This article presents some of the findings from the original research carried out with asylum seeking and refugee women in Ireland who were pregnant or who had recently given birth. The explosion in numbers in Ireland from 1998 onwards has been such that this group now comprises more than one in five of every birth in the country's three major maternity hospitals, all based in Dublin. The article explores the background reasons for the major increase in recent years of (...) this group of women. It discusses the difficult circumstances encountered by women who must engage with a system of maternity care unused to such complex needs, amidst a general policy climate of uncertainty and even hostility towards asylum seekers. The research findings contribute to the feminist literature on maternity and challenge us to examine the way in which globalization is impacting on women as mothers and the need for challenging Western states anew on the development of a more coherent model of maternity care in response to the needs of such women. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in (...) class='Hi'>maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds (...) in philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

Background Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them. Method For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' (...) perceptions of RMC written between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined. Result There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives’ conceptualizations of RMC, Midwives commitment to woman’s rights, The value and impact of RMC to midwives, Midwife’s perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives’ recommendations for optimal RMC practice. Conclusion In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required. (shrink)

Volume 20, Issue 3, March 2020, Page 88-90.

UK maternity policy makes great fanfare about providing person-centered care, built around what the pregnant woman or birthing person needs. Maternity Voices Partnerships involving healthcare professionals and women are supposed to guide policy and practice at the local level. UK consent law prioritizes the pregnant person's own conception of the risks and factors that are material to her care. The COVID-19 pandemic has shown how tenuous a hold these laudable principles actually have when the going gets (...) tough. (shrink)

This paper critically analyses ‘the paradox of autonomy and consent in maternity care’. It argues that maternity care has certain features that increase the need for explicit attention to, and respect for, both autonomy and rigorous informed consent processes. And, moreover, that the resulting need is considerably greater than in almost all other areas of medicine. These features are as follows: (1) maternity care involves particularly socially sensitive body parts that are regularly implicated in (...) consent‐centred procedures, as well as in unconsented interventions, in ordinary, non‐medical life; and (2) much of maternity care (especially intervening in childbirth) is medically unique, in that it harms one patient (the mother) not primarily for the promotion of her own health but for the benefit of another (the baby). The apt comparison, within medicine, is therefore with non‐therapeutic research and transplantation medicine—both of which have elevated consent requirements characterized by very rigorous consent processes. At the same time—and this delivers the titular paradox—the importance of autonomy and consent in maternity care is at particular risk of being denied or disregarded. Jointly, these considerations make a very strong case for change: attention to and respect for autonomy and consent should be (1) core values; (2) key points of practical attention in the years ahead; and (3) central quality indicators in maternity care. (shrink)

In this article, the authors use the context of childbirth to consider the power that is endemic in certain forms of evidence within maternity care research. First, there is consideration of how the current evidence hierarchy and experimental‐based studies are the gold standard to determine and direct women's maternity experiences, although this can be at the detriment of care and irrespective of women's needs. This is followed by a critique of how the predominant means to assess (...) women's experiences via satisfaction surveys is of limited utility, offering impartial and restricted insights to assess the quality of care provision. A counter position of hermeneutic phenomenology as research method is then described. This approach offers an alternative perspective by penetrating the taken‐for‐granted ordinariness of an event (such as childbirth) to elicit rich emic meanings. Whilst all approaches to understanding maternity care have a place, depending on the question(s) being asked, the contribution of phenomenology is how it can uncover a depth of contextual understanding into what matters to women and to inform and transform care delivery. (shrink)

