We thank Dr Dixon for her letter in response to our article. According to the New Zealand College of Midwives World Wide Web site ( http://www.midwife.org.nz/home/personnel , accessed April 13, 2013), Dr Dixon is “Midwifery Advisor–Practice Advice and Research” for the college. Inasmuch as she does not appear to be an officer of the college, we assume that she speaks only for herself and not also for the college.

Dr Dixon’s presentation of our position distorts it beyond recognition. We nowhere adopt the discourse of fetal rights; indeed, we have explicitly rejected it. Dr Dixon is a maternal rights–based reductionist: the “rights of pregnant women over their bodies” is absolute, admitting of no limits and therefore no exceptions. In maternal rights–based reductionism, the pregnant woman is the only patient. Like fetal rights–based reductionism, Dr Dixon’s extreme view has no place in professional obstetric ethics.

To repeat, the concept of the fetus as a patient is beneficence based, not rights based. In professional obstetric judgment, beneficence-based obligations to the fetal patient must in all cases be balanced against beneficence-based and autonomy-based obligations to the pregnant woman. The pregnant woman also has beneficence-based obligation to the fetus and the soon-to-be-born child, which means that her rights are not absolute; they are justifiably limited. Far from treating pregnant women as “vessels to grow babies,” recognizing and supporting a woman’s fulfillment of this obligation respects her as a moral agent with obligations as well as rights. Dr Dixon is an egregious reductionist: the only relevant considerations are the absolute rights of the pregnant woman and the physician’s subordination to them. The result is to replace a relational account of the moral agency of pregnant women with the impersonal discourse of unlimited rights over one’s body. This approach to obstetric ethics disrespects the pregnant woman as a moral agent and eliminates professionalism from obstetric ethics.

Finally, Dr Dixon’s defense of planned home birth on the grounds that “no one can promise complete safety regardless of birth setting” is a transparent attempt to avoid accountability for answering the central issue in planned home birth: does planned home birth create increased, preventable, and therefore professionally unacceptable perinatal risks?