The question is not where you gave birth. It is what you were told first.
A woman who has been given these numbers, in absolute terms, and chooses a home birth has made an informed decision. That is what this stage is for.
Disclosure, one last time and in full. The doctor whose name is on this guide has published on planned home birth for more than a decade, with Dr Frank Chervenak and Dr Laurence McCullough. He is a known critic of it. Several of the studies quoted in this stage are his. This topic sets out the ethical position he has argued in print, names it as his, and then sets out the positions that disagree with it. You are the one deciding.
The position, as published. It is called the professional responsibility model of obstetric ethics. Applied to this question, it says that a specialist should tell a woman what the evidence shows, make a recommendation, and recommend hospital birth. In the authors' own words: Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth.
The same paper's next sentence is the one that is usually cut, and it is the more demanding half: Perinatologists have the professional responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital.
The obligation is not only to warn you. It is to fix the hospital experience that sends women away from it. A 2013 paper by the same group puts the same duty this way: obstetricians should advocate for a safe home-birth-like experience in the hospital.
If your hospital is the reason you are considering leaving it, that is the hospital's problem to solve, and this guide's author has said so in print for a decade.
What "directive counseling" means, since it sounds worse than it is. In the authors' own definition: Women are empowered to make informed decisions when the obstetrician makes ethically justified recommendations, which is known as directive counseling. Recommendations are ethically justified when the outcomes of one form of management is clinically superior to another.
A recommendation is not an instruction. A doctor who refuses to tell you what she thinks is not respecting you, she is withholding something you can use.
And the order of the words matters. The current formulation, from 2026: Clinically, professional responsibility requires fully informed consent leading to directive counseling, which should not be misinterpreted as paternalism but as an ethical duty to recommend hospital birth as the safest option while respecting patient autonomy.
Consent comes first in that sentence. The recommendation follows the disclosure; it does not replace it.
The same author's review states the duty in the plainest terms available: As part of the informed consent process, pregnant patients interested in out-of-hospital births should be informed of its increased perinatal risks.
And one of the mortality studies ends with a duty rather than a conclusion: These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births.
The paper on Apgar scores ends with two sentences, and the second one is the one a patient most needs: The increased risk of 5-minute Apgar score of 0 and seizures or serious neurologic dysfunction of out-of-hospital births should be disclosed by obstetric practitioners to women who express an interest in out-of-hospital delivery. Physicians should address patients' motivations for out-of-hospital delivery by continuously improving safe and compassionate care of pregnant, fetal, and neonatal patients in the hospital.
Now the other side, which is not a token. This is one contested position among several, and it is contested by serious people using overlapping evidence.
ACOG's own document contains the counterweight inside the majority position: each woman has the right to make a medically informed decision about delivery.
England's national guideline goes further and makes supporting your decision a recommendation: support them in their choice of setting wherever they choose to give birth…
The American College of Nurse-Midwives disputes the empirical premise for appropriately selected women. A formal published debate under the title "Home birth is unsafe" ran in a British journal in 2015 with a case for and a case against; this guide could not obtain the text of either side, so neither is characterised here beyond the fact that both exist.
"What are you not telling me because you think it will worry me?"
"What would change your advice?"
"If I decide differently from what you recommend, will you still care for me?"