Despite the entrenched acceptance of normal science in health care, it appears that authoritative, positivist, linear, risk averse, certainty-based thinking can only get us so far along the route of optimum health. This paper examines labor and childbirth as a paradigm case of a complex adaptive system (CAS) and offers the example of techniques used in a master-level course on normal childbirth to illustrate how maternity care clinicians can be introduced to complexity-based thinking through reflexive analysis of (...) real life clinical narratives. It suggests that these techniques might be used as a basis for answering the question, what is likely to work for this person, in this situation, given the range of evidence, and given their values and beliefs, my values and beliefs, and my clinical skills and knowledge? Topics discussed in this paper include complexity, pregnancy, and childbirth; mainstreaming complexity-focused decision making in maternity care; and using story in practice. In conclusion, complexity theory appears to offer a good explanatory model for pregnancy and childbirth, both in general, and for specific individuals. Future work in this area should examine the efficacy and limits to formal story telling in maternity care, with the aim of increasing optimal maternity care for mothers and babies, and for the staff and organizations that deliver the care. (PsycINFO Database Record (c) 2010 APA, all rights reserved). (shrink)

FOSTER J, CHIANG F, HILLARD RC, HALL P and HEATH A. Nursing Inquiry 2010; 17: 309–316 Team process in community‐based participatory research on maternity care in the Dominican RepublicA cross‐cultural team consisting of US trained academic midwife researchers, Dominican nurses, and Dominican community leaders have partnered in this international nursing and midwifery community‐based participatory research (CBPR) project in the Dominican Republic to understand the community experience with publicly funded maternity services. The purpose of the study was to (...) understand community perceptions of maternity services. This article highlights the activities that the research team carried out during each phase of the research process, and how they established team identity, team trust, and team efficacy. This research has created a platform for new avenues for health providers and community to partner to improve maternal‐newborn care. Community‐based participatory research is one way forward to address the past and present inequities constitutive of global health disparities. (shrink)

Adversities in pregnancy, including poor diet and stress, are associated with increased risk of developing both metabolic and mental health disorders later in life, a phenomenon described as fetal programming or developmental origins of disease. Predominant hypotheses proposed to explain this relationship suggest that the adversity imposes direct changes to the developing fetus which are maintained after birth resulting in an increased susceptibility to ill health. However, during pregnancy the mother, the developing fetus, and the placenta are all exposed to (...) the adversity. The same adversities linked to altered offspring outcome can also result in suboptimal maternal care, which is considered an independent adverse exposure for the offspring. Recent key experiments in mice reveal the potential of prenatal adversity to drive alterations in maternal care through abnormal maternal–pup interactions and via alterations in placental signaling. Together, these data highlight the critical importance of viewing fetal programming holistically paying attention to the intimate, bidirectional, and reiterative relationship between mothers and their offspring. (shrink)

Fetal and Maternal Bodies brings together the voices of abortion providers, abortion counselors, clinic owners, neonatologists, bioethicists, and historians to discuss how and why providing abortion care is moral work. The collection offers voices not usually heard as clinicians talk about their work and their thoughts about life and death. In four subsections--Providers, Clinics, Conscience, and The Fetus--the contributions in this anthology explore the historical context and present-day challenges to the delivery of abortion care. Contributing authors address the (...) motivations that lead abortion providers to offer abortion care, discuss the ways in which anti-abortion regulations have made it increasingly difficult to offer feminist-inspired services, and ponder the status of the fetus and the ethical frameworks supporting abortion care and fetal research. Together these essays provide a feminist moral foundation to reassert that abortion care is moral work. (shrink)

Both patterns of maternal sensory signals and sensitive care have shown to be crucial elements shaping child development. However, research concerning these aspects of maternal care has focused mainly on maternal sensitivity with fewer studies evaluating the impact of patterns of maternal behaviors and changes in these indices across infancy and childhood. The aims of this study were to explore how maternal unpredictability of sensory signals and sensitivity develop and associate with each other from infancy to toddlerhood and (...) whether elevated maternal depressive and anxiety symptoms relate to maternal unpredictable signals and sensitivity in toddlerhood. The study population consisted of 356 mother–child dyads assessed at 30 months; a subset of 103 mother–child dyads additionally participated in 8 months assessment. Maternal unpredictability and sensitivity were assessed from video-recorded free-play episodes at 8 and 30 months. Maternal depressive and anxiety symptoms were assessed with questionnaires at gestational weeks 14, 24, 34 and 3, 6, 12, and 24 months. Mean level of mothers’ unpredictability decreased on average whereas sensitivity did not change between infancy and toddlerhood. Both maternal unpredictability and sensitivity showed moderate level of individual stability from infancy to toddlerhood and these two measures were modestly correlated within each age. Elevated maternal depressive and anxiety symptoms were not related to unpredictability but related to lower maternal sensitivity in toddlerhood. These results identify unpredictable sensory signals as a characteristic of parental care that is independent of standard quality measures and suggest that it may be less influenced by maternal depressive and anxiety symptoms. (shrink)

