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1.
Obstet Gynecol ; 136(5): 1036-1039, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030860

RESUMO

The population of women within carceral systems is growing rapidly. A portion of these individuals are pregnant and will deliver while incarcerated. Although shackling laws for pregnant persons have improved, incarcerated patients are forced to labor without the support of anyone but a carceral officer and their medical staff. We believe access to continuous labor support is critical for all pregnant persons. Carceral systems and their affiliated hospitals have the opportunity to change policies to reflect that continuous labor support is a basic human right and should be permitted for incarcerated pregnant persons in labor, either through a doula program or a selected person of choice.


Assuntos
Parto Obstétrico/ética , Trabalho de Parto/psicologia , Direitos do Paciente/legislação & jurisprudência , Assistência Perinatal/ética , Prisioneiros/psicologia , Entorno do Parto , Parto Obstétrico/legislação & jurisprudência , Feminino , Humanos , Assistência Perinatal/legislação & jurisprudência , Gravidez , Prisioneiros/legislação & jurisprudência
2.
J Perinat Med ; 48(5): 450-452, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32401227

RESUMO

If the worries about the coronavirus disease 2019 (COVID-19) pandemic are not already enough, some pregnant women have been questioning whether the hospital is a safe or safe enough place to deliver their babies and therefore whether they should deliver out-of-hospital during the pandemic. In the United States, planned out-of-hospital births are associated with significantly increased risks of neonatal morbidity and death. In addition, there are obstetric emergencies during out-of-hospital births that can lead to adverse outcomes, partly because of the delay in transporting the woman to the hospital. In other countries with well-integrated obstetric services and well-trained midwives, the differences in outcomes of planned hospital birth and planned home birth are smaller. Women are empowered to make informed decisions when the obstetrician makes ethically justified recommendations, which is known as directive counseling. Recommendations are ethically justified when the outcomes of one form of management is clinically superior to another. The outcomes of morbidity and mortality and of infection control and prevention of planned hospital birth are clinically superior to those of out-of-hospital birth. The obstetrician therefore should recommend planned hospital birth and recommend against planned out-of-hospital birth during the COVID-19 pandemic. The COVID-19 pandemic has increased stress levels for all patients and even more so for pregnant patients and their families. The response in this difficult time should be to mitigate this stress and empower women to make informed decisions by routinely providing counseling that is evidence-based and directive.


Assuntos
Betacoronavirus , Entorno do Parto , Infecções por Coronavirus/prevenção & controle , Aconselhamento Diretivo/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidado Pré-Natal/métodos , Parto Obstétrico/ética , Parto Obstétrico/métodos , Aconselhamento Diretivo/ética , Medicina Baseada em Evidências , Feminino , Hospitalização , Humanos , Participação do Paciente/métodos , Segurança do Paciente , Gravidez , Cuidado Pré-Natal/ética
3.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32241824

RESUMO

Multiple births are increasing in frequency related to advanced maternal age and fertility treatments, and they have an increased risk for congenital anomalies compared to singleton births. However, twins have the same congenital anomalies <15% of the time. Thus, having multiple births with discordant anomalies is a growing challenge for neonatologists. Although external anomalies can often be spotted quickly at delivery or sex differences between multiples can rapidly identify those with internal anomalies described on prenatal ultrasound, we present a case of male multiples, who would optimally receive different initial resuscitation strategies on the basis of the presence or absence of an internal anomaly. The similar size of 4 extremely preterm quadruplets raises concern for whether accurate, immediate identification of 1 neonate with a congenital diaphragmatic hernia will be reliable in the delivery room. Clinicians discuss the ethical considerations of an "all for one" approach to this resuscitation.


Assuntos
Cesárea/ética , Salas de Parto/ética , Ruptura Prematura de Membranas Fetais/diagnóstico , Ruptura Prematura de Membranas Fetais/terapia , Lactente Extremamente Prematuro , Gravidez de Quadrigêmeos , Cesárea/métodos , Parto Obstétrico/ética , Parto Obstétrico/métodos , Feminino , Humanos , Lactente Extremamente Prematuro/fisiologia , Recém-Nascido , Intubação Intratraqueal/ética , Intubação Intratraqueal/métodos , Gravidez , Gravidez de Quadrigêmeos/fisiologia
4.
Best Pract Res Clin Obstet Gynaecol ; 67: 113-126, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32245630

