A bit of medical paternalism? A qualitative study on power relations between women and healthcare providers when deciding on mode of birth in five public maternity wards of Argentina

Reproductive Health

Research

G. Carroli¹  H. Mølsted Alvesson²  C. Hanson²  M. Vila Ortiz³  C. Gialdini⁴  A. P. Betrán⁵ 

[1] Centro Rosarino de Estudios Perinatales, Rosario, Argentina;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Centro Rosarino de Estudios Perinatales, Rosario, Argentina;Facultad de Ciencias de la Salud Blanquerna, Universidad Ramón Llull, Barcelona, Spain;Centro Rosarino de Estudios Perinatales, Rosario, Argentina;UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland;

关键词: Mode of birth;    Decision-making;    Caesarean section;    Power relations;    Medical paternalism;   

DOI  :  10.1186/s12978-023-01661-5

 received in 2023-05-13, accepted in 2023-08-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundWhether women should be able to decide on mode of birth in healthcare settings has been a topic of debate in the last few decades. In the context of a marked increase in global caesarean section rates, a central dilemma is whether pregnant women should be able to request this procedure without medical indication. Since 2015, Law 25,929 of Humanised Birth is in place in Argentina. This study aims at understanding the power relations between healthcare providers, pregnant women, and labour companions regarding decision-making on mode of birth in this new legal context. To do so, central concepts of power theory are used.MethodsThis study uses a qualitative design. Twenty-six semi-structured interviews with healthcare providers were conducted in five maternity wards in different regions of Argentina. Participants were purposively selected using heterogeneity sampling and included obstetrician/gynaecologists (heads of department, specialists working in 24-h shifts, and residents) and midwives where available. Reflexive thematic analysis was used to inductively develop themes and categories.ResultsThree themes were developed: (1) Healthcare providers reconceptualize decision-making processes of mode of birth to make women’s voices matter; (2) Healthcare providers feel powerless against women’s request to choose mode of birth; (3) Healthcare providers struggle to redirect women’s decision regarding mode of birth. An overarching theme was built to explain the power relations between healthcare providers, women and labour companions: Healthcare providers’ loss of beneficial power in decision-making on mode of birth.ConclusionsOur analysis highlights the complexity of the healthcare provider-woman interaction in a context in which women are, in practice, allowed to choose mode of birth. Even though healthcare providers claim to welcome women being an active part of the decision-making processes, they feel powerless when women make autonomous decisions regarding mode of birth. They perceive themselves to be losing beneficial power in the eyes of patients and consider fruitful communication on risks and benefits of each mode of birth to not always be possible. At the same time, providers perform an increasing number of CSs without medical indication when it is convenient for them, which suggests that paternalistic practices are still in place.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023