The socioeconomic and ethnic characteristics of parents are some of the most important correlates of adverse health outcomes in childhood. However, the relationships between ethnic, economic, and behavioral factors and the health outcomes responsible for this pervasive finding have not been specified in child health epidemiology. The general objective of this paper is to propose a theoretical approach to the study of maternal behaviors and child health in diverse ethnic and socioeconomic environments. The specific aims are: (a) to describe a (...) causal pathway between the utility that women obtain through work outside the home and through child care and disease hazard rates in childhood using an optimization model; (b) to specify the influence of ethnic and socioeconomic factors on model constraints; (c) to use the model as a tool to learn about how different combinations of maternal wage labor and child care time might influence child health outcomes in diverse social contexts; (d) to identify parameters that will require measurement in future research; (e) to discuss research strategies that will enable us to obtain these measurements; and (f) to discuss the implications of the model for biostatistical modeling and public health intervention. Optimization models are powerful heuristic tools for understanding how ethnic, environmental, family, and personal characteristics can place important constraints on both the quality and quantity of care that women can provide to their children. They provide a quantitative appreciation for the difficult trade-offs that most women face between working in order to purchase basic goods that children cannot do without (e.g., food, clothing, shelter, health insurance), and increasing offspring well-being through child care (e.g., training in social skills, affection, protection from environmental hazards, help with homework). (shrink)

This book exploits the power of phenomenological methods to access and describe lived moral experiences of pain and suffering for patients, their families and the wider community. Creating new fields of communication for patients, their family members and health professionals in shared decision making processes, this book builds on knowledge about suffering to help and guide correct action in preventing and relieving chronic pain and improving systems of care. It offers a new phenomenology for understanding moral experience in serious (...) illness and suffering, and its implication for policy, practice and research. A series of applied chapters, looking at individual experiences of suffering and care experiences, present some areas of ethical inquiry, including: pain and suffering maternal care ethics evaluation and moral deliberation about treatment options decision-making and moral agency end-of-life experiences of care. Exploring how moral phenomenology could provide fruitful alternatives to traditional frameworks in bioethics, this is an important addition to the literature. It will be of interest to scholars and students of bioethics and phenomenological methods in the health and human services. (shrink)

It has been shown that various types of stress initiate different physiological and neuroendocrine disorders. Oxytocin is mainly produced in the supraoptic nucleus and paraventricular nucleus of the hypothalamus. Hypothalamic OT has antistress effects and attenuates the hypothalamic–pituitary–adrenal axis. One mechanism behind the antistress effects of OT is mediated through the inhibition from GABAA receptors on corticotropin-releasing factor expression at the PVN. Various manual therapies such as acupuncture, transcutaneous electrical nerve stimulation, and massage initiate the stimulation of somatosensory neurons of (...) the body. It is well-known that TENS simulates OT expression, while it inhibits CRF expression at the PVN following chronic stress loading in rodents. Upregulation of OT expression at the hypothalamus is activated by the somatosensory stimulation, which is mediated via the spinothalamic pathway. Thus, somatosensory stimulation is beneficial in treating stress-associated symptoms. Hypothalamic OT is associated with the social behaviors, including maternal care and affiliation. Childhood neglect and/or child abuse are severely responsible for deleterious long-term effects on the cognitive/social activity and behavioral development. At parturition, a profound amount of OT is released into the systemic circulation in response to vaginal and cervical stimulation caused by the body of fetus, which induces the onset of maternal behavior. Peridural anesthesia effectively impairs the sensitivity to vaginal and cervical stimulation at parturition. OT levels in cerebrospinal fluid is significantly reduced following peridural anesthesia. The vaginal delivery mothers had significantly more OT pulses than the caesarian section mothers. Due to low levels of endogenous OT, maternal behavior could be interrupted by epidural anesthesia and CS at parturition because of the reduction of the usual sensory input from the genitalia. (shrink)

