Refusal of emergency caesarean delivery in cases of non-reassuring fetal heart rate is an independent risk factor for perinatal mortality

Ribak, Rachel; Harlev, Avi; Ohel, Iris; Sergienko, Ruslan; Wiznitzer, Arnon

doi:10.1016/j.ejogrb.2011.04.008

Cited by 11 publications

(13 citation statements)

References 17 publications

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“…Both studies included women in the refusal group, even if they subsequently consented to recommended treatment, and found that refusal of treatment was an independent risk factor for perinatal mortality. Ribak et al (2011) also identified a trend towards higher rates of adverse perinatal outcomes where the delay between recommendation and consent to treatment was greater than 20 minutes. A Dutch study similarly examined the outcomes of Jehovah's Witnesses women who had declined blood products (van Wolfswinkel et al, 2009).…”

Section: Perinatal Outcomes In Women Who Decline Recommended Carementioning

confidence: 94%

“…Several case reports have been published on this topic, attesting to the ethical and moral turmoil experienced by clinicians (see Avci, 2015;Biscoe & Kidson-Gerber, 2015;Brass, 2012;Curtis, 2010;Dann, 2007;Osuna et al, 2015;Perry et al, 2002;Weiniger et al, 2006). Several studies have also described the demographics and clinical outcomes of women who have declined recommended care (see Ande et al, 2010;Fiscella et al, 2007;Iris et al, 2009;Ribak et al, 2011;Tucker Edmonds et al, 2014). However, women's own voices have been given less attention in the literature on this topic.…”

Section: Delimiting the Scopementioning

confidence: 99%

“…Two Israeli studies (Iris et al, 2009;Ribak et al, 2011) examined the characteristics of women who declined medical intervention during labour and birth, and two US studies examined discharge from hospital against medical advice (Fiscella et al, 2007;Tucker Edmonds et al, 2014). In the Israeli studies, Iris et al (2009) included women who refused CS or blood transfusion (without specifying indications), while Ribak et al (2011) included women who refused emergency CS due to non-reassuring fetal heart patterns. Both studies were populationbased and found that women who declined medical intervention were usually older, of higher parity and more likely to be members of a minority ethnic group than women who did not refuse treatment.…”

Section: Characteristics Of Women Who Decline Recommended Carementioning

confidence: 99%

“…Some attention has also been given to the perinatal outcomes of women who declined recommended maternity care, consistently reporting poorer perinatal outcomes. The two Israeli studies described above (Iris et al, 2009;Ribak et al, 2011) et al, 2009) or between 1988 and 2009 (n=203, out of 10944 women who were advised to have a CS; Ribak et al, 2011). Both studies included women in the refusal group, even if they subsequently consented to recommended treatment, and found that refusal of treatment was an independent risk factor for perinatal mortality.…”

Section: Perinatal Outcomes In Women Who Decline Recommended Carementioning

confidence: 99%

“…Women who decline recommended maternity care may have poorer perinatal outcomes (Iris et al, 2009;Ribak et al, 2011) and debate continues over the nature of a pregnant woman's obligations to her fetus (Savulescu, 2007;Scott, 2000). However, there are few, if any, circumstances under which any such obligations could override a competent woman's right to refuse medical treatment (Berkowitz, 2004;Burrows, 2001).…”

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: Perinatal Outcomes In Women Who Decline Recommended Carementioning

confidence: 94%