ABSTRACT
OBJECTIVE: To explore the practices of obstetrician-gynecologists (ob-gyns) in the United States surrounding postpartum sterilization when the Medicaid consent form was not valid. METHODS: Using the American College of Obstetricians and Gynecologists' online directory, we conducted a qualitative study where we recruited ob-gyns practicing in 10 geographically diverse U.S. states for a qualitative study using semi-structured interviews conducted by telephone. We analyzed interview transcripts using the constant comparative method and principles of grounded theory. RESULTS: Thirty ob-gyns (63% women, 77% nonsubspecialized, and 53% academic setting) were interviewed. Although most physicians stated that they did not perform sterilizations without a valid Medicaid sterilization form, others noted that they sometimes did due to a sense of ethical obligation toward their patient's health, being in a role with more authority or seniority, interpreting the emergency justification section of the form more broadly, or backdating the form. The physicians who said that they never went ahead without a signed form tended to work at large institutions and were concerned with losing funding and engaging in potentially illegal or fraudulent behavior. CONCLUSION: Physicians' varied behaviors related to providing postpartum sterilization without a valid Medicaid consent form demonstrate that the policy is in need of revision. Unclear terminology and ramifications of the Medicaid sterilization policy need to be addressed to ensure equitable care.
Subject(s)
Consent Forms/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Physician's Role , Postpartum Period/ethics , Sterilization, Reproductive/legislation & jurisprudence , Consent Forms/ethics , Female , Humans , Interviews as Topic , Medicaid/ethics , Pregnancy , Sterilization, Reproductive/ethics , United StatesSubject(s)
Biological Specimen Banks , Blood Specimen Collection , Decision Making , Informed Consent , Mothers/psychology , Adult , Blood Specimen Collection/ethics , Blood Specimen Collection/psychology , Ethics, Research , Female , Humans , Infant, Newborn , Information Literacy , Informed Consent/psychology , Informed Consent/standards , Postpartum Period/ethics , Postpartum Period/psychology , Pregnancy , Quality ImprovementABSTRACT
Inpatient insertion of long-acting reversible contraceptives (LARC) (intrauterine devices and implants) is increasingly offered to women immediately after childbirth. Enthusiasm for this approach stems from robust safety, effectiveness, and cost-effectiveness data and responsiveness to women's needs and preferences. Although clinical evidence for immediate postpartum LARC is well-established, the ethical implications of enhancing access to this care have not been fully considered. Contraceptive policies and practices often embody a tension between fostering liberal availability and potentially coercive promotion of some methods. Historical contraceptive policies and contemporary disparities in LARC use point to the need to consider whether health policies and health care practices support all women's reproductive wishes. Immediate postpartum LARC services need to be designed and implemented with the goal of ensuring autonomy and equity in postpartum contraceptive care. To this end, these services should include strategic plans to promote universal availability, prevent coercion, and enable device removal.
Subject(s)
Contraception/ethics , Inpatients/psychology , Intrauterine Devices/ethics , Postpartum Period/ethics , Social Justice , Contraception/methods , Female , Humans , Time FactorsSubject(s)
Patient Satisfaction , Postnatal Care , Female , Humans , Infant, Newborn , Midwifery/ethics , Midwifery/methods , Midwifery/organization & administration , Nurse Midwives/ethics , Nurse Midwives/organization & administration , Postnatal Care/ethics , Postnatal Care/methods , Postnatal Care/organization & administration , Postpartum Period/ethics , Quality of Health Care/organization & administration , Surveys and QuestionnairesABSTRACT
This paper articulates a careful and detailed objection to the moral permissibility of postnatal abortion. Giubilini and Minerva (2012) claim that if being unable to nurture one's newborn child without significant burdens to oneself, family or society, is a proper moral ground for the demand that the life of a fetus be terminated, then 'after-birth abortion should be considered a permissible option for women who would be damaged by [rearing the child or] giving up their newborns for adoption.' It will be shown that the permissibility of postnatal abortion does not follow from the argument's premises, in particular, the premise that the newborn is not a person in the morally relevant sense.