Maternity careproviders often have strong views concerning a woman’s choice of where to give birth. These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should “count,” instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.

The design of medical knowledge-based computer systems requires effective interdisciplinary communication for the development of a community sharing common goals and a common language for design. Over the past 9 years the Perinatal Research Group, an interdisciplinary team of computer scientists, engineers and clinicians, have developed a prototype knowledge-based computer system to aid clinicians in the care of women in labour. The group were uncertain which approach to adopt to progress this system from a prototype to a useful clinical (...) tool to support decision making. A case study and activity theory analysis, of an existing clinical knowledge-based computer system in routine use, helped to resolve a number of communication and methodological issues that the design team encountered. Sharing of backgrounds and perspectives caused the design team to question previous assumptions and to explore alternative functions and roles for knowledge-based computer systems in maternity care. We are now undertaking a longitudinal case study and activity theory analysis of obstetric teams and women in labour to analyse the relationships between clinicians, patients and technology. This work will inform the development of our knowledge-based computer system to place the patient at the centre of the decision-making process. (shrink)

Differences in infant caregiving behavior between cultures have long been noted, although the quantified comparison of touch-based caregiving using uniform standardized methodology has been much more limited. The Parent-Infant Caregiving Touch scale was developed for this purpose and programming effects of early parental tactile stimulation on infant hypothalamic-pituitary adrenal -axis functioning, cardiovascular regulation and behavioral outcomes, similar to that reported in animals, have now been demonstrated. In order to inform future studies examining such programming effects in India, we first aimed (...) to describe and examine, using parametric and non-parametric item-response methods, the item-response frequencies and characteristics of responses on the PICTS, and evidence for cross-cultural differential item functioning in the United Kingdom and India. Second, in the context of a cultural favoring of male children in India, we also aimed to test the association between the sex of the infant and infant “stroking” in both cultural settings. The PICTS was administered at 8–12 weeks postpartum to mothers in two-cohort studies: The Wirral Child Health and Development Study, United Kingdom and the Bangalore Child Health and Development Study, India. Mokken scale analysis, parametric item-response analysis, and structural equation modeling for categorical items were used. Items for two dimensions, one for stroking behavior and one for holding behavior, could be identified as meeting many of the criteria required for Mokken scales in the United Kingdom, only the stroking scale met these criteria in the sample from India. Thus, while a comparison between the two cultures was possible for the stroking construct, comparisons for the other non-verbal parenting constructs within PICTS were not. Analyses revealed higher rates of early stroking being reported for the United Kingdom than India, but no sex differences in rates in either country and no differential sex difference by culture. We conclude that PICTS items can be used reliably in both countries to conduct further research on the role of early tactile stimulation in shaping important child development outcomes. (shrink)

