Hippocratic ideal, Faustian bargain and Damocles' sword: erosion of patient autonomy in obstetrics

Abstract

Objectives-This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Methods-Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2004 are presented.

Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care

“…32-36 The rise in cesarean delivery rates has been attributed in part to the inability of community hospitals to manage high-risk mothers, 37 coupled with a reluctance to transfer them. 38 In lieu of antenatal transfer, practitioners tend to deliver these mothers, transferring the newborn if they are unable to provide the appropriate care; hence, both mother and newborn may receive suboptimal care.…”

“Run, Hide, Fight,” or “Secure, Preserve, Fight”: How Should Health Care Professionals and Facilities Respond to Active Shooter Incidents?

“…Prominent professional codes of ethics assert that patient welfare is a primary responsibility, and this implies that professionals have a duty to accept risks to themselves to care for their patients . Codes and commentators also, however, recognize that the duty to benefit patients is not absolute . It is, for example, limited by the availability of resources and by legitimate professional interests in personal integrity, autonomy, and self‐protection.…”

“…[8][9][10] Codes and commentators also, however, recognize that the duty to benefit patients is not absolute. 11,12 It is, for example, limited by the availability of resources and by legitimate professional interests in personal integrity, autonomy, and self-protection.…”

After a Cesarean…What's a Birth Professional to Do?

“…The risks of RCS, especially for a woman planning more than two pregnancies, are almost universally ignored, or only appear in the fine print of the consent form presented to a woman on the day of her scheduled surgery. There can be no argument that the primary maternity care provider bears a large part of the burden to accurately present risks and benefits of both RCS and VBAC, and there is also little doubt that factors beyond academic knowledge play an important role-so called ''medicolegal concerns,'' corporate financial concerns, and lack of training in nonmedicalized birth all play into the current climate of reliance on surgery (see Rybak, 2009). However, given that the typical consumer spends less than 10 minutes with her caregiver at any given exam, there are other players in this arena who can and should be a force for accurately educating the consumer.…”