In September, the Australian Parliament initiated an inquiry into Obstetricians and Gynecologists (Obgyns) amid allegations of “obstetric violence” (Social Media Birth Plans). This term describes instances where pregnant individuals feel violated during the birthing process due to gaps between their expectations and care provided. The Australian Medical Association (AMA) argues that social media has significantly contributed to skewed perceptions of childbirth, giving parents unrealistic ideals of a flawless birthing experience. This, in turn, has created a considerable gap between the patient’s birth plan and the reality that healthcare professionals sometimes face. Balancing the safety of both the birthing parent and the unborn child is the physician’s goal. In order to do so, doctors may occasionally need to disregard the detailed birthing plans crafted by expectant parents. The AMA emphasizes that part of the problem is the lack of proper education provided to the parents, leaving them with the feeling that their autonomy has been intentionally disregarded. The tension between paternalism and patient autonomy, aggravated by concerns around informed consent, lies at the heart of this issue.
Doctors face a dilemma between doing what they believe is best for the patient and adhering to the patient’s wishes when childbirth doesn’t go as planned. Daniel Groll argues that competent patients have the right to make informed decisions about their care. However, the complexity arises when a patient’s choices impact both themselves and their unborn child. It begs the question of whether a birth-giver’s personal preferences should take precedence over the well-being of another human, the preborn child. This creates a conflict between personal autonomy and the interests of others, a complex dilemma.
The complexity extends further when considering the experiences of nurses and midwives who feel stifled in advocating for their patients. While life-threatening situations require immediate action, sometimes, the deviation from a birth plan is more convenient for the doctor than medically necessary for the parent. Issues like unnecessary induction and other non-essential procedures can arise, raising questions about whether doctors are prioritizing patient welfare or their own ease.
This issue is even more concerning when considering the expertise of experienced nurses and midwives who often understand what is medically necessary, highlighting instances where doctors are acting inappropriately rather than paternalistically. Furthermore, procedures such as vaginal checks may not always be medically necessary. One nurse explained she had to physically restrain a physician from conducting a cervical check without consent (Social Media and Birth Plans). This incident, coupled with the sentiment shared by eighty percent of members of the Nurse and Midwife Association who feel unable to effectively advocate for their patients, indicates that doctors are not merely acting paternalistically but rather selfishly (Social Media and Birth Plans).
Another significant concern is informed consent, particularly the information aspect. Informed consent becomes impossible when patients lack a realistic understanding of what’s occurring. It’s not only about signing a form; it’s about having a genuine grasp of the situation. It’s counterproductive to commit to something without a genuine comprehension of the situation. This is where social media plays a substantial role. When individuals rely on influencers or celebrities as their primary sources of medical information, genuine understanding becomes hard to get. Consequently, patients struggle to comprehend why certain measures are taken, leaving them feeling violated (Social Media and Birth Plans). In such situations, doctors face a critical decision between adhering to a patient’s possibly shortsighted preferences and providing proper care.
This indicates the vital importance of building a doctor-patient relationship and educating patients before childbirth. It’s far more effective for a doctor to dispel misconceptions when a mother is not in a high-pressure situation rather than attempting to have that conversation while she is undergoing the stress of medical procedures. As emphasized by Millum and Bromwich, patients are more likely to make decisions that align with their values when they have access to adequate information.
It’s important to note that the power dynamics between patients and doctors can sometimes lead to patients merely submitting to authority rather than making autonomous decisions. This is exacerbated when doctors provide a one-sided perspective, undermining the patient’s ability to consent with a full understanding of the situation.
An expectant parent reading an article about the disregard for birth plans has valid reasons to feel apprehensive. The foundation of the doctor-patient relationship relies on trust, and instances of not respecting birth plans erode the trust that doctors have worked to establish over generations. Considering the heightened protectiveness many parents feel toward their newborn babies, it’s entirely reasonable to expect a lack of trust in their doctors. Furthermore, this situation creates an opportunity for the “crunchy community” to step in and spread potentially misleading information about the birthing process, perpetuating a cycle of mistrust.
A physician must approach this topic with care and sensitivity. While having an honest and open conversation about the realities of childbirth and the potential limitations of a birthing plan can be crucial for a positive birthing experience, a doctor must also be cautious not to inadvertently frighten the parent or make them feel isolated. It’s essential to strike a balance that informs the patient while ensuring they still feel empowered to have a voice in the delivery room.
The very fact that this conversation is taking place offers hope for the future of medicine. As society continues to hold individuals and institutions accountable for their actions in a public forum, there’s the potential for a restoration of trust in the doctor-patient relationship. Doctors will need to prioritize patient education from the beginning, not just during delivery. This approach can foster stronger interpersonal connections between doctors and patients, with the potential to be truly transformative.