“Real decision-making is hard to find” - Swiss perinatal care providers’ perceptions of and attitudes towards decision-making in birth: A qualitative study

Rost, Michael; Stuerner, Zelda; Niles, Paulomi; Arnold, Louisa

doi:10.1016/j.ssmqr.2022.100077

Cited by 7 publications

(8 citation statements)

References 68 publications

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“…Data were analyzed employing reflexive thematic analysis 30,31 and organized using MAXQDA—a software program for qualitative data analysis. Analysis is described in more detail elsewhere 13 . Reflexive thematic analysis requires researchers to critically reflect on their own underlying assumptions and positionalities 31 .…”

Section: Methodsmentioning

confidence: 99%

“…Further details on study design and ethics approval are presented elsewhere. 13 standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.…”

Section: Methodsmentioning

confidence: 99%

“…We sent emails and postal invitation letters to 21 hospitals with birthing services (>1000 births/year) and 14 birth centers in, introducing the study. 13 Interested practitioners contacted us. The only inclusion criterion was that practitioners were involved in intrapartum care.…”

Section: Recruitment and Participantsmentioning

confidence: 99%

“…Analysis is described in more detail elsewhere. 13 Reflexive thematic analysis requires researchers to critically reflect on their own underlying assumptions and positionalities. 31 Our backgrounds span Psychology, Bioethics, Medicine, Gender Studies, Midwifery, and Critical Feminist Theory.…”

Section: Recruitment and Participantsmentioning

confidence: 99%

“…Practitioners framed birth as "a process where you have to trust" (13), thereby suggesting that trust is not something that needs to be explicitly earned or fostered. Also, they lament a lack of continuity of care causing a situation in which they "do not know the woman, not even her healthstatus" (I11), causing a high(er) need for communication in the intrapartum period.…”

Section: Relationshipsmentioning

confidence: 99%

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Between “a lot of room for it” and “it doesn't exist”—Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland

Rost,

Stuerner,

Niles

et al. 2023

Birth

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BackgroundNumerous studies show that negative birth experiences are often related to birthing people's loss of autonomy. We argue that a fetal‐focused decision‐making framework and a maternal–fetal conflict lens are often applied, creating a false dichotomy between autonomy and fetal beneficence. Given the high prevalence of autonomy‐depriving decision‐making, it is important to understand how autonomy can be enhanced.MethodsWe interviewed 15 Swiss perinatal care practitioners (eight midwives, five physicians, and two doulas) and employed reflexive thematic analysis. We offer a reflection on underlying assumptions and researcher positionality.ResultsWe generated two descriptive themes: advancing and limiting factors of autonomy. Numerous subthemes, grouped at the levels of companion, birthing person, practitioners, birthing person–practitioner relationship, and structural determinants are also defined. The most salient advancing factors were practitioners' approaches to decision‐making, antenatal contacts, and structural determinants. The most salient limiting factors were various barriers within birthing people (e.g., expertise, decisional capacity, and awareness of own rights), practitioners' attitudes and behavior, and structural determinants.DiscussionThe actualization of autonomy is multifactorially determined and must be understood against the background of power structures both underlying and inherent to decision‐making in birth. Practitioners attributed a significant proportion of limited autonomy to birthing people themselves. This reinforces a “mother‐blame” narrative that absolves obstetrics of primary responsibility. Practitioners' recognition of their contributions to upholding limits on autonomy should be leveraged to implement training towards rights‐based practice standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Recruitment and Participantsmentioning

confidence: 99%

Section: Recruitment and Participantsmentioning

confidence: 99%

Section: Relationshipsmentioning

confidence: 99%

See 3 more Smart Citations

Between “a lot of room for it” and “it doesn't exist”—Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland

Rost,

Stuerner,

Niles

et al. 2023

Birth

Self Cite

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The case of poor postpartum mental health: a consequence of an evolutionary mismatch – not of an evolutionary trade-off

Dahan¹

2023

Biol Philos

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Women’s and Provider’s Moral Reasoning About the Permissibility of Coercion in Birth: A Descriptive Ethics Study

Eichinger,

Büchler,

Arnold

et al. 2024

Health Care Anal

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Evidence shows that during birth women frequently experience unconsented care, coercion, and a loss of autonomy. For many countries, this contradicts both the law and medical ethics guidelines, which emphasize that competent and fully informed women’s autonomy must always be respected. To better understand this discordance, we empirically describe perinatal maternity care providers’ and women’s moral deliberation surrounding coercive measures during birth. Data were obtained from 1-on-1 interviews with providers (N = 15) and women (N = 14), and a survey of women (N = 118). Analyses focused on an in-depth exploration of responses to a question on the permissibility of coercion in birth whose wording was borrowed from a Swiss medical-ethical guideline. Reasons for and against a principle permissibility of coercive measures in birth were grouped into clusters of reasons to build a coherent explanatory framework. Factors considered morally relevant when deliberating on coercion included women’s decisional capacity, beneficence/non-maleficence, authority through knowledge on the part of providers, flaws of the medical system, or the imperative to protect the most vulnerable. Also, we identified various misconceptions, such as the conviction that a pathological birth can justify coercion or that fetal rights can justifiably infringe on women’s autonomy. Information and education on the issue of coercion in birth are urgently needed to enable women to fully exercise their reproductive autonomy, to prevent long-term adverse health outcomes of women and children, and to reconcile the medical vigilance which has lead to a reduction of perinatal morbidity and mortality with women’s enfranchisement in their own care.

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“Real decision-making is hard to find” - Swiss perinatal care providers’ perceptions of and attitudes towards decision-making in birth: A qualitative study

Cited by 7 publications

References 68 publications

Between “a lot of room for it” and “it doesn't exist”—Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland

Between “a lot of room for it” and “it doesn't exist”—Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland

The case of poor postpartum mental health: a consequence of an evolutionary mismatch – not of an evolutionary trade-off

Women’s and Provider’s Moral Reasoning About the Permissibility of Coercion in Birth: A Descriptive Ethics Study

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