Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117395

Elizabeth M. Armstrong, PhD, MPA, Woodrow Wilson School of Public and International Affairs, Princeton University, Office of Population Research, Wallace Hall, Princeton, NJ 08544, 609-258-6981, ema@princeton.edu

This paper examines the ways in which the perception and communication of risk are distorted in medical decision-making around pregnancy and delivery, to the detriment of the pregnant woman and often her fetus or infant as well. The paper considers three specific instances of such distorted decision-making: 1. medical management of non-obstetrical conditions (including both chronic conditions, such as maternal depression, and acute conditions, such as suspected appendicitis); 2. delivery decisions (including issues of VBAC, elective cesarean sections, and home birth); 3. decision-making around prenatal genetic screening and testing. Two problems arise in each context. First, instead of regarding available data as demarcating ranges of reasonable options within which women's values, preferences and needs (including their sense of what is best for the fetus) should hold sway, clinicians often regard clinically insignificant differences in risk as designating a univocal course of action, for directively counseling women or determining hospital policies (for example, regarding mode or location of delivery). Second, decisions are often driven by a narrow focus on risks to fetal well-being (for example, recommending that a pregnant woman stop taking antidepressants) without a full consideration of the ways in which fetal wellbeing in fact depends on maternal wellbeing. Moreover, in each instance, the evidence base for best practice is often ignored and women's autonomy may be seriously compromised. In this paper, we present an ethics framework for obstetrical practice that is both evidence-based and patient-centered.

Learning Objectives:

• • Identify three specific distortions of risk perception and communication in obstetrics.
  • Recognize the clinical and cultural determinants of risk distortion and the adverse consequences of such distortions for pregnant women and their fetuses.
  • Construct an evidence-based ethics framework for assessing and managing risk in obstetrics.

Keywords: Maternal and Child Health, Ethics

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.