advice she received from physicians.

Homebirth advocates often argue that they don’t believe that a C-section is necessary in these high risk situations, but a parental belief system, whether religious or secular, is not a defense against medical neglect. For example:

Some families may refuse advice because they lack trust in physicians or organized medicine because of what they have heard from friends or the media or because of previous negative experiences with the health care system.


Medical neglect evaluations should focus on the child’s needs rather than the caregiver’s motivations or justifications. Religious objections, therefore, should not be granted fundamentally different status from other types of objections.

Although competent adults have the right to refuse life-saving medical care for themselves, the US Supreme Court has stated that parents do not have the right to deny their children necessary medical care. The court made this clear in 1944 in Prince v Massachusetts. “The right to practice religion freely does not include the liberty to expose the community or child to communicable disease, or the latter to ill health or death. . . . Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children. . . .” The American Academy of Pediatrics has taken a firm stance on the rights of seriously ill children to receive lifesaving medical care even if their parents subscribe to religious beliefs that are antithetical to medical care.

In other words, there is no special status granted to medical neglect motivated by religion or by subcultural belief systems.

So it doesn’t matter if a mother thinks that birth is to be “trusted.”

It doesn’t matter that self proclaimed midwives, doulas and childbirth educators tell her that a C-section is not necessary.

And it doesn’t matter that she believes she will be traumatized in the hospital.

It is still, morally, medical neglect.

Of course, in the case of high risk obstetric situations, the medical needs of the unborn child are balanced by the medical needs and the personal wishes of the mother. Since every competent adult is legally entitled to refuse surgery, even indicated surgery, a pregnant woman cannot be compelled to have a C-section. Furthermore, since unborn children have no legal rights, the mother is legally entitled to place her medical needs, or simply her personal wishes, above the medical needs of her baby.

Legally, then, the mother cannot be prevented from committing this form of medical neglect, but that does not change the fact that in high risk situations homebirth is morally a form of medical neglect.