Abstract
BackgroundLike all health care consumers, pregnant women have the right to make autonomous decisions about their medical care. However, this right has created confusion for a number of maternity care stakeholders, particularly in situations when a woman’s decision may lead to increased risk of harm to the fetus. Little is known about care providers’ perceptions of this situation, or of their legal accountability for outcomes experienced in pregnancy and birth. This paper examined maternity care providers’ attitudes and beliefs towards women’s right to make autonomous decisions during pregnancy and birth, and the legal responsibility of professionals for maternal and fetal outcomes.MethodsAttitudes and beliefs around women’s autonomy and health professionals’ legal accountability were measured in a sample of 336 midwives and doctors from both public and private health sectors in Queensland, Australia, using a questionnaire available online and in paper format. Student’s t-test was used to compare midwives’ and doctors’ responses.ResultsBoth maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions. Interprofessional differences were evident, with midwives and doctors significantly differing in their responses on five of the six items.ConclusionsMaternity care professionals inconsistently supported women’s right to autonomous decision making during pregnancy and birth. This finding is further complicated by care providers’ poor understanding of legal accountability for outcomes experienced in pregnancy and birth. The findings of this study support the need for guidelines on decision making in pregnancy and birth for maternity care professionals, and for recognition of interprofessional differences in beliefs around the rights of the woman, her fetus and health professionals in order to facilitate collaborative practice.
Highlights
Like all health care consumers, pregnant women have the right to make autonomous decisions about their medical care
Women’s autonomy Care providers were asked to rate their agreement with, “For the safety of the baby, the maternity care team sometimes need to override the needs of the woman” and “Encouraging women to have more control over their childbearing compromises safety”
Legal accountability Health professionals were asked to rate their agreement with, “Legally, doctors are responsible, even in collaborative models” and “The current maternity care system allows all to be legally accountable for their own actions in a collaborative team.”
Summary
Like all health care consumers, pregnant women have the right to make autonomous decisions about their medical care This right has created confusion for a number of maternity care stakeholders, in situations when a woman’s decision may lead to increased risk of harm to the fetus. The seemingly clear principle of autonomy has created confusion and tension for a number of maternity care stakeholders including women, care providers, policy makers and insurers [2,3,4]. It is important to understand care providers’ perceptions of women’s autonomy and the rights of the fetus in order to inform clinical practice as well as to support women to understand and exercise their right to autonomy during pregnancy and birth
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