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Induction of labour for post-term pregnancy

02 June 2014
14 min read
Volume 22 · Issue 6

Abstract

There has been a shift in healthcare philosophy in recent decades beyond simple requirement of client consent to treatment towards a more intricate notion of informed choice. Debate continues as to whether advocacy of shared decision-making in maternity care is more rhetoric or reality. In the context of management of so-called ‘prolonged’ pregnancy, the scope and authenticity of informed choice withers under scrutiny. It is considered that induction of labour at this juncture in pregnancy has become routinised, affecting an illusion of safety and depressing maternal stimulus to exercise choice. The offer of induction for advanced gestation has thus acquired normative power. Observation during clinical practice has revealed that there may be ethical failings in risk communication, manifested in data manipulation and scaremongering. However, a culture of powerlessness constrains midwives and compels them to seize the risk agenda and adopt the ‘medical standard’ for this common intervention.

Recent decades have seen a theoretical power shift from clinician authority to user autonomy alongside a public and political movement emphasising personal choice and control in relation to maternity care (Department of Health (DH), 1993; NHS Executive, 1996). A new language and philosophy continues to resonate in current UK reports and policy documents, which advocate a humanistic, woman-focused service and promote childbearing women as active consumers and decision-makers (DH, 2004; DH, 2007; DH, 2010). The contemporary approach to care appears to revoke the traditional paternalistic biomedical model, which prioritised the physical aspects of pregnancy and assigned ‘patient’ status to the childbearing woman.

Research on childbirth indicates that women's participation in healthcare decisions is strongly associated with feelings of trust (Levy, 1998a), lower levels of fear (Melender, 2002; Green and Baston, 2003), increased responsibility for health of self and baby (Harrison et al, 2003), improved self-esteem and lower incidence of postnatal depressive symptoms (Chalmers, 1982; Jomeen and Martin, 2008), shorter recovery periods (Green et al, 1988) and more favourable maternal feelings towards the newborn, as well as improvements in the child's long-term health and wellbeing (Bowlby, 1988; Schore, 2003; Verny, 2002).

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