PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 2
ETHICAL CONSIDERATIONS IN PRE AND PERINATAL
EDUCATION
-Shivakumar
Belavadi, PPNE, Bangalore, India
TOPIC -
Identify
and discuss at least two ethical issues facing the pre and perinatal psychology
educator. Give examples of how these issues can rise up in the process of
education, and how they can be addressed.
I am
outlining two issues which have come up in the context of my engagements with parents
at the Prenatal Stage (in the course of Pregnancy) in India. I am considering
myself ‘as a PPNE’, since I have been taking up similar engagements over the
years.
A. Where the Parent(s) seek the advice of a PPNE on a
medical opinion given by the consulting Obstetrician.
It is
common in India for expecting parents to seeking information and opinions from
multiple sources. A typical scenario is in the case of pregnant women/parents
who first consult with their regular doctor (Obstetrician) and subsequently seek
the Guidance of PPNE on what action they should take.
As a
PPNE, I first recognise that the area in which a PPNE operates is primarily of
sharing information leading to education of the listener. A PPNE is not a
therapist and does not possess medical knowledge and skills of a licensed
medical practitioner or a professional Obstetrician. As a first step I
recognize my limits.
At a
secondary level, there is an element of trust between the consulting
Obstetrician and the pregnant lady. Any words spoken by a PPNE which disturbs
or shakes the trust between a doctor and patient, should be avoided.
That
said the PPNE, also stands in a position of trust as the parent/pregnant lady
is seeking guidance. This becomes even more relevant where the words of the
obstetrician seem to be coming a notch below the expected level of knowledge of
a practicing professional. A case in instance would be where the pregnant lady
is routinely advised to take medication for Gestational Diabetes or
Hypertension. In such situations, I as a PPNE do know that medication should
not be the first recourse.
To
bestow the sense of autonomy and choice to the parents, I inform them that now there
is a respected and recognized body of knowledge that speaks of minimal medication,
especially for Gestational Diabetes or Hypertension. I give them reference of
the writings / works of senior medical professionals including obstetricians
and gynaecologists. These infuse a sense of dignity for the parent & child
and the parents develop a sense of respect for natural processes.
I
suggest to them that they should revisit their consulting Obstetrician with
this information and seek guidance from them. More often than not, I have seen
that when the empowered parents revisit the obstetrician, it improves the
relationship between them and irrespective of the final advice given by the
doctor. In some cases , it has also avoided unnecessary medication being given
to the pregnant lady. Where medically necessary, the parent is always informed
that the guidance of the obstetrician should prevail.
B. Where a pregnant lady begins to consult at a Hospital/Provider
where there is a well-known predisposition for performing C section deliveries.
There
are certain hospitals/providers in India where over 80% of pregnancy cases result
in Caesarean deliveries. When I as the
PPNE becomes aware that the pregnant woman is going to such a provider- an
ethical dilemma comes up on further course of action.
In India,
in cities the concept of midwifery/doulas/birthing centres are almost
non-existent. It is routine for pregnant women to begin the process of
consulting at a Hospital or Nursing homes as they are called in India and
finally admit themselves at the same place in the final stage of pregnancy when
they are about to deliver the baby.
Again
the PPNE is not the competent person to guide a pregnant woman on the choice of
a doctor/provider. That is respecting the pregnant woman’s choice and autonomy.
However, Integrity and responsibility would expect that the situation be
considered in a wider perspective.
The
system of taking ‘informed consent’ is observed more in breach than in
observance by the providers/hospitals in India. This is patently unfair and
unlawful, but a common practice in India. In many ways it demeans the autonomy
of the parent who visits the provider.
In such
a scenario, where hospitals / providers are known to perform a disproportionate
number of C sections, it may be necessary for the PPNE to educate the pregnant
woman/parents on the benefits of normal delivery and also mention the
alternative providers they may approach. This will obviously be easier to handle
earlier in the course of pregnancy.
It may
be a good point to mention of 3 or 4 alternate providers whose statistical
record of C section and normal deliveries are well known. This is done to
provide the parents with choice and also avoid any imputation of bias or undue
favouring.
