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Jan, Nola and All
This question of rights of patients to medical
interventions and informed choice is complex and varied as there are many
factors are involved.
Balance of risk of intervention vs risks of no
intervention
Source of information - is it biased
Subjectivity/objectivity of both client and
caregiver
Medical interventions - Should the offering of
these interventions be made on medical need or client demand?
It is a constant balancing act as the following
cases show
One woman, at booking, insisted on c/s as first
birth was traumatic (PIH, induction, forceps, dyspareunia for many months) and
the first 12 months were a huge struggle though she breastfed well and was
properly infatuated with her baby. She was living in difficult conditions -
isolated on a remote cattle station, generator power for a few hours/day only,
alone with baby all day and with heavy additional workload.
They had very changed circumstances the second
time around as they had shifted into town where there was lots of good family
support and I felt sure that vaginal birth second time around would have been
a different and probably healing experience for her, but in her mind the
whole difficult year was due to her delivery. She went on to have
elective c/s which was what she felt she needed to do for her emotional well
being.
(This woman had shared care with GP after her
initial booking)
Another woman, 40 year old
primip, also presented at antenatal booking
determined to have an elective c/s. This decision was also fear based -
and after several visits and much discussion she changed her mind and gradually
developed confidence in her ability to give birth vaginally which she did end up
doing with relative ease and much satisfaction even though she had to transfer
to a neighbouring town to give birth as that weekend we had no obstetrical
cover!!!.
(This woman had continuity of care with a midwife
in the antenatal period after her booking)
Another 40 year old primip lawyer I met recently
had an elective c/s so that she could be "in control"
(This woman only ever saw an
obstetrician)
I have recently had a couple of women quite
insistent on their "right" to a c/s when they were in labour. The
caregivers involved denied their requests as there was no good medical
indication and had to be quite forceful at the time. The women were later
very thankful for the "denial" of their "rights" and though difficult the
caregivers were able to deny them because of the relationships developed
throughout the antenatal period.
We all know that many, many women
verbalise fear based desires when they are in transition or at a difficult
point in labour or pregnancy - should we take these at face value? I guess
if you don't know the woman already it is much harder to make the right
judgements. ROLL OUT NMAP!
Sandra
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- [ozmidwifery] Re: presentation - words of wisdom? Nola Aicken
