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Clémence Schantz, Marie Lhotte, Anne-Charlotte Pantelias

    Sante Publique (Vandoeuvre-Les-Nancy, France)
    |June 20, 2022
    PubMed
    Summary

    Midwives face ethical dilemmas when women request caesarean sections, balancing natural birth principles with patient autonomy. Listening to requests and considering broader medical indications allows ethical support for patient choice.

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    Area of Science:

    • Medical Ethics
    • Obstetrics
    • Patient Autonomy

    Background:

    • Patient rights and autonomy are central in childbirth decisions.
    • Midwives, as primary caregivers for physiological pregnancies, face ethical considerations regarding women's childbirth choices.
    • This study explores the ethical acceptability of midwives supporting women's decisions for caesarean sections.

    Purpose of the Study:

    • To investigate the ethical perspectives of midwives and women on the concept of "caesarean section on demand."
    • To understand the ethical tensions midwives experience when a woman requests a caesarean section.
    • To explore how midwives navigate patient autonomy and established obstetric principles.

    Main Methods:

    • Ancillary study within the CESARIA research program.
    • Conducted 37 semi-directive interviews with midwives and women.
    • Utilized qualitative research methods to explore ethical viewpoints.

    Main Results:

    • Most women and midwives perceive childbirth as "natural" and view caesarean requests as pathological.
    • Midwives experience ethical tension between promoting vaginal birth (beneficence, non-maleficence) and respecting patient autonomy.
    • Respect for patient choice and freedom is a key consideration for midwives.

    Conclusions:

    • The ethical challenge of "caesarean section on demand" centers on the listening process, not just acceptance.
    • Broadening the definition of medical indication beyond obstetrics is crucial.
    • Ethically supporting women's caesarean requests involves respecting their autonomy while considering wider indications.

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