Ethics for the pediatrician: obstetric conflict: when fetal and maternal interests are at odds

The interests of the fetus generally are aligned with those of the pregnant woman. When they are not, the fetal best interests should be discussed, but respect for the autonomy of the pregnant woman and her bodily integrity should prevail. Gender bias and discrimination toward women should be avoided, and the circumstance of pregnancy should not be used as a reason to infringe upon or limit a competent woman’s rights. Evidence indicates that providing prenatal care and treatment in a supportive, rather than coercive way is the most effective way to promote both maternal and child health. Concerns about potential harm to the fetus related to maternal decisions must be evaluated in the context of the best medical evidence, including what is known and what is uncertain. Threats or legal coercion should not be used to force treatment, in particular, to impose cesarean delivery. Hospital guidelines can be developed to support a framework of shared decision-making in the situation of maternal-fetal conflict and provide guidance for compassionate conflict resolution. Pediatricians have an important role in informing the discussion about care and outcomes. At times, an ethics consult maybe helpful to mediate conflict resolution. Intervention by the courts is rarely appropriate or indicated and should be avoided.