RESUMO

Respectful maternity care is recommended by the World Health Organization and refers to care that maintains dignity, privacy, confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth. In this paper, we review the evidence of respectful maternity care and discuss considerations for professional practice for health care providers. While there is limited evidence on what type of interventions can improve respectful maternity care, promising skills development for providers has included training on values, transforming attitudes, and interpersonal communication. Within a health facility, enabling environments may be created by setting up quality improvement teams, monitoring experiences of poor treatment, mentorship, and improved working conditions for staff. In order to provide respectful care, health facilities and health systems must be structured in a way that supports and respects providers, and ensures adequate infrastructure and organisation of the maternity ward.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/normas , Relações Profissional-Paciente , Qualidade da Assistência à Saúde , Respeito , Parto Obstétrico/ética , Feminino , Humanos , Serviços de Saúde Materna/ética , Gravidez
5.
J Perinat Neonatal Nurs ; 34(1): 38-45, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996643

RESUMO

Comfort is a fundamental human need to seek relief, ease, and transcendence. Comfort is relevant to women in labor who experience intense pain and mixed emotions. The subjective meaning of comfort in labor for women is not fully understood. This work was part of a phenomenological study of the experience of childbirth, in which the dynamic of keeping-it-together-falling-apart was identified as an essential quality of women's perceptions of childbirth. Comfort was a salient element of keeping-it-together-falling-apart. In this report, the concept of comfort is explored in greater depth, using qualitative descriptive analysis. Eight participants, aged 23 to 38 years, with spontaneous vaginal births, were each interviewed twice about the childbirth experience. Comfort was a holistic experience of relaxation and relief, where the needs of the body and the person were being met. Comfort and pain coexisted with each other, and relief of pain did not always provide comfort. Women had an innate knowledge of comfort, but their capacity for choice was at times restricted by caregivers in the hospital. There are aspects of labor care that do not support comfort, particularly as it relates to mobility and choice. Prioritizing comfort as well as pain relief may contribute to a more holistic, satisfying birth experience for women.


Assuntos
Parto Obstétrico , Saúde Holística/ética , Dor do Parto , Trabalho de Parto , Parto/psicologia , Conforto do Paciente , Adaptação Psicológica , Adulto , Parto Obstétrico/ética , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Humanos , Dor do Parto/fisiopatologia , Dor do Parto/psicologia , Dor do Parto/terapia , Trabalho de Parto/fisiologia , Trabalho de Parto/psicologia , Acontecimentos que Mudam a Vida , Manejo da Dor , Gravidez , Pesquisa Qualitativa
6.
AMA J Ethics ; 21(10): E902-903, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31651389

RESUMO

Many health professions students struggle with deciding whether and when to challenge their teachers. This graphic memoir, When Good Women Do Nothing, conveys what happened one day in the life of a paramedic student called to help an incarcerated, handcuffed woman in labor who gave birth on a stretcher. The memoir documents numerous clinical and ethical disagreements and decision points throughout the paramedic team's time with this patient.


Assuntos
Tomada de Decisões , Mulheres/psicologia , Pessoal Técnico de Saúde/ética , Parto Obstétrico/ética , Feminino , Histórias em Quadrinhos como Assunto , Humanos , Recém-Nascido , Defesa do Paciente/ética , Defesa do Paciente/psicologia , Gravidez , Prisioneiros
7.
Semin Fetal Neonatal Med ; 24(6): 101029, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31606328

RESUMO

There is very little law-either case law or statutory law - that regulates delivery room decisions about resuscitation of critically ill newborns. Most of the case law that exists is decades old. Thus, physicians cannot look to the law for much guidance about what is permissible or prohibited. Local hospital policies and professional society statements provide some guidance, but they cannot be all-inclusive and encompass all potentially encountered scenarios. Ultimately, the physician, the medical team, and the parents must try to reach a shared decision about the best course of action for each individual infant and each unique family. In this paper, we review some of the case law that may be applicable to such decisions and make recommendations about how decisions should be made.


