gms | German Medical Science

4th International Conference of the German Society of Midwifery Science (DGHWi)

Deutsche Gesellschaft für Hebammenwissenschaft e. V.

16.02.2018, Mainz

“Caesarean delivery on maternal request” between the poles of autonomy and heteronomy

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  • corresponding author Yvonne Gacki - University of Applied Sciences (Hochschule für Gesundheit), Bochum, Germany
  • Ute Lange - University of Applied Sciences (Hochschule für Gesundheit), Bochum, Germany

German Association of Midwifery Science. 4th International Meeting of the German Association of Midwifery Science (DGHWi). Mainz, 16.-16.02.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc18dghwiP08

doi: 10.3205/18dghwi14, urn:nbn:de:0183-18dghwi149

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/meetings/dghwi2018/18dghwi14.shtml

Published: February 13, 2018

© 2018 Gacki et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: In the mid-1990s, the term of “caesarean delivery on maternal request” (“CDMR”) occurs in German literature for the first time. Since then, the term has become popular on an international scale and is often associated with autonomy or heteronomy. Within the appearance of “women’s requests” also “patient autonomy” has been established as key concept. This development meant a changed representation of the childbearing women as a subject. This evolution was related to an increased responsibility of women especially in decision making. Due to a lack of a uniform, clear definition of “CDMR” in Germany, but also worldwide, valid statistic research seems difficult to establish. Moreover, findings show that a “choice” even does not appear as an appropriate notion to childbearing women [1], [2]. In Germany, present findings indicate a rate of “CDMR” of two to three per cent at most, what thus means to be a marginal problem. Even though, this phenomenon is paid particular attention, which makes it even more interesting to analyze the reasons for this development. At this point, the existent correlation of autonomy and “CDMR” seem to be central to this debate, further, it creates a competitive relationship between women as subjects and evidence. Thus, in this contradictory situation models of decision-making and ethics try to operate in a guiding way. A mostly individual-centered theoretical approach that focus women as rational acting individuals cannot describe adequately “CDMR” between the poles of autonomy and heteronomy.

Methods: The present work aims at analyzing the conceptualization of the subject in research on “CDMR” between the poles of autonomy and heteronomy. It particularly focusses the perspectives of autonomy, decision making as well as the problematic use of “choice”. In order to do so, the paper uses the method of a meta-analytical review of qualitative research that focusses women’s perspective on the phenomenon of “CDMR”.

Findings: Except for one of the six included studies, childbearing women who “choose” “CDMR” are described as determined due to cultural, social, physical and structural influences [3], [4]. At the same time these women are represented as rational acting, autonomous individuals choosing “CDMR”. Only one study adjusts in case of “CDMR” an absolute autonomy and responsibility and illustrates decision-making as a process of interaction neither rational nor comparable to a market logic [5]. Regarding the term “maternal request” the chosen studies all notice difficulties referring to the conceptual meaning of “CDMR” but only two studies get to reflecting on the semantics of “CDMR” [3], [4].

Conclusion/Discussion: In conclusion, self-determination, decision making and “choice” define the continuum between autonomy and heteronomy. This generally evokes conflicts and challenges in research and practice. Specifically, it causes a dilemma between autonomy and evidence and implements the woman’s absolute responsibility. The unquestioned use of “CDMR” demands further research that defines “CDMR” in a more integrated way. Moreover, intertwined theories of subject and human action, not only from an individualized or structuralized point of view, are needed to improve further research on the phenomenon of “CDMR”.

Ethical criteria and conflict of interests: The research / project was not submitted to an ethics committee for the following reasons: Review. It was financed from own resources. There is no conflict of interest.


References

1.
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