Villarmea Stella, Kelly Brenda
Department of Philosophy, University of Oxford, Oxford, UK.
Department of Philosophy, University of Alcala, Madrid, Spain.
J Eval Clin Pract. 2020 Apr;26(2):515-519. doi: 10.1111/jep.13375.
RATIONALE, AIMS, AND OBJECTIVES: The benefits for shared decision-making (SDM) in delivery of high-quality and personalized care are undisputed, but what is it about the dynamics of the delivery room that leads some to doubt that true SDM is possible? How difficult can it be to establish SDM as the norm when caring for a woman in labour? The discussion around SDM, autonomy, and rationality is timely and highly relevant to wider practice.
The concept of a person's autonomy in decision-making about their body and health is generally accepted and is indeed enshrined in law in many countries. This ought to lay the foundation for SDM in obstetrics. Yet, women's experience speaks to an uncomfortable truth, namely, that it is far from commonplace. We are interested in exploring this tension between the law and the practice.
We examine a theory of female rationality and its application to women in labour, and juxtapose this with the view from the front line of care delivery. Is a woman in labour able to fully engage in an SDM process? In answering this question, associations in the discourses and practises around women's capacity during labour are revealed, which act as barriers, consciously or unconsciously, to establishing SDM as the norm in obstetrics and midwifery.
CONCLUSION(S): The recent UN report advocating a human rights-based approach to end mistreatment and violence against women in reproductive health services has a particular focus on childbirth and obstetric violence. This paper contributes to the recognition of obstetric violence as a human rights violation. It offers conceptual tools to diagnose the impact of gender stereotypes during childbirth and to eliminate women's discrimination in the field of reproductive health.
原理、目的和目标：共享决策（SDM）在提供高质量和个性化护理方面的益处是无可争议的，但产房的动态环境中究竟是什么导致一些人怀疑真正的共享决策是否可行？在护理分娩妇女时，将共享决策确立为规范会有多难？围绕共享决策、自主性和合理性的讨论恰逢其时，且与更广泛的实践高度相关。
个人在身体和健康决策方面的自主性概念已被普遍接受，并且在许多国家确实已写入法律。这本应为产科中的共享决策奠定基础。然而，女性的经历揭示了一个令人不安的事实，即这远非常态。我们有兴趣探索法律与实践之间的这种矛盾。
我们研究了女性合理性理论及其在分娩妇女中的应用，并将其与护理一线的观点并列。分娩中的女性能够充分参与共享决策过程吗？在回答这个问题时，揭示了围绕女性分娩时能力的话语和实践中的关联，这些关联有意或无意地成为在产科和助产中将共享决策确立为规范的障碍。
联合国最近倡导基于人权的方法来消除生殖健康服务中对妇女的虐待和暴力的报告特别关注分娩和产科暴力。本文有助于将产科暴力确认为侵犯人权行为。它提供了概念工具，以诊断分娩期间性别刻板印象的影响，并消除生殖健康领域对妇女的歧视。
