Attitudes of Midwives in Sweden Toward a Woman’s Refusal of an Emergency Cesarean Section or a Cesarean Section on Request

Danerek, Margaretha; Maršál, Karel; Cuttini, Marina; Lingman, Göran; Nilstun, Tore; Dykes, Anna Karin

doi:10.1111/j.1523-536x.2010.00440.x

Cited by 19 publications

(18 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent research strives for a holistic understanding of childbirth experiences, based on women’s perceptions of risk (Sharma et al, 2011), the myriad of meanings underlying notions of ‘control’ (Namey & Lyerly, 2010), pain (Declercq et al, 2008), previous delivery outcomes (David et al, 2010; Kaimal & Kuppermann, 2010; Pang et al, 2008), race (Getahun et al, 2009; Rosenthal & Lobel, 2011; Selo-Ojeme et al, 2008), medical record information (Wibe et al, 2011), midwifery practices (Danerek et al, 2011), and community factors (Leone et al, 2008). These influences are increasingly viewed as interacting, and are replacing the antagonistic view of defensive medicine that dominated earlier literature (Bassett et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

Tully

Ball

2013

Social Science & Medicine

View full text Add to dashboard Cite

International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women’s accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean).

show abstract

Section: Introductionmentioning

confidence: 99%

Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

Tully

Ball

2013

Social Science & Medicine

View full text Add to dashboard Cite

show abstract

“…These debates about the status of the fetus are relevant here insofar as they reflect how clinicians' views on the fetus may influence women's care. Most empirical research about pregnant women who decline recommended care has been devoted to refusal of caesarean section (CS; see Adams et al, 2003;Chigbu et al, 2009;Chigbu & Iloabachie, 2007;Cuttini et al, 2006;Danerek et al, 2011;Samuels et al, 2007) and, to a lesser extent, blood products (see Iris et al, 2009;van Wolfswinkel et al, 2009). Studies examining other maternal refusals are rare.…”

Section: Delimiting the Scopementioning

confidence: 99%

“…Most of the published literature concerning women who decline recommended care focusses on the experiences of clinicians (Chigbu et al, 2009;Cuttini et al, 2006;Danerek et al, 2011) and their attitudes to court intervention (Samuels et al, 2007); the experiences of women are less commonly described. Three papers (Chervenak & McCullough, 1990;Deshpande & Oxford, 2012;Pinkerton & Finnerty, 1996)…”

Section: Introductionmentioning

confidence: 99%

“…Although these studies have generally reported low levels of willingness to seek court orders to compel pregnant women to accept recommended care, they have not investigated strategies that might address ethical and medico-legal concerns of doctors. Similarly, only two studies investigated midwives' attitudes and experiences of caring for women who decline recommended care (Danerek et al, 2011;Thompson, 2013). One of those studies (Danerek et al, 2011) found that Swedish midwives prioritised fetal well-being above respect for maternal autonomy and therefore sought to persuade women to accept recommended care.…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, only two studies investigated midwives' attitudes and experiences of caring for women who decline recommended care (Danerek et al, 2011;Thompson, 2013). One of those studies (Danerek et al, 2011) found that Swedish midwives prioritised fetal well-being above respect for maternal autonomy and therefore sought to persuade women to accept recommended care. The second study (Thompson, 2013) Chigbu & Iloabachie, 2007;Iris et al, 2009;Ribak et al, 2011) and blood products (Ribak et al, 2011;van Wolfswinkel et al, 2009), had high rates of adverse clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

Jenkinson¹

View full text Add to dashboard Cite

Background: The right to refuse medical treatment, held by all competent adults and unaltered by pregnancy status, is a central tenet of respectful maternity care. This right is well established in case law, midwifery and obstetric ethical guidance and health policy. However, when pregnant women decline recommended care, concerns about maternal and fetal safety can lead to conflict. Clinicians may feel their own autonomy is challenged and also grapple with ethical and medico-legal concerns. Processes to guide clinicians when women decline recommended care are rare and unstudied. Aim: This thesis set out to support women's rights in maternity care by investigating the research question: Could a documentation and communication process support pregnant women's rights to decline recommended maternity care? Methods: A sequential, explanatory mixed-methods study was undertaken in a Brisbane (Australia) tertiary maternity hospital where a structured process, the Maternity Care Plan (MCP), had been established to guide communication and documentation when women declined recommended care. The first stage of the study was quantitative and mapped the scope and use of the MCP process via a retrospective cohort study of women with MCPs. Results of the quantitative stage then informed selection of participants for the qualitative phase of the study which involved thematic analysis of in-depth semi-structured interviews with women, midwives, and obstetricians. Within the qualitative phase, two layers of thematic analysis were undertaken. The first layer of thematic analysis was descriptive, and focused on participant's experiences of the MCP process, while the second layer applied a more critical and feminist lens, foregrounding the underlying values and attitudes that drove care when pregnant women declined to follow professional advice. Findings: The retrospective cohort study included 52 women with MCPs and concluded that the MCP process enabled clinicians to provide care outside of hospital policies but was used rarely, for a narrow range of situations and with significant variation in its application. These results were then followed up in interviews with nine women, twelve midwives, and nine obstetricians. The descriptive thematic analysis of interviews found that obstetricians felt protected and reassured by the structured documentation and communication, while other clinicians felt reassured by the perception of obstetric authorisation. This, in turn, protected women's access to maternity care. However, inconsistencies in the implementation of the MCP process, and fragmented care, diminished both the utility of the process and women's access to it. While the MCP process 3 provided a symbol of respect for maternal autonomy, the larger forces of patriarchy and medical hegemony remained largely unchallenged. The feminist thematic analysis then identified both supportive and punitive interactions between women and clinicians, depending on whether the woman's birth intentions were perceived by individual clinicians to transg...

show abstract

Attitudes of Swedish midwives towards management of extremely preterm labour and birth

et al. 2012

Self Cite

View full text Add to dashboard Cite

Attitudes of Midwives in Sweden Toward a Woman’s Refusal of an Emergency Cesarean Section or a Cesarean Section on Request

Cited by 19 publications

References 34 publications

Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

Attitudes of Swedish midwives towards management of extremely preterm labour and birth

Contact Info

Product

Resources

About