Holy consent – a dilemma for medical staff when maternal consent is withheld for emergency caesarean section

Weiniger, Carolyn F.; Elchalal, Uriel; Sprung, C. L.; Weissman, Charles; Matot, Idit

doi:10.1016/j.ijoa.2005.10.002

Cited by 10 publications

(10 citation statements)

References 13 publications

(23 reference statements)

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“…Emergency cesarean section is indicated when the life of a fetus is in danger, for example, in a situation with fetal distress (17). Refusal of emergency cesarean section is extremely rare, but sometimes, although fully informed and competent, women refuse the recommended intervention.…”

mentioning

confidence: 99%

“…Because obstetricians and midwives cooperate in the care of complicated pregnancies and births, it is important that their team work functions smoothly (10). Several studies, mainly involving obstetricians, have been carried out to explore their attitudes toward women’s refusal to undergo a recommended cesarean section (2,17,19,26) and also their attitudes toward cesarean section on request (24,25). To our knowledge, no studies have been performed that describe the attitudes of midwives about the obstetrician’s decision making when a woman refuses or requests a cesarean section.…”

mentioning

confidence: 99%

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

Danerek

Maršál

Cuttini

et al. 2011

Birth

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mentioning

confidence: 99%

mentioning

confidence: 99%

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

Danerek

Maršál

Cuttini

et al. 2011

Birth

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show abstract

“…3 This opens the proverbial PandoraÕs box of forced obstetrical intervention and the problem for the anesthesiologist who is asked to administer an anesthetic to an unwilling woman. The third article deals with the situation where a mother consciously decides to put the health of her unborn child at risk in order to save the life of her living child.…”

mentioning

confidence: 99%

Maternal autonomy: ethics and the law

Sullivan

Douglas

2006

International Journal of Obstetric Anesthesia

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“…Nonetheless, these studies collectively raise questions about respect for women's autonomy in maternity care. Several case reports have been published on this topic, attesting to the ethical and moral turmoil experienced by clinicians (see Avci, 2015;Biscoe & Kidson-Gerber, 2015;Brass, 2012;Curtis, 2010;Dann, 2007;Osuna et al, 2015;Perry et al, 2002;Weiniger et al, 2006). Several studies have also described the demographics and clinical outcomes of women who have declined recommended care (see Ande et al, 2010;Fiscella et al, 2007;Iris et al, 2009;Ribak et al, 2011;Tucker Edmonds et al, 2014).…”

Section: Delimiting the Scopementioning

confidence: 99%

“…These case studies illustrate the challenging nature of a much broader range of maternal refusals than the attitudinal studies described above, which focus almost exclusively on CS refusal. Case studies have documented clinicians' experiences of refusal of induction of labour (IOL; Dann, 2007), episiotomy (Perry et al, 2002), blood products (Biscoe & Kidson-Gerber, 2015), aspects of routine intrapartum care (Avci, 2015;Curtis, 2010) and CS (Brass, 2012;Osuna et al, 2015;Weiniger et al, 2006) and arise from a range of national contexts, including New Zealand, USA, Australia, England, Spain, Turkey and…”

Section: Clinicians' Experiences Of Maternal Refusalmentioning

confidence: 99%

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

Jenkinson¹

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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...

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Holy consent – a dilemma for medical staff when maternal consent is withheld for emergency caesarean section

Cited by 10 publications

References 13 publications

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

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

Maternal autonomy: ethics and the law

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

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