Finding autonomy in birth

American Journal of Bioethics, 2012

Scholarly blog of the International Journal of Feminist Approaches to Bioethics, 2014

In this brief scholarly blog entry (available using the link below), I consider an April 2014 article in The Atlantic on Brazilian use of C-section which reaches extremely high rates. Specifically, I consider the role of the pregnant woman's medical autonomy in this case and in the US, drawing on Lyerly et al.'s excellent 2012 Hastings Center Report article, "Risk and the Pregnant Body," to consider how women's autonomy is constrained by the way risk and other concerns are viewed by both providers and patients.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2005

on recognising the significance of respect for female autonomy in this debate. This was overlooked at the highprofile meeting held at Tygerberg Hospital last year, where a diverse body of speakers took critical positions. 3 Several issues concern me about that meeting: the presence of funders, the fact that medico-legal experts were required to pronounce on moral issues, but mostly, the absence of a bioethicist. The issue of respect for female autonomy was consequently not even raised.

2012

This is an exploratory study of women’s childbearing decisions and outcomes in non- medically indicated cesarean section childbirths (CS). Focusing on the structure-agency dichotomy, the research is guided by Anthony Giddens’ theory of structuration used in the context of the medicalization framework in order to analyze elements of personal choice and medical jurisdiction in childbearing methods. Quantitative analysis of secondary data and a thematic content analysis of Internet forums are conducted in order to analyze women’s perceptions of autonomy and constraint in their childbearing decisions and outcomes. The findings suggest that the polarization between second- and third wave feminist critiques on medical intervention in childbirth, and between structure and agency, impede our understanding of the complex phenomenon. Applying structuration theory to the medicalization framework helps to work through this polarization, further lending support to third-way feminism.

Feminism & Psychology, 2012

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The virtual mentor : VM, 2004

Choice" is a central concept in the struggle for reproductive freedom around the world. Yet one of the most damaging consequences of our bruising abortion debates is the gutting of choice itself. In US political discourse, "choice" has come to be identified almost exclusively with the right to choose an abortion, and "reproductive rights" has been conflated with this narrow, legalistic notion of choice. But for many women, reproduction includes both the prevention of unwanted pregnancy and the process of carrying a pregnancy, progressing through labor, and giving birth to a child. Wherever a woman finds herself on that spectrum, her experience of reproductive choice is not just a yes-or-no decision protected in law; rather, the experience of reproductive freedom is profoundly influenced by her interactions with the health system. Thus access to health care must be a core element of choice. Moreover, access ultimately means more than getting in the door. In a system that respects, upholds, and values reproductive freedom, access implies entrée to health care practices that acknowledge the complexity of the reproductive experience for women-its social, psychological, and political dimensions-and that honor the different choices women make throughout that experience. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.

Nursing Ethics

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles.

Feminism & psychology, 2007

This thesis examines correlations between the midwifery philosophy of care and feminist reconfigurations of autonomy and choice. Based on content analysis, two sets of divergent models are compared: the medical model of informed consent and mainstream frameworks of autonomy, and the midwifery model of informed choice and feminist relational approaches. This investigation begins by examining the classic Principle of Respect for Patient Autonomy and the process of informed consent as proposed by Beauchamp and Childress. A critical survey of this framework brings to light shortcomings of bioethical theories that maintain a narrow ideology of autonomy and a limited perception of human characteristics. In response to mainstream bioethicists' theories of autonomy, many feminists have offered a relational approach recognizing the individual as situated within a broader social matrix. Distinguishing the unique elements of a relational model, Susan Sherwin's framework contrasts that of Beauchamp and Childress. Relational methods emphasize the manner in which external forces may enhance or restrict one's sense of self-trust and their capacity for autonomous decision-making. Autonomy is thus a process, developed and augmented through the acquisition of a series of skills. The midwifery model of care and the process of informed choice demonstrate an applied form of relational autonomy. Midwives aim to extend a women's sense of selftrust and empower her through the decision-making process. Shifting beyond the consent paradigm of the medical model, autonomy is respected in a fuller sense.

The Journal of clinical ethics, 2013

Maternity careproviders often have strong views concerning a woman's choice of where to give birth.These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should "counts' instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.

Since the advent of medicalization in health care that saw childbirth brought into hospitals, there have been numerous theories, in particular feminist theories, arguing this has acted to deprive birthing women of their autonomy and ability to make informed decisions regarding their own health and that of their unborn/newborn children. Many of the existing scholarly theories pertaining to birth focus on the competing discourses of the dominant medical model versus the social model. Drawing on these debates, this paper aims to examine the impact of childbirth experience on mothering, utilising a qualitative, grounded theory methodology to facilitate in-depth exploration and analysis of participants’ lived experience. Ten interviews with mothers who have given birth within the last five years were conducted, in order to analyse the complex causal factors contributing to birthing choices and construction of identity. These include sociological context, health care structures, policy, and current discourses around maternity, mothering, social support and women’s health. The emerging narratives revealed that several women experienced a profound disconnection between their hopes and expectations for the birth, and the birthing experience itself – which for some was fraught with anxiety, fear, and a perceived lack of control over the process. This study argues that while existing feminist and post-structuralist theory pertaining to the patriarchal and disciplining structures of medicalization are salient to the debate, a more nuanced perspective is necessary in order to explain why women’s birthing experience is often socially and systemically devalued. By examining the problem through a social justice framework, I argue that conditions of mutual recognition are imperative to foster a relationship of trust and respect between maternity care providers and birthing women. Only then, can women truly experience autonomy and ability to exercise informed choice s in childbirth.