Childbearing trans and nonbinary people are confronted with the heteronormative and cisgender frameworks that underpin “maternity” services. We explored the educational needs of 108 perinatal staff in the United Kingdom as related to the needs of trans and nonbinary service users. Participants were most confident in formulating care plans and least confident about the provision of colleagues’ perinatal care in this context. While the majority of participants were positive toward the trans and nonbinary communities, they considered that (...) those communities remain marginalized in perinatal services. Transphobic, anti-trans, and nonbinary attitudes were highlighted by our respondents. Our findings suggest that caregivers witnessed transphobia among colleagues and were apprehensive themselves about providing care to childbearing trans and nonbinary people. They reported a cisheteronormative model of care that lacked awareness of trans and nonbinary issues. The educational needs identified included information about the practicalities of childbearing as a trans or nonbinary person, how to use inclusive language effectively, and creating policies and processes for supporting childbearing trans and nonbinary people. These caregivers’ preferences included hearing from trans and nonbinary people and sharing best practices among themselves, with open discussions about how to be inclusive. (shrink)

This study explores the factors associated with neonatal mortality and maternal health care in Nepal. The subjects were 4375 births reported in the 1996 Nepal Family Health Survey. Maternal and child health care was found to have a significant association with neonatal mortality, although preceding birth interval and sex of child had stronger effects. Four aspects of maternal care were found to be highly associated with region, household ownership of assets, mothers education. This indicates that accessibility, affordability (...) and availability of maternal health care are important factors to consider in future research on neonatal mortality. (shrink)

Since the mid-1980s, there has been a gradual ethical drift in the provision of maternal care in African health facilities in general, and in Cameroon in particular, despite government efforts. In fact, in Cameroon, an increasing number of caregivers are reportedly not providing compassionate care in maternity services. Consequently, many women, particularly the financially vulnerable, experience numerous difficulties in accessing these health services. In this article, we highlight the unequal access to care in public maternity (...) services in Cameroon in general and the Noun Division in particular. For this study, in addition to documentary review, two qualitative data collection techniques were used: direct observation and individual interviews. Following the field work, the observation data were categorized and analyzed to assess their relevance and significance in relation to the topics listed in the observation checklist. Interviews were recorded using a dictaphone; they were subsequently transcribed and the data categorized and coded. After this stage, an analysis grid was constructed for content analysis of the transcripts, to study the frequency of topics addressed during the interviews, as well as divergences and convergences among the respondents. The results of this data analysis showed that money has become the driving force in service provision. As such, it is the patient’s economic capital that counts. Considered “clients”, pregnant women without sufficient financial resources wait long hours in corridors; some die in pain under the indifferent gaze of the professionals who are supposed to take care of them. In sharp contrast, the findings revealed that financially privileged patients are able to bribe caregivers to attract their favour and obtain prompt, careful, and effective care. These ethical abuses observed in the Noun public health facilities drive women to use, from the beginning of their pregnancies to the delivery, only healthcare delivered by traditional health attendants. (shrink)

A longitudinal perspective on motherhood that spans the experience of gestation, birthing, the care of young children, and the mother’s relation to her grown children makes way for a conception of the mother as essentially plural. It shall be argued in this paper that maternity is necessarily tied to surrogacy, that it is divided into a multiplicity of tasks inevitably parceled out to multiple agents. In this essay, the analysis of maternal surrogacy is focused on the phenomenon of (...) mothering from a distance, a maternal practice engendered by the feminization and globalization of labor markets. By both affirming the value of maternal surrogates and questioning the limits of surrogacy, this analysis of motherhood challenges both the economic exploitation that engenders and sustains distant mothering and the gendered division of care labor that supports the global economy of care. (shrink)

Anti-abortion proponents argue that a fetus holds the status of a person akin to healthy adult human beings. The fetus possesses inherent dignity and a fundamental right to life, which must be resp...

