TY - JOUR
AU - Cheeseman, Marie
AB - Abstract The safety of home birth is widely debated. The European Court of Human Rights (ECtHR) recently made two conflicting rulings on home birth, Ternovszky v Hungary and Dubská and Krejzová v the Czech Republic. In Ternovszky v Hungary, the ECtHR essentially forced Hungary to change existing legislation to allow home birth. In contrast, in Dubská and Krejzová v the Czech Republic, the Court found Czech Republic's stringent regulations against home birth acceptable. We describe these cases, the different evidence used and interpreted by the court and examine the ethical conflict between maternal autonomy and the rights of the newborn. Introduction Since 2010, the European Court of Human Rights (ECtHR) has made two separate rulings on home birth. In both cases, the applicants claimed that laws in their countries violated Article 8 of the European Convention of Human Rights: the right to respect for private and family life. They stated that these laws potentially exposed health professionals who assisted in home birth to legal consequences, preventing them from choosing where they gave birth. In both Hungary and the Czech Republic, government decrees exposed healthcare professionals found assisting in home birth to legal sanction.1 In the case of Ternovszky v Hungary, the ECtHR ruled against the government decree, finding it in violation of maternal autonomy, and cited evidence that home birth was no more risky than hospital birth.2 In contrast, in the case of Dubská and Krejzová v the Czech Republic, the ECtHR highlighted the importance of protection of the neonate, that home birth was not unequivocally without risk, and ruled that the government decree was within the margin of appreciation that member states were entitled to in looking after the public health rights of their countries, and hence there was no violation of Article 8.3 These different rulings demonstrate inconsistency in the approach of the court to home birth and illustrate the influence that existing domestic processes and regulations have on the willingness of the court to mandate change within a member state. This article explores the above cases in light of the court rulings, and it discusses how these exemplify the importance of health professional and stakeholder involvement to create evidence-based maternity services tailored to countries’ resources, values, and infrastructure, as well as regulations that uphold women's autonomy in choosing where to give birth. Ternovszky v Hungary The applicant in Ternovszky v Hungary was a pregnant Hungarian national who wanted a home birth. She claimed the national laws meant that professional assistance would be unavailable to her at home due to the risk of liability for practising ‘in a manner … not in compliance with the law’.4 In 2010, the ECtHR ruled that the Hungarian law in question; section 101(2) of Government Decree No. 218/1999 (XII.28) (‘[T]he Government shall] determine [in a decree] the professional rules and conditions governing birth outside an institution and the causes excluding the possibility of such birth’)5 violated the autonomy of women, preventing them from choosing home birth. During this case, the Hungarian government explained that there were processes underway to develop specific regulations for home birth due to recent unfortunate circumstances resulting in maternal or neonatal death in the home birth setting.6 However, at the time of the case, there were no existing specific regulations providing guidelines or protocols for home birth. While there was professional consensus in Hungary that home birth was less safe than hospital birth, there was no evidence of healthcare professionals being sanctioned when practising home birth. There were around 150 home births in Hungary between 2008 and 2009, with only one case where an administrative procedure was implemented in relation to the home birth. The court deemed this to be evidence that women were not actively dissuaded from home births, and that there were no appropriate regulations or governance for or against this process.7 The Court concluded that there was legal uncertainty in Hungarian law, which meant home birth could not be confidently accessed by Hungarian women, and consequently their autonomy could not be respected in freely making the decision to choose place of delivery. The ECtHR ruled that section 101(2) of Government Decree No. 218/1999 was contradictory to sections 15 and 20 of the 1997 Hungarian Health Care Act emphasising patient free choice to accept or reject medical intervention.8 The Court noted that the government decree on this matter was ‘prone to arbitrariness’ and was unlawful,9 emphasising the absence of regulation around birth outside a