Assuntos
Estado Terminal , Salas de Parto , Parto Obstétrico , Doenças do Recém-Nascido , Relações Médico-Paciente/ética , Ressuscitação , Adulto , Estado Terminal/psicologia , Estado Terminal/terapia , Tomada de Decisão Compartilhada , Salas de Parto/ética , Salas de Parto/legislação & jurisprudência , Salas de Parto/organização & administração , Parto Obstétrico/ética , Parto Obstétrico/legislação & jurisprudência , Parto Obstétrico/psicologia , Emergências/psicologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/psicologia , Doenças do Recém-Nascido/terapia , Responsabilidade Legal , Complicações do Trabalho de Parto/terapia , Gravidez , Ressuscitação/ética , Ressuscitação/psicologia
8.
Ceska Gynekol ; 84(1): 23-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213054

RESUMO

OBJECTIVE: To point out principles of blood sparing surgery. Medical ethical moral and legal aspects of operations on Jehovahs Witnesses. DESIGN: Retrospective clinical study. Review of articles. SETTING: Dept. of Gynecology and Obstetrics, University Hospital, Olomouc; Dept. of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlín. MATERIALS AND METHODS: 72 Jehovahs Witnesses patients were operated on for various benign and malignant gynecological diseases since 2007-2017. All patiens were operated according to the rules of blood sparing surgery. RESULTS: There were no excesive blood loss at any of the operations. The estimated blood loss was between 10 to 550 ml. CONCLUSIONS: The main principles of blood sparing surgery should be applied not only for Jehovahs Witnesses but for all patients. Even if the blood transfusion is the last resort for excessive blood loss during complicated operations it always carries some health risks. There are also the economical aspects. Blood transfusions should be therefore used only at very rare occasions. Jehovahs Witnesses refuse blood transfusions at all even if it is the only life saving resort. Our legislation deal with this problem but there are also moral and ethical aspects. The attitude of gynecological surgeons how to solve this problem differ a great deal.


Assuntos
Transfusão de Sangue , Ética Médica , Testemunhas de Jeová , Princípios Morais , Religião e Medicina , Transfusão de Sangue/ética , Parto Obstétrico/ética , Feminino , Hemorragia , Humanos , Legislação Médica , Gravidez , Estudos Retrospectivos
9.
BMC Med Ethics ; 20(1): 27, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029121

RESUMO

BACKGROUND: There is unanimous agreement regarding the need to ethically conduct research for improving therapy for patients admitted to hospital with acute conditions, including in emergency obstetric care. We present a conceptual analysis of ethical tensions inherent in the informed consent process for randomized clinical trials for emergency obstetric care and suggest ways in which these could be mitigated. DISCUSSION: A valid consenting process, leading to an informed consent, is a cornerstone of this aspect necessary for preservation and maintenance of respect for autonomy and dignity. In emergency obstetric care research, obtaining informed consent can be problematic, leading to ethical tension between different moral considerations. Potential participants may be vulnerable due to severity of disease, powerlessness or impaired decisional capacity. Time for the consent process is limited, and some interventions have a narrow therapeutic window. These factors create ethical tension in allowing potentially beneficial research while avoiding potential harms and maintaining respect for dignity, human rights, justice and autonomy of the participants. CONCLUSION: Informed consent in emergency obstetric care in low- and middle-income countries poses numerous ethical challenges. Allowing research on vulnerable populations while maintaining respect for participant dignity and autonomy, protecting participants from potential harms and promoting justice underlie the ethical tensions in the research in emergency obstetric and newborn care. Those involved in research conduct or oversight have a duty of fair inclusion, to avoid denying participants the right to participate and to any potential research benefits.


Assuntos
Parto Obstétrico/ética , Países em Desenvolvimento , Serviços Médicos de Emergência/ética , Consentimento Informado por Menores/ética , Consentimento Livre e Esclarecido/ética , Terapia Intensiva Neonatal/ética , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Humanos , Recém-Nascido
10.
Indian Pediatr ; 56(1): 13-17, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30806353

RESUMO

When delivery is anticipated near the limit of viability, both the family and the caregiver are faced with many complex and ethically challenging decisions. It must be remembered that the decisions that are made are going to impact the entire life of the baby and the family. Such decisions should be based on the best available evidence about the prognosis for the infant. If the chance of mortality and serious morbidity for an infant is high (but not too high), parental discretion around provision of life-sustaining treatment is appropriate. In this article, we discuss issues on survival and outcomes of extremely premature infants, and the available guidelines.


Assuntos
Tomada de Decisão Clínica/ética , Parto Obstétrico/ética , Lactente Extremamente Prematuro , Nascimento Prematuro/mortalidade , Feminino , Humanos , Gravidez
11.
Bioethics ; 33(4): 475-486, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30358905

RESUMO

There are reasons to believe that decision-making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women's decisional capacity. Decision-making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to 'understanding' alone. A systematic literature search identified a total of 20 empirical studies focused on women's decision-making about epidural analgesia for labor pain. Our review of these studies suggests that empirical evidence to date is insufficient to determine whether women undergoing labor are capable of consenting to epidural analgesia. Given such uncertainties, sufficient information about pain management should be provided as part of prenatal education and the consent process must be carefully conducted to enhance women's autonomy. To fill in the significant gap in clinical knowledge about laboring women's decision-making capacity, well-designed prospective and retrospective studies may be required.


