Elizabeth Prochaska, barrister and founder of Birthrights, the UK organisation dedicated to improving women’s experience of pregnancy and childbirth by promoting respect for human rights, looks in detail at recent Australian research which focused on care providers’ perceptions of autonomy. The full article can be found in MIDIRS Midwifery Digest, Sep 2013, vol 23, number 3.
“Misunderstanding autonomy in childbirth
We are all born free, says the
In UK law, pregnant women remain as free to make choices as any other person (S v St George’s Healthcare Trust 1998). They can choose to drink and smoke in pregnancy, to birth with or without assistance, wherever they choose. They are free to make decisions about their fetus for themselves, so long as they do not unlawfully terminate their pregnancy. This simple principle is known in law as the principle of autonomy. It is the basic means by which the law respects our human capacity to make decisions for ourselves.
Recent Australian research reveals that maternity care providers have a poor understanding of the legal principle of autonomy (Kruske et al 2013). In the first ever study focusing on care providers’ perceptions of autonomy, the researchers questioned 336 midwives and doctors working in public and private health care in Queensland.
They were asked to rank their agreement with various statements about responsibility for decision making during childbirth. The statements included the following ‘the final decision should always rest with the woman’ and ‘for the safety of the baby, the maternity care team sometimes need to override the needs of the woman’. The majority of midwives and doctors agreed that women were the final decision makers in childbirth. However, the majority of doctors also agreed with the statement that women’s decisions sometimes needed to be ‘overridden’ for the safety of the fetus. Midwives remained neutral. The two statements are, of course, two sides of the same coin. You cannot logically believe that women have the final say over their treatment and believe, at the same time, that their views can be displaced by concerns about fetal safety.”
‘Misunderstanding autonomy in childbirth’, the complete article, can be found in the September issue of MIDIRS Midwifery Digest, page 397.
Birthrights is a UK organisation dedicated to improving women’s experience of pregnancy and childbirth by promoting respect for human rights.
On 18th October 2013, Birthrights is hosting the Dignity in Childbirth Forum’ at the Royal College of Physicians in London. Speakers include: Davina McCall, Lesley Page, President of the Royal College of Midwives, Mumsnet, White Ribbon Alliance and the British Institute for Human Rights. Birthrights will present a ground-breaking survey of 1,000 women on their experiences of respect and choice during childbirth. Visit www.birthrights.org.uk for details of the full programme and further information about Birthrights.
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