Obstetric Autonomy and Informed Consent

Abstract

I argue that public officials and health workers ought to respect and protect women's rights to make risky choices during childbirth. Women's rights to make treatment decisions ought to be respected even if their decisions expose their unborn children to unnecessary risks, and even if it is wrong to put unborn children at risk. I first defend a presumption of medical autonomy in the context of childbirth. I then draw on women's birth stories to show that women's medical autonomy is often ignored during labor. Medical interventions are performed during childbirth without women's consent. Childbirth is risky and some coercive medical interventions may be understood as attempts to protect children and to prevent mothers from acting impermissibly. However, even if it is wrong to make risky choices during childbirth, women have rights to do wrong in these cases. Therefore, coercive medical interventions are impermissible during childbirth and institutions should adopt specific protections for obstetric autonomy.

The highly complex phase of intrapartum management: when clinical and medico-legal aspects overlap

“…Our analysis of the research findings has highlighted that there is no universally acknowledged approach regarding the management of intrapartum phase, and some manoeuvres frequently used in the obstetric-gynaecological field could be perceived from the women as dangerous on the psycho-physical integrity of the pregnant women and unborn children [8][9][10][11][12][13][14][15][16]. However, some of the authors [4,[15][16][17][18][19][20] believe that universally recognized guidelines are needed in order to provide guidance and legitimize the activity of the obstetrician in intrapartum management.…”

From a phenomenology of birth towards an ethics of obstetric care

“…Moreover, respecting women's autonomy in childbirth means accepting her medically inadvisable choices too, even if they put the unborn infant at risk, as long as the women has received full disclosure and is not mentally incapable to understand what her decision entails; 'Though there are strong moral reasons for women in labour to mitigate the risks to unborn infants, they would not violate anyone's rights by failing to do so whereas forced interventions during childbirth would violate the mother's medical rights'. 23 Among the many factors interfering with women's autonomy are the structural axioms of medicalised childbirth: As shown above, many authors criticise the overmedicalisation, technisation and the patriarchal hierarchies of childbirth as disempowering women, not allowing them to be 'mistress in her own body', 50(p. 29) and leaving them with a feeling of passivity and alienation. 40,29,43 One reason for this situation is, that the medical model of childbirth 'privileges obstetric knowledge, technological beneficence and institutional control whether or not it is actually rational or beneficial'.…”

“…21 In view of this objectification problem, it is crucial to put the subjective perspective of those affected at the centre of ethical considerations. 21 Although empirical studies worldwide show that both the birthing subject's a will and knowledge are regularly ignored in obstetrics, 22,23 women's experience of obstetric violence is often disbelieved, both during birth and afterwards. 24 This epistemic dimension of obstetric violence has recently received increased attention and phenomena such as silencing, gaslighting, or hermeneutic and testimonial injustice have been discussed as pervasive features of obstetric violence.…”

Going solo: the law and ethics of childbirth during the COVID-19 pandemic

“…67 Although this requirement of informed consent 'is deeply enshrined in both US moral and legal doctrine', 68 women's birth stories reveal that they have been induced and sedated, and have even undergone cesarean sections without having given consent. 69 The pervasiveness of the phenomena prompted several scholars to underscore the idea that childbirth, in and of itself, does not constitute a 'medical emergency' as defined in the informed consent doctrine, 70 and that despite the pain of labor, women do retain the capacity to give informed consent during childbirth. 71 The importance of informed consent, specifically in the context of childbirth, provides therefore a third element of the ethical argument against requiring women to give birth alone.…”