Assuntos
Analgesia Epidural/ética , Tomada de Decisões/ética , Consentimento Livre e Esclarecido/ética , Dor do Parto/tratamento farmacológico , Trabalho de Parto , Competência Mental , Autonomia Pessoal , Analgesia Epidural/psicologia , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Analgésicos Opioides/administração & dosagem , Ansiedade/etiologia , Cognição , Compreensão , Parto Obstétrico/ética , Emoções , Feminino , Humanos , Consentimento Livre e Esclarecido/psicologia , Dor do Parto/psicologia , Trabalho de Parto/psicologia , Manejo da Dor/ética , Manejo da Dor/métodos , Gravidez , Gestantes/psicologia , Estresse Psicológico/etiologia
13.
AMA J Ethics ; 20(1): 238-246, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29542434

RESUMO

Argentina passed a law for humanized birth in 2004 and another law against obstetric violence in 2009, both of which stipulate the rights of women to achieve respectful maternity care. Clinicians and women might still be unaware of these laws, however. In this article, we discuss the case of a fourth-year medical student who, while visiting Argentina from the United States for his obstetric rotation, witnesses an act of obstetric violence. We show that the student's situation can be understood as one of moral distress and argue that, in this specific instance, it would be appropriate for the student to intervene by providing supportive care to the patient. However, we suggest that medical schools have an obligation to better prepare students for rotations conducted abroad.


Assuntos
Parto Obstétrico/ética , Ética Médica , Assistência Perinatal , Relações Médico-Paciente/ética , Estresse Psicológico , Estudantes de Medicina , Violência/ética , Argentina , Temas Bioéticos , Parto Obstétrico/legislação & jurisprudência , Educação Médica , Feminino , Humanos , Intercâmbio Educacional Internacional , Legislação Médica , Obrigações Morais , Parto , Assistência Perinatal/ética , Assistência Perinatal/legislação & jurisprudência , Gravidez , Faculdades de Medicina , Estudantes de Medicina/psicologia , Estados Unidos , Violência/legislação & jurisprudência , Direitos da Mulher
14.
J Obstet Gynecol Neonatal Nurs ; 47(1): 94-104, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28453947

RESUMO

OBJECTIVE: To conduct a secondary qualitative analysis of a phenomenological study of traumatic childbirth to identify the types and frequency of mistreatment of women during childbirth in high-income countries. DESIGN: Analytic expansion was the type of secondary analysis chosen to make further use of a primary qualitative data set to ask a new question that was not included the original study aims. SETTING: The primary data set of women's experiences of traumatic childbirth was obtained via the Internet. PARTICIPANTS: The Internet sample of 40 mothers consisted of 23 women from New Zealand, 8 from the United States, 6 from Australia, and 3 from the United Kingdom who experienced traumatic births. METHODS: Krippendorff's content analysis of categoric distinction was used to analyze the mothers' narratives of their traumatic births. The typology of mistreatment and abuse of women during childbirth in health care facilities worldwide outlined by Bohren et al. provided the categories for the content analysis. RESULTS: Six types of disrespectful and abusive treatment during childbirth were reported by participants, from those reported most often to least often: Failure to Meet Professional Standards of Care, Poor Rapport Between Women and Providers, Verbal Abuse, Physical Abuse, Health System Conditions/Constraints, and Stigma/Discrimination. CONCLUSION: Findings confirm results from studies of mistreatment of women during childbirth in health care facilities in low- and middle-income countries. Prevention and elimination of mistreatment of women during childbirth are the ethical responsibility of all obstetric health care providers.