medical institution in itself, as an interference in allowing Hungarian women to choose where to give birth. The Court reiterated the importance of maternal autonomy. DubskÁ and KrejzovÁ v the Czech Republic This second judgment by the ECtHR on the issue of home birth arose out of two separate applications brought against the Czech Republic, the first by Ms Šárka Dubská (on May 4 2011) and the second by Ms Alexandra Krejzová (on May 7 2012), which were then joined by the ECtHR on December 11 2014.10 Ms Šárka Dubská found her hospital birth experience stressful with her first child and subsequently chose to give birth to her second child at home alone as she was unable to find professional assistance. Ms Alexandra Krejzová had given birth to two children, in 2008 and 2011, at home with the assistance of unauthorised midwives. Her third child was born in a maternity hospital, but she felt that the hospital had not respected her wishes during and after delivery. The applicants argued that the Czech Republic laws did not allow unrestricted access to home birth and was in violation of Article 8 of the Convention.11 Domestic law in the Czech Republic regarding birth outside an institution is as follows: the Medical Services Act,12 which stipulates under section 11(5) that healthcare services must be provided by appropriately licensed practitioners in an appropriate setting, per Decree No. 92/2012,13 with free and informed consent of the patient (section 28(1)),14 and are fully equipped per Decree No. 221/2010 of the Ministry of Health on technical equipment at healthcare institutions.15 These decrees specify that midwives conduct deliveries in rooms specially equipped for such a purpose and outline the specific equipment requirements in such a room: a birthing bed for a delivery room or other appropriate device for carrying out a physiological delivery, an examination light, a sterile clamp or rubber band for the umbilical cord, sterile scissors, electronic foetal monitoring (EFM), a pulse oximeter, a suction unit, a laryngoscope and instruments to secure the airways, a suitable space and surface for treating newborns, scales for newborns, an instrument to measure the newborn's length, and a source of medical oxygen.16 Furthermore, it is specified that such a place was a maximum of 15-min drive from a hospital that could perform a birth by caesarean section.17 Neither decree provides for the possibility of health professionals attending home births.18 Dubská and Krejzová contended that while home births were not illegal in the Czech Republic, the extensive legal requirements did not allow home birth. They claimed that this case was similar to Ternovszky v Hungary and disproportionately intruded upon their right to private life as guaranteed by Article 8.19 The ECtHR made no reference to Ternovszky v Hungary in its judgment but focussed on the margin of appreciation, a doctrine of the ECtHR describing the degree of discretion member states are allowed in fulfilling European Convention of Human Rights obligations domestically.20 The Court acknowledges that countries are mostly equipped to determine their own laws and regulations and to enforce them, taking into account domestic values, resources, and systems in the interests of the population. An application is only admissible to the Court once it has been deemed that domestic processes to address the proposed violation of a right have been exhausted. Once admitted, the Court determines if the interference to a given right is necessary for a democratic society, that it was in accordance with the law, and that it is proportionate given that member states need to balance individual or group rights with societal needs.21 In this case, regarding the Czech Medical Services Act and Decree 221/2010, the Court noted that it interfered with the applicants’ right to respect for their private life. However, this interference with the right to respect for a private life was in accordance with the law. The Court noted that the law functioned to protect the health of mothers and babies in the Czech Republic in a health system with low rates of perinatal mortality and safe maternal care currently (without home birth). The law focussed primarily on protecting the best interest of the child; thus, the burden experienced by women due to being unable to choose the place of birth was not disproportionate nor excessive. Consequently, the Court noted that this was a ‘complex matter of health-care policy’,22 with no clear consensus between EU member states, and a lack of unequivocal evidence of safety for both mothers and babies in home birth. Therefore, the Court found that the Czech Republic did not exceed the wide margin of appreciation afforded to them by the court in