Cet article se propose d’analyser une source de l’administration coloniale en Gold Coast au début des années 1930. Rédigée par un responsable du Département médical, elle évoque le mécontentement d’une puis de plusieurs femmes médecins britanniques, affectées à des postes de Protection maternelle et infantile, c’est-à-dire une branche préventive de la médecine, qui les assigne à des tâches de care. Insatisfaites à la fois de leurs conditions de travail et de leurs salaires, ces doctoresses protestent par voie de pétition (...) contre cette affectation systématique en PMI et défient ainsi le consensus de l’époque, qui veut que les femmes aient à la fois des compétences particulières et une vocation naturelle pour ce domaine. (shrink)

In this provocative new book, renowned educator and philosopher Nel Noddings extends her influential work on the ethics of care toward a compelling objective—global peace and justice. She asks: If we celebrate the success of women becoming more like men in professional life, should we not simultaneously hope that men become more like women—in caring for others, rejecting violence, and valuing the work of caring both publicly and personally? Drawing on current work on evolution, and bringing concrete examples from (...) women’s lived experience to make a strong case for her position, Noddings answers this question by locating one source of morality in maternal instinct. She traces the development of the maternal instinct to natural caring and ethical caring, offering a preliminary sketch of what a care-driven concept of justice might look like. Finally, to advance the cause of caring, peace, and women’s advancement, Noddings urges women to abandon institutional, patriarchal religion and to seek their own paths to spirituality. (shrink)

The unpredictability of maternal sensory signals in caregiving behavior has been recently found to be linked with infant neurodevelopment. The research area is new, and very little is yet known, how maternal anxiety and depressive symptoms and specific parental characteristics relate to the unpredictable maternal care. The aims of the current study were to explore how pre- and postnatal maternal anxiety and depressive symptoms and self-regulation capacity associate with the unpredictability of maternal sensory signals. The study population consisted of (...) 177 mother-infant dyads. The unpredictability of the maternal sensory signals was explored from the video-recorded mother-infant free play situation when the infant was 8 months of age. Pre- and postnatal anxiety and depressive symptoms were measured by questionnaires prenatally at gwks 14, 24, 34, and 3 and 6 months postpartum. Maternal self-regulation capacity, a trait considered to be stable in adulthood, was assessed using adult temperament questionnaire when the infant was 12 months of age. We found that elevated prenatal maternal anxiety symptoms associated with higher unpredictability in the maternal care while depressive symptoms were unrelated to the unpredictability of maternal care. Moreover, the association was moderated by maternal self-regulation capacity, as higher anxiety symptoms during pre-and postnatal period were associated more unpredictability among the mothers with low self-regulation capacity. The combination of higher amount of maternal anxiety symptoms and lower self-regulation capacity seems to constitute specific risk for the unpredictable maternal care. (shrink)

We must reconceive the ethical relationship between mothers and their newborn babies. The intertwinement of mother and baby does not disappear with birth but rather persists in the form of postpartum maternal tethering. Drawing upon three years of ethnographic fieldwork and training in the United States and China, I argue that dependencies associated with postpartum maternal tethering make it extremely difficult for postpartum mothers to act autonomously, even in the relational sense. Breaching this tether opens up new possibilities for thinking (...) about the bioethics of vulnerability, dependency, and care by denaturalizing and desanctifying the mother-baby relationship and diversifying newborn care. (shrink)

Currently, many women who are expecting to give birth have no option but to attempt vaginal delivery, since access to elective planned caesarean sections (PCS) in the absence of what is deemed to constitute ‘clinical need’ is variable. In this paper, we argue that PCS should be routinely offered to women who are expecting to give birth, and that the risks and benefits of PCS as compared with planned vaginal delivery should be discussed with them. Currently, discussions of elective PCS (...) arise in the context of what are called ‘Maternal Request Caesarean Sections’ (MRCS) and there is a good deal of support for the position that women who request PCS without clinical indication should be provided with them. Our argument goes further than support for acceding to requests for MRCS: we submit that healthcare practitioners caring for women with uncomplicated pregnancies have a positive duty to inform them of the option of PCS as opposed to assuming vaginal delivery as a default, and to provide (or arrange for the provision of) PCS if that is the woman's preferred manner of delivery. (shrink)

