Maternity Care Plans: A retrospective review of a process aiming to support women who decline standard care

Jenkinson, Bec; Kruske, Sue; Stapleton, Helen; Beckmann, Michael; Reynolds, Maree; Kildea, Sue

doi:10.1016/j.wombi.2015.05.003

Cited by 14 publications

(15 citation statements)

References 37 publications

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“…This escalation to consultant obstetrician may also have created a barrier and discouraged some women from persisting with their birth intentions. However, given the realities of a hierarchical institutional culture (Katz Rothman, 1989), enabling midwives or registrars to create MCPs may well have diminished the value of the process in the eyes of obstetricians and the institution (and thus the utility of the process), in much the same way that women's birth plans were not accorded status (Jenkinson et al, 2015). Nonetheless, the MCP policy, which guaranteed continued access to maternity care, created an important symbol of respect for maternal autonomy at an organisational level.…”

Section: Discussionmentioning

confidence: 99%

“…•Published paper (see Chapter Four): Jenkinson, B., Kruske, S., Stapleton, H., Beckmann, M., Reynolds, M., Kildea, S. (2015). Maternity Care Plans: A retrospective review of a process aiming to support women who decline standard care.…”

Section: Qualitative Phasementioning

confidence: 99%

“…The policy directs a consultant obstetrician to meet with such women during the antenatal period to discuss and document their intentions in an MCP, which is then circulated to all obstetricians and to midwifery managers. The policy recognises the woman's rights to refuse recommended care and assures them of ongoing access to care at the hospital, Our earlier studies of the MCP process found that it was used narrowly and inconsistently, and generally not created until late pregnancy, meaning most maternity care did not occur in the context of an MCP (Jenkinson et al, 2015). Also, while we found that the MCP process provided a symbol of respect for maternal autonomy, the larger forces of patriarchy and medical hegemony remained largely unchallenged (Jenkinson et al, 2016).…”

Section: Orientationmentioning

confidence: 99%

“…This policy context presented a unique opportunity to examine a process for discussing, documenting and providing maternity services to women who declined recommended care. A retrospective cohort study that analysed the content of MCPs and described demographics and clinical outcomes of women with MCPs is reported elsewhere (Jenkinson et al, 2015). That study found that during the first three and a half years implementation, only 52 MCPs were created, relating to a narrow range of clinical scenarios and mostly authored by a small subset of obstetricians.…”

Section: Introductionmentioning

confidence: 99%

“…That study found that during the first three and a half years implementation, only 52 MCPs were created, relating to a narrow range of clinical scenarios and mostly authored by a small subset of obstetricians. Although this suggests that the process was under-utilised, MCPs appeared to enable women to decline aspects of recommended care and clinicians to provide maternity care that may have deviated from hospital policies (Jenkinson et al, 2015). This paper documents women's, midwives' and obstetricians' experiences of the MCP process.…”

Section: Introductionmentioning

confidence: 99%

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Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

Jenkinson¹

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Background: The right to refuse medical treatment, held by all competent adults and unaltered by pregnancy status, is a central tenet of respectful maternity care. This right is well established in case law, midwifery and obstetric ethical guidance and health policy. However, when pregnant women decline recommended care, concerns about maternal and fetal safety can lead to conflict. Clinicians may feel their own autonomy is challenged and also grapple with ethical and medico-legal concerns. Processes to guide clinicians when women decline recommended care are rare and unstudied. Aim: This thesis set out to support women's rights in maternity care by investigating the research question: Could a documentation and communication process support pregnant women's rights to decline recommended maternity care? Methods: A sequential, explanatory mixed-methods study was undertaken in a Brisbane (Australia) tertiary maternity hospital where a structured process, the Maternity Care Plan (MCP), had been established to guide communication and documentation when women declined recommended care. The first stage of the study was quantitative and mapped the scope and use of the MCP process via a retrospective cohort study of women with MCPs. Results of the quantitative stage then informed selection of participants for the qualitative phase of the study which involved thematic analysis of in-depth semi-structured interviews with women, midwives, and obstetricians. Within the qualitative phase, two layers of thematic analysis were undertaken. The first layer of thematic analysis was descriptive, and focused on participant's experiences of the MCP process, while the second layer applied a more critical and feminist lens, foregrounding the underlying values and attitudes that drove care when pregnant women declined to follow professional advice. Findings: The retrospective cohort study included 52 women with MCPs and concluded that the MCP process enabled clinicians to provide care outside of hospital policies but was used rarely, for a narrow range of situations and with significant variation in its application. These results were then followed up in interviews with nine women, twelve midwives, and nine obstetricians. The descriptive thematic analysis of interviews found that obstetricians felt protected and reassured by the structured documentation and communication, while other clinicians felt reassured by the perception of obstetric authorisation. This, in turn, protected women's access to maternity care. However, inconsistencies in the implementation of the MCP process, and fragmented care, diminished both the utility of the process and women's access to it. While the MCP process 3 provided a symbol of respect for maternal autonomy, the larger forces of patriarchy and medical hegemony remained largely unchallenged. The feminist thematic analysis then identified both supportive and punitive interactions between women and clinicians, depending on whether the woman's birth intentions were perceived by individual clinicians to transg...

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Section: Discussionmentioning

confidence: 99%

Section: Qualitative Phasementioning

confidence: 99%

Section: Orientationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

Jenkinson¹

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Women’s views and preferences regarding the mode of birth after cesarean section: Polish cross-sectional web-based survey

Sys

Baranowska

Kajdy

et al. 2022

European Journal of Obstetrics & Gynecology and Reproductiv

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The experiences of women, midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis

2017

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declining recommended care situated women at the intersection of two powerful normative discourses: medical dominance and the patriarchal institution of motherhood. Significant pressures on women's autonomy resulted from an apparent gap between clinicians' espoused and reported practices. Implications for policy and practice include a need for specific guidance for clinicians providing care in situations of maternal refusal, the potential value of an independent third-party for advice and advocacy, and the development of models that support reflexive practice amongst clinicians.

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Maternity Care Plans: A retrospective review of a process aiming to support women who decline standard care

Cited by 14 publications

References 37 publications

Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

Women’s views and preferences regarding the mode of birth after cesarean section: Polish cross-sectional web-based survey

The experiences of women, midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis

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