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Moral implications of obstetric technologies for pregnancy and motherhood

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Abstract

Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a “good” pregnant woman and to be a “good” (future) mother. Activities in the medical field of reproduction contribute to “kinning”, that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: (1) informed consent in prenatal care, (2) obstetric sonogram, and (3) birth plan. Their widespread application is supposed to serve the moral (and legal) goal of effecting patient autonomy (and patient right). A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework.

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Notes

  1. Sonogram enables also the future father to make visual contact with the fetus. Since the fetus is constituted as a subject separated from the woman and as a being in need of protection, the future father might feel more involved and responsible for the well-being of the fetus. This is a novel situation because it facilitates the possibility of a felt engagement of the future father with the fetus. However, there still exist double standards for “responsible parenting” and “duty to assist” for the man and the woman, especially in the USA where court-ordered caesarian deliveries are known, but no court-ordered duty exists for a father, e.g. to donate a rein to his child (Little 1996: 395).

  2. This fits well to a “risk society” (Beck 1986), “a modern culture characterized by pervasive anxiety about and efforts to ´colonize´ the future (Giddens 1991) […] ‘so risks are a kind of virtual, yet real, reality’ (Beck 1998: 11)” (Wolf 2007: 612).

  3. There are certainly limits to flexibility here. The Obstetrics and Gynecology Risk Research Group convincingly argues, for instance, that cesarean delivery on maternal request would not ultimately serve the goal of ensuring autonomy to laboring women (Kukla et al. 2009; Little et al. 2008; Lyerly et al. 2007, 2009; Lyerly and Little 2010). Their argument is that such requests would lead to shifting cultural norms and medical standards towards cesarean, so that ultimately it would become harder to facilitate vaginal deliveries (Little et al. 2008). Such a medical mode of child birth would also give way to a normalization of child birth as a surgical process in spite of better knowledge about health risks associated with surgical delivery (Bergeron 2007; Mander 2007; Nilstun et al. 2008). Obstetric skills and knowledge would also be lost, e.g. for vaginal birth of fetus in breech presentation, if caesarians were more routinely performed. Because of these consequences the right to cesarean on demand is widely contested by ethicists.

  4. For trying to balance harms and benefits of ultrasound cf. McCullough and Chervenak (1994: 201–206).

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study was funded by Lichtenberg-Kolleg: The Göttingen Institute for Advanced Study in the Humanities & Social Sciences, University of Goettingen, Germany (Fellow-in-Residence 2011). This article does not contain any studies with human participants or animals performed by any of the authors.

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  1. Institute for Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland

    Susanne Brauer

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  1. Susanne Brauer
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Brauer, S. Moral implications of obstetric technologies for pregnancy and motherhood. Med Health Care and Philos 19, 45–54 (2016). https://doi.org/10.1007/s11019-015-9635-8

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