Assuntos
Atitude do Pessoal de Saúde , Mulheres Maltratadas/estatística & dados numéricos , Parto Obstétrico/ética , Parto/psicologia , Abuso Físico/estatística & dados numéricos , Resultado da Gravidez , Austrália , Parto Obstétrico/psicologia , Feminino , Instalações de Saúde , Humanos , Incidência , Recém-Nascido , Internacionalidade , Nova Zelândia , Abuso Físico/ética , Gravidez , Relações Profissional-Paciente , Pesquisa Qualitativa , Medição de Risco , Inquéritos e Questionários , Reino Unido , Estados Unidos , Violência/estatística & dados numéricos
15.
Matronas prof ; 19(1): 12-20, 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-173296

RESUMO

OBJETIVOS: Conocer la opinión de las matronas de Baleares en cuanto al derecho de autonomía, el respeto a la intimidad, el trato y la adecuación de la práctica obstétrica durante el embarazo, el parto y el puerperio, en función de las recomendaciones de las estrategias y guías de práctica clínica del Ministerio de Sanidad. MÉTODOS: Se llevó a cabo un estudio de tipo descriptivo y transversal en una muestra de matronas del sistema público de Baleares, en el que se obtuvo información acerca de las variables de la matrona (años tras la titulación, lugar de trabajo) y variables de opinión (intimidad, trato, autonomía, adecuación de la práctica), a partir de un cuestionario elaborado ad hoc tras una revisión bibliográfica y técnica del grupo nominal. RESULTADOS: De 173 matronas, respondieron 139 (80,3%), 99 de hospital y 40 de atención primaria. En el 43,8% hubo un acuerdo importante en que el embarazo, el parto y el puerperio normales son atendidos como fisiológicos. El 50% expresaba un acuerdo importante en que la elevada carga asistencial dificulta que la atención sea personalizada, respetuosa y de calidad. Sólo el 5,8% expresó un desacuerdo importante en que el plan de parto favorece que la mujer elija cómo desea ser atendida. Las participantes afirmaron que la intimidad se garantiza, aunque el 41,6% consideraba que el número de profesionales presentes en el parto era sólo el imprescindible. El 60,9% mostró un acuerdo importante en que se crea un clima de confianza y respeto. El 28,8% refería un importante grado de acuerdo en que se practican técnicas innecesarias y/o inadecuadas por miedo. CONCLUSIONES: Las matronas opinan que la atención obstétrica en Baleares es, en general, respetuosa y se ofrece un trato humanizado, pero de sus respuestas también se deduce que existe un margen de mejora que cabe tener en cuenta


OBJECTIVES: To know the opinion of midwives of the Balearic Islands (Spain) about respect for autonomy, privacy, assistance and adequacy of obstetric practice during pregnancy, childbirth and postpartum as compared to the Strategy at normal birth document and clinical practice guidelines of the Ministry of Health. METHODS: Descriptive cross-sectional study. Population: midwives of Balearic Islands public health service. Midwife variables (years since graduation, work place). Opinion variables (privacy, assistance, autonomy, practice adequacy). Questionnaire elaborated ad hoc after bibliographic review and nominal group technique. RESULTS: 139/173 midwives answered (response rate= 80.3%), 99 from hospital and 43 from PHC. A 43.8% referred important agreement on normal pregnancy, childbirth and puerperium being treated like physiological processes. A 50% referred important agreement on the burden of care making difficult a personalized, respectful and high quality assistance. Only 5.8% expressed high disagreement with a childbirth plan facilitates that women choose how they would like to be assisted. They affirmed that privacy is guaranteed, even though 41.6% considered that the number of professionals present during delivery were those needed. A 60.9% referred important agreement with a close and respectful relationship is created. A 28.8% referred important agreement with unnecessary and/or inadequate interventions being performed. CONCLUSIONS: Midwives believe that obstetric assistance in the Balearic Islands is in broad terms respectful and that humanized care is provided, but from their responses also suggest there is room for improvement


Assuntos
Humanos , Feminino , Gravidez , Humanização da Assistência , Direitos do Paciente/ética , Parto Obstétrico/ética , Tocologia/tendências , Autonomia Pessoal , Inquéritos e Questionários , Período Pós-Parto
17.
Narrat Inq Bioeth ; 7(3): 215-220, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29249714

RESUMO

These mother-told stories of birth, describing disrespectful and harmful care, make the invisibility of birthing women visible. The concerns and needs of women in labor fade in the face of hospital policies and the perceived needs of their soon-to-be-born babies. Bioethics contributes to this lack of regard for mothers by framing the moral problems of birth in terms of maternal-fetal conflict, where the autonomy of the mother is weighed against the obligation of beneficence to the baby. Replacing the principlist commitment to autonomy with respect-an obligation that does not compete with beneficence-is a first step toward correcting the problems in care identified here.


