Women refusing standard obstetric care: Maternal-fetal conflict or doctor-patient conflict?

Evidence based guidelines can help healthcare practitioners to provide better and more cost effective care for the average patient with a specific medical problem [1]. During the past 15 years, the Cochrane Collaboration, NICE, and many other national and international organizations have provided obstetric medicine with a wealth of new evidence based guidelines. However, more protocolized care also means less room for personalized medicine. Not all patients have the same perception of risk as medical staff [2] and some attach more importance to avoiding a certain intervention (for instance caesarean section) than to incurring a small increase in risk of perinatal morbidity or mortality. One of the consequences of the plethora of protocols in obstetric medicine could be a real or perceived increase in the number of patients who wish to go outside the standard of care. No quantitative surveys on this subject have been done to date, so exact numbers are not available. Much is still unclear among professionals about the rights of a pregnant woman, those of her fetus, and the legal position of a healthcare provider who is willing to assist a woman who wants to give birth outside the standard protocol. The debate is as yet unresolved whether the law can or indeed should intervene in situations where the woman’s decision seems to put the fetus’s life at risk. This is often described by obstetricians as a maternal-fetal conflict. In this paper we will provide some insight into the legal and ethical context surrounding women’s rights in childbirth and the issues mentioned above. We will also review some professional organizations’ statements on these issues. Legal measures against pregnant women in literature.