Elective cesarean birth: Issues and ethics of an informed decision

2004 ◽  
Vol 49 (5) ◽  
pp. 421-429 ◽  
Author(s):  
Barbara L. McFarlin
2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Michelle T. Nguyen ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak ◽  
Kathryn J. Shaw ◽  
Dominique Luckey

Abstract Background A fetal diagnosis poses ethical challenges when a woman requests elective cesarean delivery for psychosocial reasons. We address the ethical challenges of counseling such patients. Case presentation A 36-year-old G4P2012 has chosen to continue a pregnancy despite a high likelihood of trisomy 18. At 36.5 weeks she was admitted for preeclampsia with severe features and requested to be delivered by primary cesarean section. Due to the poor prognosis associated with trisomy 18, the patient’s request for cesarean delivery was declined even when her baby changed to breech presentation with Category 2 fetal heart rate (FHT). The patient subsequently experienced a traumatic stillbirth and post-traumatic shock disorder (PTSD). Conclusion The obstetrician’s goal should be to transform the patient’s request into an informed decision. The obstetrician should explain that, while a cesarean could increase the likelihood of a live birth, it will not alter long-term neonatal outcomes and entails net biomedical risk for the current and future pregnancies. The obstetrician should ensure that the patient understands these clinical realities. The obstetrician should support the patient’s decision-making about whether to accept the risks of cesarean delivery for psychosocial benefit. The obstetrician should initiate counseling during prenatal visits to empower the patient with information to meaningfully exercise her autonomy. If the patient makes an informed decision for cesarean delivery, it becomes ethically permissible. Plans regarding intrapartum management and mode of delivery should be documented in case the patient is delivered by a physician who was not involved in prenatal counseling.


2020 ◽  
Vol 12 (1) ◽  
pp. 45-48
Author(s):  
Aisha Alshdefat ◽  
Abdalla Alshdaifat

1996 ◽  
Vol 40 (3) ◽  
pp. 161???162
Author(s):  
D. R. GRAMBLING ◽  
S. K. SHARMA ◽  
P. F. WHITE ◽  
T. VAN BEVEREN ◽  
A. S. BALA ◽  
...  

1995 ◽  
Vol 81 (1) ◽  
pp. 90-95 ◽  
Author(s):  
David R. Gambling ◽  
Shiv K. Sharma ◽  
Paul F. White ◽  
Toosje Van Beveren ◽  
Arumugham S. Bala ◽  
...  

2018 ◽  
Vol 46 (2) ◽  
pp. 151-154 ◽  
Author(s):  
Karin Demšar ◽  
Matija Svetina ◽  
Ivan Verdenik ◽  
Natasa Tul ◽  
Isaac Blickstein ◽  
...  

AbstractObjective:To identify the prevalence of and to determine the risk factors for developing a fear of childbirth (tokophobia).Methods:We evaluated 191 pregnant women during Parenting and Childbirth Classes. Participants were approached when attending Parenting and Childbirth Classes between June 2014 and September 2014 and were asked to complete several questionnaires related to depression (CES-D), anxiety (STAI X1 and X2), satisfaction with life (SWLS), delivery expectation/experience (W-DEQ), and specific fears.Results:Most (90%) of the responders were nulliparous. As many as 75% of the participants reported low to moderate tokophobia, whereas 25% exhibited high or very high fear of childbirth. Pathological fear occurred in 1.6% of the participants. The most significant was the fear of having an episiotomy followed by fear of having no control on the situation and fear of pain. An association exists between a preferred elective cesarean birth and tokophobia.Conclusions:The results draw attention to the need for early detection and treatment of fear of childbirth. The data may help identifying women at risk that require prenatal psychological intervention.


1995 ◽  
Vol 81 (1) ◽  
pp. 90-95 ◽  
Author(s):  
David R. Gambling ◽  
Shiv K. Sharma ◽  
Paul F. White ◽  
Toosje Van Beveren ◽  
Arumugham S. Bala ◽  
...  

Author(s):  
Brianna C. Halasa ◽  
Allison C. Sylvetsky ◽  
Ellen M. Conway ◽  
Eileen L. Shouppe ◽  
Mary F. Walter ◽  
...  

Objective This study aimed to investigate human fetal exposure to non-nutritive sweeteners (NNS) by analyzing amniotic fluid and umbilical cord blood. Study Design Concentrations of four NNS (acesulfame-potassium [ace-K], saccharin, steviol glucuronide, and sucralose) were measured in amniotic fluid (n = 13) and cord blood samples (n = 15) using liquid chromatography-mass spectrometry. Amniotic fluid samples were obtained for research purposes at the time of term elective cesarean birth or clinically indicated third trimester amnioreduction at Mercy Hospital for Women (Melbourne, Australia). All except four women were in the fasting state. Cord blood samples were obtained from an independent cohort of newborns whose mothers were enrolled in a separate clinical trial at the National Institutes of Health. Results Ten of 13 amniotic fluid samples contained at least one NNS (ace-K, saccharin, steviol glucuronide, and/or sucralose). Maximum amniotic fluid NNS concentrations of ace-K, saccharin, steviol glucuronide, and sucralose were 78.9, 55.9, 93.5, and 30.6 ng/mL, respectively. Ace-K and saccharin were present in 100% and 80% of the cord blood samples, with maximal concentrations of 6.5 and 2.7 ng/mL, respectively. Sucralose was not detected and steviol glucuronide was not measurable in any of the cord blood samples. Conclusion Our results provide evidence of human transplacental transmission of NNS. Based on results predominantly obtained from rodent models, we speculate that NNS exposure may adversely influence the offsprings' metabolic health. Well-designed, prospective clinical trials are necessary to understand the impact of NNS intake during pregnancy on human development and long-term health. Key Points


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