Despite the fact that the requirement to obtain informed consent for medical procedures is deeply enshrined in both U.S. moral and legal doctrine, empirical studies and anecdotal accounts show that women's rights to informed consent and refusal of treatment are routinely undermined and ignored during childbirth. For example, citing the most recent Listening to Mothers survey, Marianne Nieuwenhuijze and Lisa Kane Low state that "a significant number of women said they felt pressure from a caregiver to agree to having (...) an intervention that they did not want during birth". Specifically, Nieuwenhuijze and Low cite that "19% of women who did not have epidural analgesia felt... (shrink)

Images abound of women throughout the ages engaging in various activities. But why are there so few representations of childbirth in visual art? Feminist artist Judy Chicago once suggested that depictions of women giving birth do not commonly occur in Western culture but can be found in other contexts such as pre-Columbian art or societies previously considered "primitive." Chicago's own exploration of the theme resulted in the creation of The Birth Project (1980-85): an unprecedented series of eighty handcrafted works (...) of art created in a variety of needlework techniques by more than 130 artisans that celebrate the experience of birth and a woman's transformation into motherhood. But why is The Birth Project an aberration from today's norm? What are the reasons that childbirth remains a taboo subject in our visual culture? Why is the birthing experience--so pervasive for women--so infrequently celebrated, even by female artists? (shrink)

This chapter contains sections titled: Maybe It's Simple Sexism Do Not Go Gentle Universal Praise for the Natural? What About Natural Disasters? Focus on the Pain Recommending Pain Humble Mamas Praise Mama Notes.

Native women residing in the Subarctic and Arctic are currently struggling for the right to decide whether they will be hospitalized or have a midwife present for the birth of their children. The argument presented in this review paper outlines the cultural and clinical factors in favour of recognizing and legalizing traditional midwifery in the North and critically examines the statistical and safety concerns raised by those arguing against giving Northern Native women an alternative to evacuation from their home communities.

Philosophical inquiry into pregnancy, childbirth, and mothering is a growing area of interest to academic philosophers. This volume brings together a diverse group of philosophers to speak about topics in this reemerging area of philosophical inquiry, taking up new themes, such as maternal aesthetics, and pursuing old ones in new ways, such as investigating stepmothering as it might inform and ground an ethics of care. The theoretical foci of the book include feminist, existential, ethical, aesthetic, phenomenological, social and political (...) theories. These perspectives are then employed to consider many dimensions of pregnancy, childbirth, and mothering, which are of central importance to human existence, but are only rarely discussed in philosophical cannons. Topics include pregnancy and embodiment, breast-feeding, representations – or the lack thereof – of pregnant and birthing women, adoption, and post-partum motherhood. (shrink)

Consideration of the evolutionary and cross-cultural history of childbirth reveals many differences between the ways in which most human females have experienced childbirth and the ways in which most women in contemporary industrialized obstetric settings experience the event. In this paper I review two of these differences: the pain and anxiety of labor and delivery and the discontinuity of care provided for the mother and infant. I argue that much of the dissatisfaction with birth practices in the United (...) States results from the failure of modern obstetric practice to meet the evolved needs of mothers and infants. (shrink)

Feminists have highlighted various ways in which medicalized childbirth is connected to violence. For example, the literature is replete with examples of court-ordered Cesarean sections, intimidation in the delivery room, women diagnosed with post-traumatic stress disorder as a result of their childbirth experiences. The most common approach to the accusations about the connections between medicalized childbirth and violence has been to investigate the degree to which the evidence bears out their accuracy. In this essay, the author takes (...) a different course; instead of trying to confirm or refute reports of violence in childbirth, she posits that understanding the ways in which violence is connected to medicalized childbirth requires us to note the existence of another form of violence that has not been recognized or discussed up to this point – metaphysical violence. The primary focus of this essay is to define that other form of violence as well as to suggest places where the routine practices of medicalized childbirth perpetuate it and possible ways to resist it. (shrink)

