Informed consent and refusal in obstetrics: A practical ethical guide.
TLDR
This commentary explores how practical knowledge of the ethical and legal basis of informed consent and refusal can build trust, preserve the therapeutic alliance, and minimize risk when women refuse medical advice.Abstract:
The ethical principle of autonomy gives women a fundamental right to security of person. The principles of beneficence and nonmaleficence are caregivers’ duties to “do what is best,” and “do no harm.” Usually, women and caregivers agree on the best course of action and informed consent is straightforward. Occasionally however, a woman declines recommended treatment or requests treatment that a clinician believes is unsafe. When this occurs, the historical adage: “the doctor knows best” is no longer valid. Ethical tension between autonomy, beneficence, and nonmaleficence may cause conflict between a woman and her caregivers that can impede communication, compromise care, and contribute to poor outcomes. In these situations, negotiating informed consent or refusal can be challenging. By accepting a woman’s refusal, caregivers commonly believe they incur ethical and legal liability. Accordingly, they may withdraw care or coerce women to accept intervention. However, coercion negates consent and abandonment is unprofessional. This commentary explores how practical knowledge of the ethical and legal basis of informed consent and refusal can build trust, preserve the therapeutic alliance, and minimize risk when women refuse medical advice.read more
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Mapping integration of midwives across the United States: Impact on access, equity, and outcomes.
Saraswathi Vedam,Saraswathi Vedam,Kathrin Stoll,Marian F. MacDorman,Eugene Declercq,Renee Ann Cramer,Melissa Cheyney,Timothy J. Fisher,Emma Butt,Y. Tony Yang,Holly Powell Kennedy +10 more
TL;DR: In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes, and the MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care.
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Women's experiences of induction of labour: Qualitative systematic review and thematic synthesis
TL;DR: The review indicates that IoL is a challenging experience for women, which can be understood in terms of the gap between women's needs and the reality of their experience concerning information and decision-making, support, and environment.
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Declined care and discrimination during the childbirth hospitalization
TL;DR: It is found that women who reported having declined care for themselves or their infant during the childbirth hospitalization were more likely to report "poor treatment" based on race and ethnicity, insurance status or having a difference of opinion with a healthcare provider.
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Caring for women making unconventional birth choices: A meta-ethnography exploring the views, attitudes, and experiences of midwives.
TL;DR: In insights into the challenges women can face in seeking unconventional birth choices if they require support from midwives to do so, midwives can play a pivotal role in ensuring that respectful maternity care includes supporting women in their birthing decisions.
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No. 384-Management of Breech Presentation at Term.
Andrew Kotaska,Savas Menticoglou +1 more
TL;DR: This guideline was peer reviewed by international clinicians with expertise in vaginal breech birth and compared with the 2017 Royal College of Obstetricians and Gynaecologists Green Top Guideline 20b: Management of Breech Presentation to recommend selection criteria, intrapartum management parameters, and delivery techniques.
References
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Book
Fuzzy sets
TL;DR: A separation theorem for convex fuzzy sets is proved without requiring that the fuzzy sets be disjoint.
Journal ArticleDOI
Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery
Mark B. Landon,John C. Hauth,Kenneth J. Leveno,Catherine Y. Spong,Sharon Leindecker,Michael W. Varner,Atef H. Moawad,Steve N. Caritis,Margaret Harper,Ronald J. Wapner,Yoram Sorokin,Menachem Miodovnik,Menachem Miodovnik,Marshall W. Carpenter,Alan M. Peaceman,Mary Jo O'Sullivan,Baha M. Sibai,Oded Langer,John M. Thorp,Susan M. Ramin,Brian M. Mercer,Steven G. Gabbe +21 more
TL;DR: The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety, and the absolute and relative risks associated with a trial of labor in women with a history of cesAREan delivery are uncertain.
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