Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care

Jenkinson, Bec, Kruske, Sue, Stapleton, Helen, Beckmann, Michael, Reynolds, Maree and Kildea, Sue (2016) Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care. Women and Birth, 29 6: 531-541. doi:10.1016/j.wombi.2016.05.005


Author Jenkinson, Bec
Kruske, Sue
Stapleton, Helen
Beckmann, Michael
Reynolds, Maree
Kildea, Sue
Title Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care
Journal name Women and Birth   Check publisher's open access policy
ISSN 1871-5192
1878-1799
Publication date 2016-06-08
Sub-type Article (original research)
DOI 10.1016/j.wombi.2016.05.005
Open Access Status Not yet assessed
Volume 29
Issue 6
Start page 531
End page 541
Total pages 11
Place of publication Amsterdam, Netherlands
Publisher Elsevier BV
Collection year 2017
Language eng
Formatted abstract
Problem/Background: Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied.

Aim: To document the perspectives of women, midwives and obstetricians following the introduction of a structured process (Maternity Care Plan; MCP) to document refusal of recommended maternity care in a large tertiary maternity unit.

Methods: A qualitative, interpretive study involved thematic analysis of in-depth semi-structured interviews with women (n = 9), midwives (n = 12) and obstetricians (n = 9).

Findings: Four major themes were identified including: 'Reassuring and supporting clinicians'; 'Keeping the door open'; 'Varied awareness, criteria and use of the MCP process' and 'No guarantees'.

Conclusion: Clinicians felt protected and reassured by the structured documentation and communication process and valued keeping women engaged in hospital care. This, in turn, protected women's access to maternity care. However, the process could not guarantee favourable responses from other clinicians subsequently involved in the woman's care. Ongoing discussions of risk, perceived by women and some midwives to be pressure to consent to recommended care, were still evident. These limitations may have been attributable to the absence of agreed criteria for initiating the MCP process and fragmented care. Varying awareness and use of the process also diminished women's access to it.
Keyword Hospitals, maternity
Treatment refusal
Personal autonomy
Refusal to treat
Professional autonomy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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Created: Sat, 29 Oct 2016, 05:35:46 EST by Mike Beckmann on behalf of Obstetrics & Gynaecology - Mater Hospital