ObjectiveTo examine how physical and psychological childbirth experiences affect maternal perceptions and experiences of early infant behavioural style.BackgroundUnnecessary interventions may disturb the normal progression of physiological childbirth and instinctive neonatal behaviours that facilitate mother–infant bonding and breastfeeding. While little is known about how a medicalised birth may influence developing infant temperament, high impact interventions which affect neonatal crying and cortisol levels could have longer term consequences for infant behaviour and functioning.MethodsA retrospective Internet survey was designed to fully explore (...) maternal experiences of childbirth and her postnatal perceptions of infant behaviour. Data collected from 999 mother–infant dyads were analysed using Pearson’s correlations and multiple analyses of covariance, employing the Bonferroni method of correction to establish initially significant variables. Multiple linear regressions were conducted to determine major perinatal contributors to perceived early infant temperament.ResultsMultiple regression analyses on each of the eight Mother and Baby Scales outcome variables indicated that early infant behavioural style was largely predicted by subjective maternal states during and post-childbirth, postnatal depression scores, maternal personality traits and infant age. For example, infant age was the most significant predictor of Alert-Responsive infant behaviour, followed by maternal Postnatal Positive experience. In contrast, depression scores were the most significant predictor of Unsettled-Irregular infant behaviour, followed by Anxious-Afraid Birth Emotions and infant age. Mothers also perceived their infants as more Alert-Responsive and Easier overall after a Supported birth experience.ConclusionMaternal and infant outcomes were influenced by multiple physical and psychological perinatal variables. The mother’s subjective experience appeared to be of equal significance to more objective factors. Social support enhanced the mother’s childbirth experience, benefitting her perceptions of her baby’s early temperament. These findings provide further support for current World Health Organisation intrapartum guidelines on the importance of making childbirth a ‘positive experience’ for women. (shrink)

Abstract“Risky Business” considers hospital childbirth and the production of the concept of risk in obstetrics. Risk is a defining concept of medicalized childbirth. Approaching obstetrical risk with a goal of challenging its hold on practices demonstrates how risk itself is produced and maintained in particular institutional contexts. The goal here is to imagine new ways of understanding and assessing obstetrical risk, as part of an overall strategy of challenging technocratic approaches to childbirth and mothering. Surveying feminist approaches (...) to childbirth, the essay discusses how the mother’s health profile affects both medical education and the construction of childbirth as “risky business.”. (shrink)

Medical intervention in childbirth raises a number of ethical issues which have received too little attention in American obstetrics. A number of these issues are surveyed in the first section of this essay. In the second section, the hospital and the roles characteristically ascribed to patients, staff, and obstetrical practitioners are shown to provide an unsatisfactory social setting for birth. Several proposals for improving existing arrangements or for providing alternatives are offered. It is argued that procedures for eliciting and (...) maintaining fidelity to patient values for the birth experience are crucial elements in acceptable care. CiteULike Connotea Del.icio.us What's this? (shrink)

Sheila Kitzinger describes pain and its control throughout the various stages of childbirth. She stresses the value of antenatal preparation as well as the need for a supportive environment during the labour stages. All concerned--the porspective parents, doctors, midwives and any other personnel in a maternity unit should be educated to be able to provide such an environment.

In the United States, clinical interventions such as epidurals, intravenous infusions, oxytocin, and intrauterine pressure catheters are used almost routinely in births in the hospital setting, despite evidence that the overutilization of such interventions likely plays a key role in increasing the need for cesarean section (CS). In 2010, according to the U.S. Centers for Disease Control and Prevention, approximately 32.8 percent of births in the U.S. were by CS. The U.S. National Institutes of Health has reported that CS increases (...) avoidable maternal and neonatal morbidity and mortality. To increase understanding of what might motivate the overuse of CS in the U.S., we investigated the factors that influenced women’s decision making around childbirth, because women’s conscious and unconscious choices about giving birth could influence whether they would choose or allow delivery by CS.In this article, we report findings about women’s decisions related to place of birth—at home or in a hospital. We found that choosing a place of birth was significant in how women in our study attempted to mitigate their perceptions of the risks of childbirth for themselves and their infant. Concern for the safety of the infant was a central, driving factor in the decisions women made about giving birth, and this concern heightened their perceptions of the risks of childbirth. Heightened perceptions of risk about the safety of the fetus during childbirth were found to affect women’s ability to accurately assess the risk of using clinical interventions such as the time of admission, epidural anesthesia, oxytocin, or cesarean birth, which has important implications for clinical practice, prenatal education, perinatal research, medical decision making, and informed consent. (shrink)

