Beyond autonomy: Care ethics for midwifery and the humanization of birth

Newnham, Elizabeth; Kirkham, Mavis

doi:10.1177/0969733018819119

Cited by 53 publications

(62 citation statements)

References 28 publications

(52 reference statements)

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“…Over time, obstetrics has become the dominant voice in maternity care, with the acceptance of the discipline's knowledge and authority over other disciplines such as midwifery and nursing (Bluff & Holloway, 2008;Fahy, 2002;Newnham & Kirkham, 2019). The consequences of the subordination of midwifery include the medicalization of birth and a culture which views a woman's body as a machine to be controlled in order to protect the fetus, often leading to an imbalance of power which favours the medical profession (Shaw, 2013).…”

Section: Introductionmentioning

confidence: 99%

Women’s experiences of breech birth and disciplinary power

Morris

Geraghty

Sundin

2021

Journal of Advanced Nursing

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Aims: To explore women's experiences of breech pregnancy and birth to identify areas in practice for improvement.Design: A descriptive exploratory study was conducted involving 20 women who had experienced a breech birth between 2013 and 2018.Methods: Semi-structured interviews were audio recorded and transcribed.Transcripts were examined using a free-form 'circling and parking' style of analysis.Foucault's concepts of power/knowledge were utilized to describe existing power relations.Results: Women experienced varying degrees of disciplinary power throughout their experiences. Knowledge was used as a means of enforcing disciplinary power by some

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Section: Introductionmentioning

confidence: 99%

Women’s experiences of breech birth and disciplinary power

Morris

Geraghty

Sundin

2021

Journal of Advanced Nursing

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“…Ultimately, midwives suggest that, instead of supporting women’s empowerment needs by respecting their autonomy and authority, the healthcare system has a patronizing attitude towards them [ 41 ]: “I think it scares us, because we come from a healthcare system, paternalistic and sexist, in which we are used to making decisions for others…for us it is much easier to believe that what we are doing is what happens most often, and we come from the idea that we possess the knowledge and that the other person does not, so we are in this situation of power: I do know and you don’t know. And it’s like this, I think, it scares us to know that we don’t know what we know as much as we think, and that, in the end, what we’re affecting is a person who has the right to decide what’s best for her and not for us.” (Alisa, group B)…”

Section: Resultsmentioning

confidence: 99%

Obstetric Violence as an Infringement on Basic Bioethical Principles. Reflections Inspired by Focus Groups with Midwives

Badia

Obregón-Gutiérrez

Tricas

2021

IJERPH

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Background: obstetric violence is still far too invisible; the word “violence” generates rejection and obstetric violence is complex to define and typify, as it is a subjective experience. It has been widely analyzed from legal, sociological, and clinical perspectives, but not equally so from the bioethical point of view. This article sets out to take a more in-depth look at the experiences of midwives in order to describe the ethical perspectives of obstetric violence. We intend to describe the effects that malpractice and violence within obstetric care have on American and European bioethical principles. Methodology: A qualitative methodology of the phenomenological tradition was used: 24 midwives participated in three focus groups. Results and Discussion: four categories were arrived at; they are “the maleficence of forgetting my vulnerability”, “beneficence requires respect for my integrity and dignity”, “my autonomy is being removed from me” and “a problem of social justice towards us, women”. Conclusion: obstetric violence infringes on the main bioethical principles (non-maleficence, beneficence, autonomy, justice, vulnerability, dignity, and integrity). Beyond whether it is called violence or not, what matters from an ethical perspective is that, as long as women have such negative experiences during pregnancy and childbirth, obstetric care needs better humanizing.

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“…This is problematic, since midwifery claims a person-centered approach to perinatal care, with roots in a long tradition of resistance from medical dominance over childbearing [ 70 ]. Though midwifery ethic has long held the banner on the value of autonomy and decision-making, midwives in this study were not exempt from acting as agents of the medical system–a system that can unequivocally subsume the midwifery model of care [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

“I fought my entire way”: Experiences of declining maternity care services in British Columbia

et al. 2021

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Background The 2016 WHO Standards for improving quality of maternal and newborn care in health facilities established patient experience of care as a core indicator of quality. Global health experts have described loss of autonomy and disrespect as mistreatment. Risk of disrespect and abuse is higher when patient and care provider opinions differ, but little is known about service users experiences when declining aspects of their maternity care. Methods To address this gap, we present a qualitative content analysis of 1540 written accounts from 892 service users declining or refusing care options throughout childbearing with a large, geographically representative sample (2900) of childbearing women in British Columbia who participated in an online survey with open-ended questions eliciting care experiences. Findings Four themes are presented: 1) Contentious interactions: “I fought my entire way”, describing interactions as fraught with tension and recounting stories of “fighting” for the right to refuse a procedure/intervention; 2) Knowledge as control or as power: “like I was a dim girl”, both for providers as keepers of medical knowledge and for clients when they felt knowledgeable about procedures/interventions; 3) Morbid threats: “do you want your baby to die?”, coercion or extreme pressure from providers when clients declined interventions; 4) Compliance as valued: “to be a ‘good client’”, recounting compliance or obedience to medical staff recommendations as valuable social capital but suppressing desire to ask questions or decline care. Conclusion We conclude that in situations where a pregnant person declines recommended treatment, or requests treatment that a care provider does not support, tension and strife may ensue. These situations deprioritize and decenter a woman’s autonomy and preferences, leading care providers and the culture of care away from the principles of respect and person-centred care.

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Beyond autonomy: Care ethics for midwifery and the humanization of birth

Cited by 53 publications

References 28 publications

Women’s experiences of breech birth and disciplinary power

Women’s experiences of breech birth and disciplinary power

Obstetric Violence as an Infringement on Basic Bioethical Principles. Reflections Inspired by Focus Groups with Midwives

“I fought my entire way”: Experiences of declining maternity care services in British Columbia

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