Examining Autonomy’s Boundaries: A Follow‐up Review of Perinatal Mortality Cases in UK Independent Midwifery

Symon, Andrew; Winter, Clare; Donnan, Peter T.; Kirkham, Mavis

doi:10.1111/j.1523-536x.2010.00422.x

Cited by 39 publications

(58 citation statements)

References 13 publications

(17 reference statements)

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“…Symon et al (2010) examined 15 instances of perinatal death that occurred at term with independent midwives (Symon et al, 2010) from their 2009 study, which showed that high-risk situations such a preterm birth, twin pregnancy and vaginal breech birth at home were associated with unfavourable outcomes (Symon et al, 2009). In the 2010 study, they did an analysis of case notes and semi-structured interviews were conducted with the midwives concerned.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that, 'the women in this review had reportedly accepted the potential consequences of their high-risk situations. If reality is to match rhetoric about patient autonomy, such decision making in high-risk situations must be accepted' (Symon et al, 2010). Dahlen (in press) asked in a recent publication 'why are we not asking what is wrong with our mainstream maternity care that makes the fear of entering it worse than the fear of losing one's baby or life?…”

Section: Discussionmentioning

confidence: 99%

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Birthing outside the system: Perceptions of risk amongst Australian women who have freebirths and high risk homebirths

2012

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Birthing outside the system: Perceptions of risk amongst Australian women who have freebirths and high risk homebirths

2012

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“…However, there is evidence to indicate that some women with 'high-risk' pregnancies do plan to give birth at home. In the North-west Thames database, 11% (n¼658) of the planned home births would have been classed as 'high-risk' under the English 2007 guideline (Nove, 2011), and research using more recent data indicates that this practice still occurs (Symon et al, 2010). The fact that women with 'high-risk' pregnancies do sometimes plan a home birth raises the question of whether it is appropriate to exclude 'high-risk' pregnancies from a study of the comparative safety of different birth settings.…”

Section: Introductionmentioning

confidence: 97%

“…To eliminate the possibility of such a debate, research studies should ideally be set up to allow the possibility of some follow-up research among intrapartum transfers with negative outcomes to ascertain whether the outcome was in any way related to intended or actual place of birth. This approach was taken as part of a recent study in Scotland (Symon et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

The methodological challenges of attempting to compare the safety of home and hospital birth in terms of the risk of perinatal death

2012

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This paper identifies a number of methodological difficulties associated with the comparison of home and hospital birth in terms of the risk of perinatal death, and suggests ways in which these problems can be overcome. A review of recent studies suggests that most available data sources are unable to overcome all of these challenges, which is one of the reasons why the debate about whether perinatal death is more likely if a home birth is planned or if a hospital birth is planned has not been satisfactorily resolved. We argue that the debate will be settled only if perinatal mortality data from a sufficiently large number of maternity care providers over a sufficiently long period of time can be pooled and made available for analysis. The pooling of data will bring about its own difficulties due to variations over time and between providers and geographical areas, which would need to be taken into account when analysing pooled data. However, given the impracticality of a randomised controlled trial and the rarity of home birth in most of the Western world, we argue that more effort should be made to pool data for perinatal mortality and other rare pregnancy outcomes, and share them between health providers and researchers. Thus, high-quality analyses could be conducted, allowing all women to make an informed choice about place of birth. However, pooling data from countries or states with very different maternity care systems should be avoided.

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“…Legal measures have also been taken after the fact: several mothers have been charged with murder after refusing a caesarean section deemed necessary to save the life of their child [11][12][13][14]. Bowes, in 1981, cited jurisprudence where "the fetus may be the victim of homicide if born alive but dies as a result of prenatal injury [15].…”

Section: Introductionmentioning

confidence: 99%

Women Refusing Standard Obstetric Care: Maternal Fetal Conflict or Doctorpatient Conflict?

Hollander¹,

Dillen²,

Lagro‐Janssen³

et al. 2016

J Preg Child Health

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Objectives: Some women choose to give birth outside medical protocol or ignore medical advice. This could be perceived as a maternal-fetal conflict. Many professionals are unsure about the legal possibilities and ethical intricacies in these circumstances, and the position of the fetus. This paper attempts to elucidate and provide a framework for these issues. Methods:We did a literature search on Pubmed in October 2014, using the terms "legal/law", "pregnant/ pregnancy", "legal measures", "court-ordered caesarean/cesarean", "birth", "childbirth" and "homebirth". We also reviewed some professional organisations' guidelines.Results: Much has been written about legal restrictions and measures against women who go against medical advice, for instance court-ordered cesarean sections or forced hospital admissions. Medical professionals fear litigation in case of a bad outcome when the mother's wishes are respected. However, medical assessment of risk and benefit is sometimes inaccurate. Maternal competence is a central issue.The pregnant patient has the right to autonomy, bodily integrity, freedom and self-determination and the fetus has the right to have its life protected. However, it is unethical to invade one person's physical integrity for the benefit of another, especially if the other is not born yet. Religious rights are generally respected, but this is not unlimited.International guidelines on this subject generally state that a competent pregnant patient has the same rights as any other person and that her autonomy should prevail. Conclusions:In contrast to the general perception the conflict described is not between mother and child but between doctor and patient. Communication can be the key to solving this problem. In cases of continued disagreement, the mother's autonomy should prevail.Significance: In this era of social media and access to information for all, patients are better informed than ever before. At the same time, shared decision making is rapidly becoming the norm. Obstetrical care providers are increasingly faced with pregnant patients who refuse some or all proposed interventions. These decisions may appear to be at odds with what medical professionals deem best for the fetus. We have attempted to provide a legal and ethical framework for looking at this dilemma.

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Examining Autonomy’s Boundaries: A Follow‐up Review of Perinatal Mortality Cases in UK Independent Midwifery

Cited by 39 publications

References 13 publications

Birthing outside the system: Perceptions of risk amongst Australian women who have freebirths and high risk homebirths

Birthing outside the system: Perceptions of risk amongst Australian women who have freebirths and high risk homebirths

The methodological challenges of attempting to compare the safety of home and hospital birth in terms of the risk of perinatal death

Women Refusing Standard Obstetric Care: Maternal Fetal Conflict or Doctorpatient Conflict?

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