PurposeThe relation between fear of childbirth and gestational age is inconclusive, and self-reported need for help regarding this fear has never been investigated. This study aimed to determine the prevalence and course of FoC according to gestational age, to identify risk factors for the development of FoC, the influence of this fear on preferred mode of delivery, and self-reported need for help.MethodsNulliparous pregnant women of all gestational ages completed an online survey. The study consisted of a cross-sectional and a (...) longitudinal analysis. Women who completed the survey in the first or second trimester were approached again in their third trimester. The Wijma Delivery Expectancy Questionnaire Version A was used with a cut-off score ≥ 85 to define presence of fear of childbirth. Questionnaires indexing social support, anxiety, symptoms of depression, preferred mode of delivery, and self-reported need for help were included.ResultsIn total, 364 women were enrolled at T0, and 118 out of 184 eligible women were included in the longitudinal analysis. Point prevalence of FoC at T0 was 18.4% with no significant difference between trimesters. In the longitudinal sample, the prevalence of FoC decreased from 18.6% to 11.0%, p = 0.004. Although mean scores for FoC decreased significantly, p < 0.001, scores increased in 41 women. The presence of FoC was associated with elevated anxiety, less family support, prenatal care of the obstetrician by choice, preference for a cesarean section, and for pain relief. Women with FoC were more likely to actively seek for help compared to women without FoC.ConclusionWhile FoC is common in each trimester, prevalence decreases over the course of pregnancy. Women with FoC are often actively seeking for help, suggesting that this fear should be addressed better, and help should be offered accordingly. (shrink)

2020년 이후 출산 정책과 출산 담론은 ‘희망하는 출산을 실현하는 방향’으로 패러다임의 전환을 선언하였다. 그러나 출산을 희망한다는 것 그리고 그 희망하는 출산을 실현한다는 것은 아주 길고 근본적인 대책을 요구하는 언명이다. 이러한 패러다임의 전환은 환영해 마땅할 일이지만 이에 대한 근본적인 대책은 실존 철학적인 접근이어야 한다고 필자는 생각한다. 출산 문제는 특히 인간 출생 자체에 대한 실존 철학적 고찰을 필요로 하는 문제인데, 이러한 철학적 접근을 건너뛰면서 그 문제를 제대로 보고 있다고 여기는 것은 명백한 오류이거나 어리석은 오만이다. 필자는 우리의 초저출산 상황에 대한 좋은 해결책을 이미 (...) 아렌트의 탄생성이 제공하고 있다고 생각한다. 아렌트의 탄생성은 인간 출생에 대한 가치, 방법, 대안을 제시하고 있기 때문이다. 아렌트의 탄생성은 인간 출생의 실존적 의미인 새로운 시작, 이 새로운 시작을 할 수 있는 사회적 관계라는 방법, 그러한 세상을 만드는 행위 능력을 대안으로 제시한다. 이렇게 아렌트의 탄생성으로부터 인간 출생에 대한 철학적 고찰을 시작하는 방식은 우리 사회의 초저출산 현상을 해결하는 가장 멀고 어려운 길이지만 가장 확실한 길을 제공할 수 있을 것이다. (shrink)

Women in North America have many childbirth options. However, they must make these choices within a complex culture of birthing discourse characterized by competing knowledges and claims regarding the “ideal birth” as medicalized, natural, or woman centered. We interviewed 21 childless women and 22 new mothers to explore their perceptions of choice and birthing. The women’s interviews indicated that their birthing choices are reflective of tensions embedded in normative femininity; conflicting ideas relating to purity, dignity, and the messiness of (...) birth; and contradictions about women’s bodies as heteronormative sites of pleasure and sexuality on one hand and of asexual, selfless sources of maternal nurturance on the other. Finally, the women’s views reflected understandings of moral and normative constructs about selflessness as a core attribute of femininity and motherhood, particularly in terms of enduring pain as the “proper” means of accomplishing the rite of passage to motherhood. Although all the women described tensions between femininity and motherhood, childless women were more likely than mothers to be worried about achieving ideal, heteronormative sexuality and femininity. Likewise, women who have not yet had children and women who have experienced unplanned C-sections were more likely than those who experienced vaginal births to express that C-section births fail to fully accomplish women’s rite of passage to motherhood. (shrink)

In this paper I assess the labour ward admission policies introduced by some National Health Service trusts during the COVID-19 pandemic, arguing that these intersected with other policies in a manner which may have coerced birthing people into consenting to vaginal examinations they might have otherwise refused. In order to fully understand the potential severity of these policies, I situate this critique in the historical and contemporary context of the problematic relationship between consent and vaginal examinations. Identifying the legal wrongs (...) associated with performing coerced vaginal examinations, I highlight that the law is inadequately equipped to provide appropriate redress. Further, I illustrate that the issue explored in this paper reflects broader problems which exist with regard to the focus of, and the investment in, the maternity services. (shrink)