requiring that personnel assisting with birth meet certain criteria. Taking into account the above, there was therefore no violation of Article 8.23 To summarise, in Ternovszky v Hungary, the ECtHR found the Hungarian law that potentially exposed healthcare professionals practising home birth to conviction for practising in a non-compliant manner to be in violation of Article 8. The Court specified that because the details of this particular decree had not been defined by the Hungarian government (and the exact requirements for home birth had not been stipulated), the incomplete decree was unlawful. Hungarian women did not have full autonomy in freely choosing their place of birth, and this was a disproportionate violation of their autonomy. In contrast, in Dubská and Krejzová v the Czech Republic, the ECtHR found the detailed and comprehensive requirements in the decree for the practice of child delivery, which prohibit home birth, to be proportionate and within the margin of appreciation required to maintain the health and safety of the mother and newborn. Consequently, the intrusion upon the autonomy of women in the Czech Republic was not deemed to be in violation of Article 8. Margin of Appreciation and the ECtHR The margin of appreciation is not always used consistently or predictably by the ECtHR.24 This has recently become particularly evident in the case of home birth regulation amongst European Union Member States. In the European Union, 16 of the 32 member states expressly allow home birth in certain circumstances, and the other 16 do not regulate home birth.25 A comparison may be made with ECtHR rulings regarding abortion in its member states. Similar to the matter of home birth, there is no overall consensus in the European member states regarding the lawfulness of abortion services, and the ECtHR have never mandated domestic provision for abortion services, not even for life-threatening conditions requiring medical termination.26 Contrastingly, home birth is never required to save a woman's life, and in this case, the Strasbourg court has required a member state to legalise provision of a non-life saving service, which may even be harmful if not appropriately resourced and regulated. Decree 221/2010 was prescriptive and detailed in Czech Republic law, specifying the location and equipment required for midwifery care, whereas in Ternovszky v Hungary, the government decree was ‘yet unformed’.27 While the end result of both decrees were the same—that home birth was not explicitly prohibited but was regulated—the ECtHR reached different conclusions in these two cases. In considering the clear regulations of the Czech Republic Decree 221/2010, the Court did not interfere to change the country's law, finding that these regulations were within its margin of appreciation. This is in keeping with the ECtHR's ‘supervisory role’, as the ECtHR maintains that it is only involved when national courts’ assessment of the facts or domestic law are ‘manifestly unreasonable, arbitrary, or blatantly inconsistent with the fundamental principles of the Convention’.28 However, regarding the less detailed Hungarian Decree, the Court ruled that there was an ‘absence of specific, comprehensive legislation on the matter’29 and ruled that in this member state the interference in a woman's right to home birth was unlawful. Although the ECtHR specified that countries were afforded a wider margin of appreciation when there was no European consensus on home birth, it did not grant this to Hungary. The stipulation, instead, was that ‘for the Court, the right to choice in matters of child delivery includes the legal certainty that the choice is lawful and not subject to sanctions, directly or indirectly’.30 The Court acknowledged that the Hungarian government was tasked with clarifying the regulations for home birth by Act No. CLIV of 2009 but undermines this domestic process by dictating that ‘positive’ regulations must be written into law to facilitate access to home birth in order to uphold maternal autonomy.31 The Hungarian government applied that Ternovszky's complaint was an actio popularis—in that she was acting to defend a proposed public right, especially given that processes were underway to regulate home birth at the time of Ternovszky v Hungary. This opinion was echoed by the dissenting judge in Ternovszky v Hungary, Justice Popović, who expressed that he felt the applicant's claim was an actio popularis. This Judge concluded that because the applicant could not be proved to have had her human rights violated in her home state, nor could she have had an arguable claim at the domestic level, she was in fact not acting in her own interests for herself.32 In contrast to the Dubská and Krejzová v the Czech