Autonomy in place of birth: a concept analysis

Abstract

This article examines one of the relevant concepts in the current debate on home birth-autonomy in place of birth-and its uses in general language, ethics, and childbirth health care literature. International discussion on childbirth services. A concept analysis guided by the model of Walker and Avant. The authors suggest that autonomy in the context of choosing place of birth is defined by three main attributes: information, capacity and freedom; given the antecedent of not harming others, and the consequences of accountability for the outcome. Model, borderline and contrary cases of autonomy in place of birth are presented. A woman choosing place of birth is autonomous if she receives all relevant information on available choices, risks and benefits, is capable of understanding and processing the information and choosing place of birth in the absence of coercion, provided she intends no harm to others and is accountable for the outcome. The attributes of the definition can serve as a useful tool for pregnant women, midwives, and other health professionals in contemplating their moral status and discussing place of birth.

Conflicting attitudes between clinicians and women regarding maternal requested caesarean section: a qualitative evidence synthesis

“…The model was developed through a concept analysis in order to understand women’s choices regarding place of birth, and it can be transferred to the choice regarding mode of birth. In light of the results found in these thematic syntheses, the problem about performing CS upon maternal request could be embedded between the concepts ‘Do no harm’ and ‘Take responsibility for the outcome’, discussed in terms of Information, Capacity , and Freedom [ 45 ].…”

“…Freedom of choice is an essential and delicate component of autonomy that might be internal or external. Laws, regulations, and traditions might restrict external freedom, while internal freedom could be restricted by, e.g., anxiety [ 45 ]. There are some ethical aspects connected to freedom of choice.…”

A true choice of place of birth? Swiss women’s access to birth hospitals and birth centers

“…Being able to exercise reproductive rights and, particularly, to determine how and where to give birth qualifies as reproductive autonomy [ 20 ]. Similarly, a concept analysis on autonomy in place of birth emphasized that being capable of choosing place of birth in the absence of coercion is one prerequisite for an autonomous choice [ 21 ]. Finally, emphasizing the imperative to enable women to make reasonable choices, a Cochrane review on place of birth has pointed out that women residing in areas where they are not well informed about possible places of birth “may welcome ethically well‐designed trials that would ensure an informed choice” [ 22 , p2].…”

Patient autonomy in a high‐tech care context—A theoretical framework

“…Autonomy presumes that a person has experience, education, self‐discipline and decision‐making capacity (Keenan, ). Recently, it was suggested that information, capacity and freedom were the attributes for autonomy in the context of choosing a place to give birth (Halfdansdottir et al., ). Referring to autonomy in relation to patients in high‐tech care environments could be seen as paradoxical, as in most cases, they are vulnerable and could lack physical and/or metacognitive capacity (Levinsson, ), thus prohibiting them from remaining or becoming autonomous.…”