The highly complex phase of intrapartum management: when clinical and medico-legal aspects overlap

Abstract

Objective. Some intrapartum obstetrical practices, such as episiotomy or Kristeller Maneuver, are highly controversial within the scientific community, from the ethical, political and social perspectives. Guidelines or recommendations for the management of intrapartum care, revolving around a thorough informed consent process, can be decisive to avoiding deeply conflicting situations, where the phrase "obstetric violence" has unfortunately become relatively widespread. In this paper, the authors aimed to highlight how the use of intrapartum obstetric practices is, at times, necessary and instrumental in ensuring the well-being of the mother as well as the foetus. Materials and Methods. A broad-ranging search has been conducted, using the scientific search engines PubMed, Google Scholar, Medscape, Medline Plus and Scopus, via the following search string: "obstetric violence", "gender violence", "intrapartum care", "episiotomy", "caesarean section", "Kristeller", "childbirth", "informed consent", taking into consideration the articles from 2015 to February 2021. Results. Results of our research point to the fact that the woman's need for information on obstetric procedures is often not adequately met by health professionals, and the informed consent process is therefore not thoroughly implemented. Conclusions. The authors argue in favour of adopting an informed consent model to be submitted to the pregnant women regarding any intrapartum obstetrical procedure that may become necessary before and during labour, in order to make professional conduct more transparent and protect health care personnel from claims and lawsuits arising from unwarranted practices.

Cardiotocography in labour: an exploratory analysis of foetal heart rate (FHR) interpretative uniformity in Alto Adige

“…Many of the critical aspects related to pregnancy and childbirth can result in adverse neonatal outcomes and therefore result in medical-legal litigation [20]; among the situations presumed to be the basis of potential neonatal harm there are vaccinations during pregnancy [21], the use of drugs [22], the use of contrast agents and ionizing radiation [23] , some methods of childbirth such as waterbirth [24] and the failure to identify the causes of antenatal intracranial hemorrhage [25].…”