Republic case, the court did not consider Hungary's right for self-governance and did not allow it the wide margin of appreciation subsequently seen in Dubská and Krejzová v the Czech Republic. Hungary was not accorded the opportunity to involve and consult Hungarian stakeholders in order to develop a maternity care system that was most suited to its health resources, funding, and safety statistics. The ECtHR took away Hungary's ability to consider the safety of its child delivery system outside medical institutions and to duly regulate. By finding Decree No. 217/1999 unlawful, the court has intruded upon Hungary's ability to self-regulate in the matter of home birth, insisting that Hungary must implement regulations that support home birth. The court has therefore mandated home birth—a service that is potentially harmful when forced upon a country that may not have adequate infrastructure. Madam Ternovszky's application may indeed have achieved actio popularis. However, if the Court had found a Hungarian maternity system that was clinician-led, guideline, and protocol based, with clear regulations and appropriate oversight, it may have not been deemed to lack clarity, and perhaps the ECtHR would not have decided as it did. In the Czech Republic case, while the Court accepted that the laws impacted upon the freedom of choice of the applicants and expressed concern that the mothers choosing to give birth at home in the Czech Republic do so with ‘the acceptance of risk, but that risk is even greater due to the absence of medical assistance’,33 the Court did not mandate a system to allow home birth in this country. Notably, the single dissenting Judge, Judge Lemmens, expressed concern about the consultation process in the Czech Republic. In 2012, the Ministry of Health set up a committee to address the possibility of provision for home birth, inviting participation from stakeholders, including midwives, the Commissioner for Human Rights, physicians’ associations, care recipients, the Ministry itself, and public health insurance companies. However, physicians’ representatives boycotted the meeting, as they felt that the status quo could not be faulted in the Czech maternity system. The Ministry was unable to proceed until they excluded representatives of care recipients, midwives, and the Government's Commissioner for Human Rights from the committee; declaring that no decisions or discourse could be made unless they were precluded.34 The resulting maternity system, one that excludes home birth, developed without wide consultation, does not respect maternal autonomy, and cannot be shown to prioritise maternal wishes for women who are low risk, and thus does not fulfil its own obligation to respect every patient's right to self-determination. The Science Cited in Ternovszky V Hungary In Ternovszky v Hungary, the ECtHR acknowledged that ‘for want of conclusive evidence, it is debated in medical science whether, in statistical terms, homebirth as such carries significantly higher risks than giving birth in hospital’.35 This comment references a study of obstetric data obtained from Dutch women deemed to be at low risk.36 In this study, planned places of birth were recorded (regardless of actual place of birth), and there were no significant differences in perinatal mortality between the planned hospital births and planned home births.37 This study alone is not sufficient to support the Court's interpretation that home birth may not be more harmful than hospital birth. It instead shows that low-risk Dutch women planning to give birth at home rather than in hospital are not at increased risk of perinatal mortality. The results cannot be generalised to all healthcare systems. The Netherlands has the highest rate of home birth in the developed world,38 and it has strict criteria for selection of women suitable for home birth, infrastructure in place to facilitate home birth, and midwives who are skilled home birth attendants.39 It does not follow, as claimed by the court, that home birth does not carry significantly higher risks than hospital birth for Hungary, and it is a significant leap to then justify on this basis the implementation of an entire home birth system. The Science Cited in DubskÁ and KrejzovÁ v the Czech Republic In contrast to Ternovszky v Hungary, the Court in Dubská and Krejzová v the Czech Republic considered a range of scientific evidence. The majority of studies submitted to the Court by the Parties showed that for low-risk women with low-risk pregnancies, planned home birth did not show higher rates of perinatal mortality.40,41 However, in almost all the studies presented, the rates of medical intervention such as episiotomy, caesarean section, or assisted instrumental delivery were