Finding autonomy in birth

Bioethics. 2009 Jan;23(1):1-8. doi: 10.1111/j.1467-8519.2008.00677.x.


Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications--and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cesarean Section / adverse effects
  • Cesarean Section / ethics*
  • Cesarean Section / psychology*
  • Choice Behavior*
  • Cooperative Behavior
  • Dissent and Disputes
  • Elective Surgical Procedures / ethics
  • Elective Surgical Procedures / psychology
  • Female
  • Health Services Accessibility / ethics
  • Humans
  • Negotiating / psychology
  • Patient Education as Topic
  • Patient Participation* / psychology
  • Personal Autonomy*
  • Physician-Patient Relations / ethics
  • Pregnancy
  • Reproductive Rights* / ethics
  • Reproductive Rights* / psychology
  • Safety Management / ethics