A paper published in an Australian midwifery journal has proposed a woman-centred framework for documentation and communication when women decide to decline aspects of maternity care.
This is an important issue, as the authors note in the background to their paper:
“In high resource settings, medical dominance over childbirth is far reaching and accompanied by high rates of unnecessary intervention. This ‘too much, too soon’ phenomenon is increasingly regarded as part of obstetric violence and disrespectful maternity care, along with the more overt forms of abuse that are now well documented in some low-resource settings … the right to decline medical care is well established and unaltered by pregnancy status in most western democratic contexts [but] concerns about maternal and fetal safety can lead to conflict and a gap between clinicians espoused respect for women’s autonomy and their practices. Ethical turmoil and medico-legal concerns for clinicians are well documented, and may contribute to clinicians’ use of coercive strategies to get women to comply with recommended care.” (Jenkinson et al 2018)
I hear about this kind of coercion all the time, and I write about it frequently, but I am also heartened by the increased discussion of these issues and the proposal of frameworks like the one offered in this paper. As a systems-level policy, I don’t know whether it’s something that will be right for all women, and that’s only something that we will find out with time and experience, but it is so important that we are having these conversations and that people are proposing solutions to a what seems to be a growing problem. You can access more details of the research here.