lower in the non-hospital group. A recent trial presented to the Court, by Brocklehurst et al., which studied 64 538 low-risk women and showed that there were no increases in perinatal mortality or intrapartum-related neonatal morbidities in the planned home birth group (PHBG) compared with the planned obstetric unit birth group (POUBG) overall.42 The study applied selection criteria, enrolling only low-risk women with low-risk pregnancies. Women who planned home birth were those who started care in labour at home and those who planned obstetric unit birth were those who planned to give birth in an obstetric unit at the start of care in labour (regardless of whether they were transferred during labour or immediately after birth). The birthplace study found a slightly increased risk of perinatal mortality and intrapartum-related neonatal morbidities for nulliparous women in the PHBG; there was no difference over all when all low-risk women were considered.43 These findings are hard to extrapolate to the individual and are not necessarily a reflection that home birth is safe, but that a low-risk woman with a low-risk pregnancy giving birth in the UK who starts labour care at home does not have a higher risk of perinatal mortality or morbidity. Because randomised controlled trials cannot be done for home birth versus hospital birth, and because studies looking at data regarding actual place of birth mean the hospital group will have an increased rate of interventions and perinatal morbidity and mortality—since medical interventions and resuscitation are mostly done once the woman has been transferred—prospective cohort studies examining intended place of birth are used.44 One could argue that the safety data of a staffed, equipped obstetric unit for a woman who chooses to start labour care at home but then decides to attend an obstetric unit are now attributed to the home birth group. Since 36–45% of nulliparous women were transferred to hospital,45 and the study does not report what percentage of births actually occurred in an obstetric unit, it is impossible to know whether giving birth at home is safer for the mother and the neonate. Nevertheless, a safe home birth system must have safe obstetric unit support, and what this study does show, is that low-risk multiparous women in the UK who choose to start care in labour at home do not have an increased risk of perinatal mortality or morbidity and have a lower rate of interventions. The study findings support low-risk women with low-risk pregnancies in the UK having a choice of place of birth at the start of labour. The Court also heard that, in contrast, Evers et al. found low-risk women who started labour at home but who were then referred to hospital had a 3-fold increase in delivery-related perinatal death compared with high-risk women who started labour under the care of an obstetrician in hospital.46 There was also an American meta-analysis presented to the Court that showed home birth to carry a 3-fold increased risk of neonatal mortality,47 but which is heavily criticised for being flawed.48 Respect for Autonomy versus the Safety of the Newborn The ECtHR in the case of Ternovszky v Hungary noted that ‘the notion of personal autonomy is a fundamental principle … Therefore the right concerning the decision to become a parent includes the right of choosing the circumstances of becoming a parent’.49 To support a woman when she chooses home birth, adequate funding and support are required. The choice of birth place requires a health system that is able to fund trained home birth midwives, access to ambulances for transfer, and professional bodies to set criteria so that the right women are able to access home birth safely. This is a complex interplay of rights and responsibilities: our societies are responsible for engineering healthcare systems that enable choice and must take into account the risks involved for the unborn child.50 The accessibility of home birth in isolation does not operationalize maternal autonomy; the ‘right to choose’ in respect of maternal autonomy requires that the mother has informed consent, has access to information supported by evidence, and understands the risks and benefits of home birth with respect to herself and her baby. The Court in the case of Ternovszky v Hungary did not consider the risks to, or rights to protection of, the term foetus. In contrast, the court in Dubská and Krejzová v the Czech Republic noted that women could not have complete free choice as to the circumstances in which they gave birth and that any such choice had to be balanced against other interests, including the right to life and health of the newborn. In Dubská and Krejzová v the Czech Republic, the ECtHR cited several internal legal