The way in which midwives relate to expectant parents during the process of childbirth greatly influences the parents’ childbirth experiences for a long time. We believe that examining and describing ways of relating in naturally occurring interactions during childbirth should be considered as an ethical responsibility. This has been highlighted in relation to parents’ experiences and in the light of the relational ethics of Løgstrup. Four couples’ and nine midwives’ ways of relating were documented by 27 hours (...) of observation, including 14.5 hours of video-recorded sessions. A qualitative content analysis was conducted. The midwives strongly influenced the different ways of relating and three aspects of professional competence were disclosed. The results can contribute to reflections about current praxis as an ethical demand for midwives. (shrink)

In this article, our concern is to describe how body(ies) and self are performed in women’s birth narratives through the mediation of a number of significant elements, including technical devices. We will show how, in these narratives, (1) action is distributed among a series of actants, including professionals and technology; (2) that dichotomies appear which cannot be reduced to one of body/mind, but are more adequately described in terms of ‘body-in-labour’/’embodied self’, each of them being locally performed through the mediation (...) of medical practices, knowledge and technologies, the definition of these elements and of their relations being specific to each obstetrical configuration; (3) that part of professionals’ activities is devoted to the detailed management of the articulation between the body-in-labour and the embodied self, and to monitoring their joint transformations. (shrink)

_The Ethics of Pregnancy, Abortion and Childbirth_ addresses the unique moral questions raised by pregnancy and its intimate bodily nature. From assisted reproduction to abortion and ‘vital conflict’ resolution to more everyday concerns of the pregnant woman, this book argues for pregnancy as a close human relationship with the woman as guardian or custodian. Four approaches to pregnancy are explored: ‘uni-personal’, ‘neighborly’, ‘maternal’ and ‘spousal’. The author challenges not only the view that there is only one moral subject to consider (...) in pregnancy, but also the idea that the location of the fetus lacks all inherent, unique significance. It is argued that the pregnant woman is not a mere ‘neighbor’ or helpful stranger to the fetus but is rather already in a real familial relationship bringing real familial rights and obligations. If the status of the fetus is conclusive for at least some moral questions raised by pregnancy, so too are facts about its bodily relationship with, and presence in, the woman who supports it. This lucid, accessible and original book explores fundamental ethical issues in a rich and often neglected area of philosophy in ways of interest also to those from other disciplines. (shrink)

This article explores the characteristics of narratives told by women and men about the birth of children. The comparison focuses on the way speakers use evaluation devices to structure their experiences and to negotiate a relationship with their audience. Findings indicate that, while there are subtle contrasts between the narratives that suggest that male speakers emphasize informative meaning and women provoke an affectual response related to the disclosure of internalized expectations, there are significant macro-level similarities with both women and men (...) making use of anecodotal structures. It is argued that understanding these similarities and dissimilarities in terms of gender difference alone is overly simplistic and that gender should be understood as interacting in complex ways with a range of further potential variables connected with context. (shrink)

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The (...) medicalisation of pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

Journal of Medical Ethics Concise Argument (editorial).

This article examines the barriers to quality health care for transgender, nonbinary, and gender-expansive people (TGE) who become pregnant and give birth, identifying three central themes that emerge from the literature. These insights suggest that significant reform will be necessary to ensure access to safe, appropriate, gender-affirming care for childbearing TGE people. After illustrating the need for systemic changes that untether rigid gender norms from the provision of perinatal care, the article proposes that the Midwives Model of Care offers a (...) set of values and clinical practices that are well-suited to meet the needs of many TGE patients during pregnancy and childbirth and which should be incorporated into the healthcare system more broadly. (shrink)

Through a close analysis of various moments within two hours of video-taped interaction, we investigate properties of the setting that the participants cannot ignore even as they transform them in various ways. These properties are not under local control. What is under control is revealed in the participants' “play” with the properties, including dangerous, “deep” play. In this process, some properties of the participants are rarely mentioned (e.g., that the laboring woman is an MD), others are repeatedly emphasized (e.g. the (...) strength of contractions). And others appear in ways that have not been dealt with adequately in current theoretical frameworks. To deal with life-threatening lies, and jokes about lies, we must move away from theories of hegemonic particularity that rely on a habitus. Rather we must acknowledge the practical understandings revealed in the collective submergence of that which may be actively noted as potentially relevant and then set aside so that other tasks can be foregrounded and achieved. (shrink)

Background The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. Research Objectives The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. Research Design This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual (...) interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. Results Four key themes described the threats to women’s dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. Conclusion The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth. (shrink)

