Jenkinson Bec, Gray Lyndel, Sketcher-Baker Kirstine, Kimble Rebecca
Maternity Consumer Representative, Brisbane, Queensland, Australia.
Australian Women and Girls Health Research Centre, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2025 Apr;65(2):243-247. doi: 10.1111/ajo.13889. Epub 2024 Sep 27.
Choice, a fundamental pillar of woman-centred maternity care, depends in part on the right to decline recommended care. While professional guidance for midwives and obstetricians emphasises informed consent and respect for women's autonomy, there is little guidance available to clinicians or women about how to navigate maternity care in the context of refusal.
To describe the process and outcomes of co-designing resources to support partnership between the woman who declines recommended maternity care and the clinicians and health services who provide her care.
Following a participatory co-design process involving consumer representatives, obstetricians, midwives, maternal fetal medicine specialists, neonatologists, health service executives, and legal and ethics experts, implementation of the resources was trialled in seven Queensland Health services using Improvement Science's Plan-Do-Study-Act cycles.
Resources for Partnering with the woman who declines recommended maternity care have now been implemented statewide, in Queensland, including a guideline, two consumer information brochures (available in 11 languages), clinical form, flowcharts, consumer video, clinician education, and culturally capable First Nations resources. Central to these resources is an innovative shared clinical form, that is accessible online, may be initiated and carried by the woman, and where she can document her perspective as part of the clinical notes.
Queensland is the first Australian jurisdiction, and perhaps internationally, to formally establish this kind of guidance in clinical practice. Such guidance is identified as an enabler of choice in the national Australian strategy Woman-centred care: Strategic directions for Australian maternity services.
选择是以人为本的孕产妇护理的一个基本支柱，部分取决于拒绝推荐护理的权利。虽然针对助产士和产科医生的专业指南强调知情同意和尊重妇女的自主权，但对于临床医生或妇女而言，几乎没有关于如何在拒绝的情况下应对孕产妇护理的指导。
描述共同设计资源的过程和结果，以支持拒绝推荐孕产妇护理的妇女与提供护理的临床医生和卫生服务机构之间的合作关系。
在一个参与式共同设计过程中，消费者代表、产科医生、助产士、母胎医学专家、新生儿科医生、卫生服务管理人员以及法律和伦理专家参与其中。使用改进科学的计划-执行-研究-行动循环，在昆士兰卫生服务机构的七个部门对这些资源的实施情况进行了试验。
昆士兰州现已在全州范围内实施了与拒绝推荐孕产妇护理的妇女合作的资源，包括一份指南、两份消费者信息手册（有11种语言版本）、临床表格、流程图、消费者视频、临床医生教育以及具有文化能力的原住民资源。这些资源的核心是一种创新的共享临床表格，可在线获取，可由妇女发起并携带，她可以在其中记录自己的观点作为临床记录的一部分。
昆士兰州是澳大利亚首个，或许在国际上也是首个在临床实践中正式确立此类指导的司法管辖区。此类指导在澳大利亚国家战略《以人为本的护理：澳大利亚孕产妇服务的战略方向》中被确定为选择的促进因素。