Assuntos
Beneficência , Parto Obstétrico/ética , Mães , Assistência Perinatal/ética , Autonomia Pessoal , Pessoalidade , Relações Profissional-Paciente/ética , Temas Bioéticos , Bioética , Ética Clínica , Feminino , Feto , Necessidades e Demandas de Serviços de Saúde , Humanos , Lactente , Bem-Estar do Lactente , Bem-Estar Materno , Obrigações Morais , Parto , Gravidez , Justiça Social
18.
Obstet Gynecol ; 130(4): e187-e199, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28937572

RESUMO

Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.


Assuntos
Parto Obstétrico/normas , Viabilidade Fetal , Lactente Extremamente Prematuro , Obstetrícia/normas , Nascimento Prematuro , Consenso , Parto Obstétrico/ética , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/ética , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Obstetrícia/ética , Preferência do Paciente , Gravidez
19.
Narrat Inq Bioeth ; 7(1): 97-106, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28713150

RESUMO

A 15-year-old was admitted to the labor and delivery unit for induction of a 41-week-gestation pregnancy. Her parents, members of Jehovah's Witnesses, and the patient, who had been studying the religion but had not yet been baptized, were adamant that no blood transfusions would be accepted even if a life-threatening hemorrhage were to occur. In our analysis, we examine the underlying ethical conflict and issues raised by this case. We considered two important ethical questions in analyzing the dilemma: first, whether adolescents are capable of providing autonomous and authentic refusals for lifesaving interventions; and second, whether parents can refuse such interventions for their adolescent children based on their religious beliefs. We provided justifications for not considering the adolescent's refusal as autonomous and for overruling the parental refusal, concluding that there was ethical support for providing potentially lifesaving transfusions should they become clinically indicated. We also suggested strategies to avoid blood loss and the need for transfusions in order to respect the stated values and preferences of the patient and her family to the greatest degree possible. In order to protect the privacy of the patient and her family, details in this case have been changed and no identifiable information has been used.


Assuntos
Transfusão de Sangue/ética , Parto Obstétrico/ética , Ética Médica , Consentimento Informado por Menores , Testemunhas de Jeová , Pais , Recusa do Paciente ao Tratamento , Adolescente , Feminino , Humanos , Consentimento Livre e Esclarecido/ética , Trabalho de Parto Induzido/efeitos adversos , Autonomia Pessoal , Hemorragia Pós-Parto/terapia , Gravidez , Religião e Medicina
20.
Reprod Health ; 14(1): 60, 2017 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-28511685

RESUMO

BACKGROUND: Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services. METHODS: This study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers' RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment. We present percentages of the nine RMC indicators, mean score of providers' RMC performance and the adjusted multilevel model regression coefficients to determine the association with a quality improvement program and other facility and provider characteristics. RESULTS: Women on average received 5.9 (66%) of the nine recommended RMC practices. Health centers demonstrated higher RMC performance than hospitals. At least one form of mistreatment of women was committed in 36% of the observations (38% in health centers and 32% in hospitals). Higher likelihood of performing high level of RMC was found among male vs. female providers ([Formula: see text], p = 0.012), midwives vs. other cadres ([Formula: see text], p = 0.002), facilities implementing a quality improvement approach, Standards-based Management and Recognition (SBM-R©) ([Formula: see text], p = 0.003), and among laboring women accompanied by a companion [Formula: see text], p = 0.003). No factor was associated with observed mistreatment of women. CONCLUSION: Quality improvement using SBM-R© and having a companion during labor and delivery were associated with RMC. Policy makers need to consider the role of quality improvement approaches and accommodating companions in promoting RMC. More research is needed to identify the reason for superior RMC performance of male providers over female providers and midwives compared to other professional cadre, as are longitudinal studies of quality improvement on RMC and mistreatment of women during labor and childbirth services in public health facilities.


Assuntos
Atitude do Pessoal de Saúde , Parto Obstétrico , Serviços de Saúde Materna , Relações Profissional-Paciente , Prática de Saúde Pública , Qualidade da Assistência à Saúde , Adulto , Lista de Checagem , Estudos Transversais , Parto Obstétrico/ética , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Materna/ética , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Parto/etnologia , Parto/psicologia , Abuso Físico/estatística & dados numéricos , Gravidez , Prevalência , Relações Profissional-Paciente/ética , Prática de Saúde Pública/ética , Prática de Saúde Pública/normas , Prática de Saúde Pública/estatística & dados numéricos , Melhoria de Qualidade , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas
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