Lecture 10 (Wednesday, November 17, 2012) – Reproductive Ethics
Contemporary Issues in Ob/Gyn
Rates of caesarean
Trusting patients and patient autonomy
Maternal/fetal rights conflict
Working with other professionals
New reproductive technologies (ARTs)
Screening for genetic information
Choosing Surgical Birth
According to the argument this is the model
1. Scientific discovery
2. Improved medical practice
3. New ethical problems
4. Bioethical solution
How did this medical practice and the science that supports this come to be?
1 Lecture 10 (Wednesday, November 17, 2012) – Reproductive Ethics
Why this particular intervention or practice?
What influences and norms produce the desire for this practice?
Ethical decision making in Healthcare settings
Biomedical ethics policies (national, provincial, institutional)
Surgical Birth (CD)
Rapid increase through 1990s and 2000s
1. Longer recovery times
2. More complications
Should elective surgery be used to intervene in a natural and health process?
Caesarean delivery on maternal request (CDMR)
Why has CDMR become an issue at this moment?
Who has made CDMR an ethics issue?
1990s Studies reporting risks of pelvic floor damage in vaginal births (VD)
2006 NIH Conference On CDMR
Rise in CD rate must be from CDMR because
1. Incidence of CD rose (1990 – 2006)
2. Maternal risk profiles remained the same
1. Changing professional norms?
2. Changing social attitudes to women’s preferences during birth
2 Lecture 10 (Wednesday, November 17, 2012) – Reproductive Ethics
“There can be no ethical objection when the desire of an informed women for a surgical birth meets
the desire of a physician to apply the best of medical technology to the natural process of birth”
1. Very few women request CDMR (not good explanation for change in CD rate)
2. Poor evidence of risk for pelvic floor damage
So What Might Be Causing Increases in Surgical Birth
More complicated when we consider physician desires
CDMR versus NMISB
Non – medically indicated surgical birth
Preferences versus desires
Evidence & Physician Desires
Appropriate rate of CD?
Current rates of NMISB?
PROBLEM! Application of general recommendation to particular patient
Physician training ▯interventionalist
Research Agenda and Physician Desires
3 Lecture 10 (Wednesday, November 17, 2012) – Reproductive Ethics
Variation between countries (i.e. Netherlands)
Variation between specialties (i.e. urogynacology)
Risk and Fear
Preference for technology versus accepting natural processes
Women’s fears around birth – widel