instruments in their judgment, including the Convention of the Rights of the Child, Article 6,51 noting that the Government had a responsibility to care for the newborn, ensuring that their best interests were protected, including regulating midwives practising home birth. Importantly, they found that the rights guaranteed under Article 8 of the Convention do not allow parental rights to be placed above those of the newborn.52 Since the neonate attains rights at birth, decisions made by the mother regarding the method or place of birth can sometimes increase the risks of harm to the safety and health of the newborn, and the Government has a responsibility to protect unborn children in their country with the resources they have. These considerations were not addressed by the ECtHR in Ternovszky v Hungary. Since obstetrics ethics require health professionals to act in the best interests of mother and child, the findings in Dubská and Krejzová v the Czech Republic are arguably more considered than those in Ternovszky v Hungary. Conclusion These two very different rulings by the ECtHR on similar cases in countries that regulated against home birth create difficulty for regulators, health systems, healthcare workers, women, and unborn children. It suggests that the ECtHR is internally conflicted and inconsistent with respect to rulings regarding home birth. This may have flow-on effects for European Member States who have not expressly prohibited home birth: which government decrees will the ECtHR deem as acceptable within a country's margin of appreciation? The next time the issue of home birth regulation arises; will the Court rule that positive regulation must be in place to facilitate free and unrestricted access to home birth? Even in countries that are not resourced or set up to safely support home birth? Or, will the Court rule that Member States are entitled to defend regulations making home birth almost inaccessible as procedures that protect public health are within their margin of appreciation? Will home birth become the next topic of debate, where, like the issue of abortion, the ECtHR will continue to shy away from commenting on the ethical issues of maternal autonomy and the safety of the newborn? These questions are difficult to answer, especially given that the risks and benefits of home birth remain debated,53 and that currently available data regarding place of delivery are country specific, with few countries having sufficient numbers of women birthing at home to allow for comparison with hospital birth.54,55,56 Countries that have significant levels of home birth such as the Netherlands have well-established systems, with effective transport systems and midwives trained in home birth. Results from this country are reflective of a considered childbirth system that cannot be easily extrapolated to a country not experienced and resourced for safe home birth.57 Research regarding choice of place of delivery from established countries suggests that giving low-risk women a choice for place of delivery does not significantly increase maternal or perinatal mortality, but there is an obvious resource commitment of personnel, policy, infrastructure, and transport required by the State to uphold this autonomy.58,59 These two cases may be viewed as examples that lie on the opposite ends of a spectrum, the Hungarian case involving a lack of formal regulation and professional governance leading to a situation where home birth was frowned upon, but not prohibited, to the other extreme of dictatorial regulation in the Czech Republic that in effect meant home birth was not realistically possible due to such strict regulation that did not acknowledge maternal autonomy. When countries are not seen to develop clear professional guidelines in maternity care, women become concerned that their choice to give birth at home is not supported. The lack of clarity and regulation in Hungarian law, despite the institution of a Decree but with no further guidance about the ability to choose home birth, led to Ternovszky seeking guidance from the ECtHR. On the other hand, in the Czech Republic, unilateral decisions by physicians to exclude other stakeholders leading to prevention of free access to home birth due to one-sided laws, compelled women like Dubská and Krejzová to engage in legal processes at an international level to preserve their autonomy. These two divergent rulings on a similar matter illustrate the difficulty of legislating on home birth, the difficulty of interpreting home birth evidence, and the important influence of professional regulations and protocols in the development of legal standards domestically and internationally. Hungary has been denied the opportunity to develop a maternity