Schantz Clémence, Lhotte Marie, Pantelias Anne-Charlotte
Sante Publique. 2020 September-December;32(5):497-505. doi: 10.3917/spub.205.0497.
In a legal context focused on the right and autonomy of the patient, some women wish to be able to choose their mode of childbirth. As midwives are primary care-givers for pregnant women with a physiological pregnancy, we wanted to find out whether it was ethically acceptable for them to accompany a woman in her decision to have a caesarean section.Purpose of research: This survey is an ancillary study of the CESARIA research program validated by the Comité de Protection des Personnes Sud Méditerranée IV and declared to the CNIL. Thirty-seven semi-directive interviews were conducted with midwives and women.
The majority of women and midwives share a vision of childbirth as “natural” and consider the request for caesarean section as a pathology. When formulated, this request places midwives in a situation of ethical tension. On the one hand, midwives wish to refer women to vaginal birth as the norm, and this choice embodies the ethical principles of beneficence and non-maleficence. On the other hand, midwives express a desire to respect patient choice and freedom, illustrating the ethical principle of respect for autonomy.
The ethical issue of caesarean section on demand lies not so much in the decision to accept or not to accept a caesarean section but rather in listening to the request. Taking into consideration a medical indication more broadly than the simple obstetrical indication makes it possible to ethically support these requests while respecting the pregnant woman’s autonomy.
在以患者权利和自主权为重点的法律背景下，一些女性希望能够选择自己的分娩方式。由于助产士是生理妊娠孕妇的主要护理人员，我们想了解她们陪伴女性做出剖宫产决定在伦理上是否可以接受。
本调查是由法国南部地中海地区第四保护人类委员会批准并向法国国家信息与自由委员会申报的CESARIA研究项目的一项辅助研究。我们对助产士和女性进行了37次半指导性访谈。
大多数女性和助产士都将分娩视为“自然的”，并将剖宫产请求视为一种病理情况。当提出这种请求时，会使助产士陷入伦理困境。一方面，助产士希望将阴道分娩作为常规推荐给女性，这种选择体现了有益和无害的伦理原则。另一方面，助产士表示希望尊重患者的选择和自由，这体现了尊重自主权的伦理原则。
按需剖宫产的伦理问题不在于是否接受剖宫产的决定，而在于倾听请求。比单纯的产科指征更广泛地考虑医学指征，能够在尊重孕妇自主权的同时，从伦理上支持这些请求。