Background Respectful care during labour and childbirth, which has recently received a great deal of attention around the world, is vital for providing high-quality maternity care. However, this area has been underexplored in developing countries including Iran. Research aim This study aimed to assess postpartum women’s views regarding disrespect and abuse during labour and childbirth in Iran. Methods A qualitative study that involved a purposive sample of 21 postpartum women was conducted in Tehran, Iran, between 2019 and 2020. (...) Following the semi-structured individual interviews, a conventional content analysis was performed. Ethical considerations This research approved by Shahid Beheshti University of Medical Sciences in Tehran, Iran, with the ethical approval number 1396.810. Following explanation of the study's objectives, eligible women consented to participate in the study. The confidentiality of the participants' information and the anonymity of the analysis were maintained at all stage of the study. All data was stored on the password protected file in the researcher computer The findings were only disseminated in summary form, with no identifying of individual participants. Results Analysis of the data resulted in two main themes: ‘inappropriate interaction’ and ‘inadequate quality care’. The ‘inappropriate interaction’ theme includes ‘lack of empathy’ and ‘verbal abuse’. The second theme includes five sub-themes ‘lack of participation in decision-making’, ‘lack of privacy’, ‘ignorance of women’s pain and medical needs’, ‘rushed labour and painful procedures’, and “unsatisfying facilities’. Conclusion Providing supportive care, respectful communication, adequate participation in decision-making, maintaining privacy, attending to women’s labour pain and medical needs, and improving the quality of the physical birth environment are all examples of what labouring women consider to be respectful maternity care. To minimise disrespect and maltreatment of women during childbirth, an all-inclusive strategy engaging women, communities, healthcare professionals, managers, and educators is required. (shrink)

Transformations in the biological, medical and legal processes of infertility, substantial modifications in family structure and the advancement of methods and techniques of reproductive technology will affect the next step in both legal and medical terms to address the regulation of bioethics and law in Kosovo. There is a need to establish perspectives in both ethical and professional terms, since the Republic of Kosovo is in the process of drafting a Civil Code. Many of these issues have been raised and (...) addressed during the review and evaluation of family law in the context of harmonisation and inclusion of this law in the Civil Code of the Republic of Kosovo. During the several meetings of official members with different interest groups regarding family law, the need has been raised to regulate family law to be included in the Civil Code for motherhood and fatherhood in the case of reproduction with biomedical assistance, as well as for the birth contract as a donation for another person (so-called surrogate motherhood). These bioethical and legal issues indicate the urgent need for legal harmonisation of a multidimensional platform specifically based on the principles of public health and universal human rights Conclusion. These bio-ethical and legal interferences indicate the urgent need for legal harmonization of a multidimensional platform specifically designed based on the principles of public health and universal human rights. (shrink)

This article uses the US debate over elective Cesarean section to re-consider some of the more contentious issues raised in feminist debates about childbirth. Three waves of feminist commentary and critique in the United States are analysed in light of the ongoing debate over whether women should be able to choose Cesarean for non-medical reasons. I argue that the alternative birth movement's essentialist and occasionally moralistic rhetoric is problematic, and the idea that some women's preference for high-tech obstetrics is (...) the result of a passive 'socialization' into 'dominant values' is theoretically inadequate. On the other hand, the invocation of women's choice and appreciation of high-tech childbirth serves as a weak foundation for a feminist perspective on childbirth. By limiting their analysis to the rhetorical and discursive nature and functions of 'the medical' and 'the natural', poststructuralist critics of the alternative birth movement obscure the connection of these discourses to practices that have very different consequences for maternal and infant health and, most importantly, for the consumption of health care resources. (shrink)

It has recently been reported that some hospitals in the UK have placed a blanket restriction on the provision of maternal request caesarean sections as a result of the COVID-19 pandemic. Pregnancy and birthing services are obviously facing challenges during the current emergency, but we argue that a blanket ban on MRCS is both inappropriate and disproportionate. In this paper, we highlight the importance of MRCS for pregnant people’s health and autonomy in childbirth and argue that this remains crucial (...) during the current emergency. We consider some potential arguments—based on pregnant people’s health and resource allocation—that might be considered justification for the limitation of such services. We demonstrate, however, that these arguments are not as persuasive as they might appear because there is limited evidence to indicate either that provision of MRCS is always dangerous for pregnant people in the circumstances or would be a substantial burden on a hospital’s ability to respond to the pandemic. Furthermore, we argue that even if MRCS was not a service that hospitals are equipped to offer to all pregnant persons who seek it, the current circumstances cannot justify a blanket ban on an important service and due attention must be paid to individual circumstances. (shrink)