Cesarean Delivery on Maternal Request versus Planned Vaginal Delivery: An Ethical and Feminist Review on the Future of Childbirth
Open Access
- Author:
- Snape, Alexia
- Area of Honors:
- Interdisciplinary in Bioethics and Medical Humanities and Women's Studies
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Lindsay Fernandez-Rhodes, Thesis Supervisor
Jonathan Harold Marks, Thesis Honors Advisor
Jennifer Ann Wagner Lawlor, Thesis Honors Advisor - Keywords:
- bioethics
bioethics and medical humanities
women's studies
cesarean delivery on maternal request
elective cesarean section
medicalization of pregnancy
feminist ethics
reproductive ethics - Abstract:
- Introduction: There have been increasing concerns about the rising rate of cesarean delivery on maternal request (CDMR) and its impact on maternal and neonatal health. In March of 2006, the National Institute of Health (NIH) conducted a State-of-State conference to assess outcomes from CDMR compared to planned vaginal delivery (PVD). The elected panel concluded that there was a lack of significant evidence related to CDMR and stressed the importance of continued quantitative and qualitative research. Since 2006 the NIH has not held another conference about the state of CDMR and the possible adverse impact on maternal and neonatal health. Purpose: The goal of this thesis is to summarize any significant CDMR findings and considerations that have been published after the 2006 NIH CDMR Conference. This comprehensive literature review will provide an updated summary of biological, ethical, and feminist arguments with hopes to gain a consensus on the permissibility of this birthing option in maternal care. Method: A systematic literature view was undertaken of PubMed, CINAHL, and Web of Science using popular search terms related to CDMR, vaginal delivery, ethics, and feminism. Articles published from March 2006 to February 2020 that featured nulliparous or primigravida women with no medical indication of cesarean delivery were included. Results: A total of 50 articles were included in this review. Sixteen ethics-identified articles featured ethical theories of Utilitarianism, Principlism, Virtue Ethics, Deontology, and Casuistry. Thirty-four feminist-identified items provided a feminist analysis of the Context/Environment, Women’s Experience, and Power/Control surrounding CDMR practices in medicine. These articles highlighted the physiological, ethical, feminist, societal, and cultural influences that explained the increasing rate of cesarean delivery for the past fourteen years. It also discussed the impact of lacking clinical evidence on CDMR in comparison to PVD. Conclusion: Due to the lack of progression of clinical research on CMDR maternal and neonatal outcomes, there was a consensus when compared to PVD. Due to this lack of rigorous epidemiologic, ethical consideration of CDMR’s permissibility is still under debate. In feminist-identified literature, there was a majority condemnation of the approval and normalization of CDMR based on the impact of this medicalization of pregnancy. Based on this review, researches and authors continue to stress the need for adequate research on the potential outcomes of CDMR compared to other birthing options. Until then, health policy and guidelines should look to qualitative evidence on CDMR preference and experience to devise a healthcare initiative that is woman-centered. These efforts will hopefully create a significant impact on reproductive advancements and the future of childbirth.