system best suited to its resources and infrastructure, while the Czech Republic has been allowed to continue to legislate against home birth. Ultimately, the importance of a collegial approach, and clinician and maternal co-design of maternity systems, cannot be underestimated to ensure the development of a maternity system that is safe and respects the autonomy of women, for women, in their home countries. Footnotes 1 ECHR: Ternovszky v Hungary. No. 67545/09, ECHR 2010-XII. 2 Ibid. 3 ECHR: Dubská and Krejzová v the Czech Republic. Applications Nos 28859/11 and 28473/12. ECHR 2014-XII. 4 Hungary: Health Care Act 1997 section 101(2). Government Decree No. 218/1999: ‘a health professional who carries out activities within his or her qualifications without a licence, or carries out such activities in a manner which is not in compliance with the law or the licence, is punishable with a fine of up to 100,000 Hungarian forints’. 5 Hungary: Act No. CLIV 2009, amendment section 247(1) Health Care Act 1997. 6  See ECHR (n 1), para. 24. 7 Ibid, para 26. 8 See ECHR (n 1). 9 Ibid. 10 See ECHR (n 3). 11 Ibid. 12 The Czech Republic: Medical Services Act (No. 372/2011) (entry into force on April 1 2012). 13 The Czech Republic: Decree No. 92/2012 of the Ministry of Health on technical equipment at healthcare institutions (entry into force on April 1 2012). 14 See The Czech Republic (n 12). 15 The Czech Republic: Decree No. 221/2010 of the Ministry of Health on technical equipment at healthcare institutions (in force from September 1 2010 to March 31 2012). 16 Ibid. 17 The Czech Republic: Emergency Medical Services Act (No. 374/2011). 18 See ECHR (n 3). 19 Ibid. 20 D Spielman, ‘Allowing the Right Margin. The European Court of Human Rights and the National Margin of Appreciation Doctrine: Waiver or Subsidiarity of European Review?’ Centre for European Legal Studies Working Paper Series, February 2012. Cambridge University, Faculty of Law, p 1–30. 21 Ibid. 22 See ECHR (n 3). 23 Ibid. 24 See Spielman (n 20). 25 ECHR (n 3). 26 Johanna Westeson, ‘Reproductive Health Information and Abortion Services: Standards Developed by the European Court of Human Rights’ (2013) 122 Int J Gynaecol Obstet 173, 176. 27 See ECHR (n 1). 28 See Spielman (n 20). 29 See ECHR (n 1), para. 24. 30 Ibid. 31 See ECHR (n 1). 32 Ibid. 33 ECHR (n 3). 34 Ibid. 35 See ECHR (n 1). 36 A De Jonge and others, ‘Perinatal Mortality and Morbidity in a Nationwide Cohort of 529,688 Low-Risk Planned Home and Hospital Births’ (2009) 116 BJOG 1177, 1184. 37 Ibid. 38 HA Brouwers, W Bruinse, J Dijs-Elsinga, et al. Netherlands Perinatal Registry. Perinatal Care in the Netherlands 2013. Utrecht: Netherlands Perinatal Registry, 2014. 39 Obstetric Working Group. Final report of the Obstetric Working Group of the National Health Insurance Board of the Netherlands (abridged version, The Netherlands, 2000). 40 De Jonge and others (n 36). 41 P Brocklehurst and others, ‘Perinatal and Maternal Outcomes by Planned Place of Birth for Healthy Women with Low Risk Pregnancies: The Birthplace in England National Prospective Cohort Study’ (2011) 343 BMJ d7400. 42 Ibid. 43 Ibid. 44 O Olsen and JA Clausen, ‘Planned Hospital Birth Versus Planned Home Birth’ (2012) 9 Cochrane Database Syst Rev CD000352. 45 See Brocklehurst (n 41). 46 ACC Evers and others, ‘Perinatal Mortality and Severe Morbidity in Low and High Risk Term Pregnancies in the Netherlands: Prospective Cohort Study’ (2010) 341 BMJ c5639. 47 JR Wax and others, ‘Maternal and Newborn Outcomes in Planned Home Birth vs Planned Hospital Births: A Meta-analysis’ (2010) 203 Am J Obstet Gynecol 243.e1–8. 48 CA Michael, PA Janssen, S Vedam, EK Hutton, A de Jonge. Planned Home vs Hospital Birth: A Meta-Analysis Gone Wrong. Medscape Ob/Gyn & Women's Health (online). Available at http://www.medscape.com/viewarticle/739987 (accessed 12 January 2015). 49 See ECHR (n 1). 50 FA Chervenak and others, ‘Planned Home Birth: The Professional Responsibility Response’ (2013) 208 Am J Obstet Gynecol 31, 38. 51 United Nations Human Rights. Office of the High Commissioner for Human Rights. Convention on the Rights of the Child. 52 ECHR (n 3). 53 See Olsen and Clausen (n 44). 54 Ibid. 55 See Wax and others (47). 56 See Chervenak and others (n 50). 57 See De Jonge (n 36). 58 Ibid. 59 See Brocklehurst (n 41). © The Author 2016. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com
TI - European Court of Human Rights Rulings in Home Birth Set to Cause Trouble for the Future: A Review of Two Cases
JF - Medical Law Review
DO - 10.1093/medlaw/fwv040
DA - 2017-01-01
UR - https://www.deepdyve.com/lp/oxford-university-press/european-court-of-human-rights-rulings-in-home-birth-set-to-cause-VOaIXUaq4p
SP - 115
EP - 125
VL - 25
IS - 1
DP - DeepDyve
ER -