Ethics of care: a way towards humanised birth

Cases where women have been denied choice, respect or adequate care are a common occurrence in the maternity setting, and are often brought to light by childbirth advocacy groups. Maternity care providers, and those with a... [ view full abstract ]

Cases where women have been denied choice, respect or adequate care are a common occurrence in the maternity setting, and are often brought to light by childbirth advocacy groups. Maternity care providers, and those with a broader interest in pregnancy and childbirth, therefore need to consider how the ideal of ‘woman-centred care’ is to be maintained under current models. This presentation opens with a brief discussion of the biomedical ethical principles which underpin current practice, and follows with the argument that these principles in practice are often hollow, and sometimes detrimental. When the principal of autonomy is taken to its endpoint, and a woman declines recommended care, her wishes may be overruled and decisions made about her body which are denied her input. Those midwives and obstetricians who try to facilitate true autonomy put themselves in professional jeopardy. To this end, informed consent is also, in practice, rhetorical; women are often coerced, bullied and forced into decisions they do not want to make.

Engaging with ‘ethics of care’ theory, the idea that moving beyond an atomistic, principles-based ethics which is often swayed to support institution-centred care, to an ethics based on relationship and responsibility is proposed as being better aligned with midwifery practice. Ethics of care theory supports the primacy of the midwife-woman relationship in midwifery philosophy and can also provide an alternative to this ethical dilemma of rhetorical autonomy. If the midwife-woman relationship, which can be disrupted by the requirements of the institution, is given central importance from a moral perspective, it follows that attentive, relational and humanised birthing practices will increase as they become embedded into ethical decision-making. For reasons that will also be outlined, the issue of rhetorical autonomy occurs frequently in the maternity sector, when compared to other areas of biomedicine. Threaded through the presentation, therefore, is an outline of the political nature of ethics of care, and how it relates to the global movement of humanising birth.