Ample research links mothers’ postpartum depression (PPD) to adverse interactions with their infants. However, most studies relied on general population samples, whereas a substantial number of women are at elevated depression risk. The purpose of this study was to describe mothers’ interactions with their 6- and 12-month-old infants among women at elevated risk, although with a range of symptom severity. We also identified higher-order factors that best characterized the interactions and tested longitudinal consistency of these factors from 6 to 12 (...) months of infant age. We leveraged data from eight projects across the United States (n = 647), using standardized depression measures and an adaptation of the NICHD Mother-Infant Interaction Scales. Overall, these depression-vulnerable mothers showed high levels of sensitivity and positive regard and low levels of intrusiveness, detachment, and negative regard with their infants. Factor analyses of maternal behaviors identified two overarching factors—“positive engagement” and “negative intrusiveness” that were comparable at 6 and 12 months of infant age. Mothers’ ability to regulate depressed mood was a key behavior that defined “positive engagement” in factor loadings. An exceptionally strong loading of intrusiveness on the second factor suggested its central importance for women at elevated depression risk. Mothers with severe depressive symptoms had significantly more “negative intrusiveness” and less “positive engagement” with their 6-month-old infants than women with moderate or fewer depressive symptoms, suggesting a potential tipping point at which symptoms may interfere with the quality of care. Results provide the foundation for further research into predictors and moderators of women’s interactions with their infant among women at elevated risk for PPD. They also indicate a need for evidence-based interventions that can support more severely depressed women in providing optimal care. (shrink)

In this book, Alison Stone develops a feminist approach to maternal subjectivity. Stone argues that in the West the self has often been understood in opposition to the maternal body, so that one must separate oneself from the mother and maternal care-givers on whom one depended in childhood to become a self or, in modernity, an autonomous subject. These assumptions make it difficult to be a mother and a subject, an autonomous creator of meaning. Insofar as mothers nonetheless strive (...) to regain their subjectivity when their motherhood seems to have compromised it, theirs cannot be the usual kind of subjectivity premised on separation from the maternal body. Mothers are subjects of a new kind, who generate meanings and acquire agency from their position of re-immersion in the realm of maternal body relations, of bodily intimacy and dependency. Thus Stone interprets maternal subjectivity as a specific form of subjectivity that is continuous with the maternal body. Stone analyzes this form of subjectivity in terms of how the mother typically reproduces with her child her history of bodily relations with her own mother, leading to a distinctive maternal and cyclical form of lived time. (shrink)

In this book, Alison Stone develops a feminist approach to maternal subjectivity. Stone argues that in the West the self has often been understood in opposition to the maternal body, so that one must separate oneself from the mother and maternal care-givers on whom one depended in childhood to become a self or, in modernity, an autonomous subject. These assumptions make it difficult to be a mother and a subject, an autonomous creator of meaning. Insofar as mothers nonetheless strive (...) to regain their subjectivity when their motherhood seems to have compromised it, theirs cannot be the usual kind of subjectivity premised on separation from the maternal body. Mothers are subjects of a new kind, who generate meanings and acquire agency from their position of re-immersion in the realm of maternal body relations, of bodily intimacy and dependency. Thus Stone interprets maternal subjectivity as a specific form of subjectivity that is continuous with the maternal body. Stone analyzes this form of subjectivity in terms of how the mother typically reproduces with her child her history of bodily relations with her own mother, leading to a distinctive maternal and cyclical form of lived time. (shrink)

There has been increased interest in the potential of maternal immunisation to protect maternal, fetal, and infant health. Maternal tetanus vaccination is part of routine antenatal care and immunisation campaigns in many countries, and it has played an important part in the reduction of maternal and neonatal tetanus. Additional vaccines that have been recommended for routine maternal immunisation include those for influenza and pertussis, and other vaccines are being developed. Maternal immunisation is controversial since regulators, professionals, and the public (...) are often reluctant to accept pharmaceutical interventions during pregnancy. So far, little attention has been given to the ethics of vaccination during pregnancy. In this Personal View we argue that maternal immunisation should be offered in response to concrete, severe risks of disease for mother and child, and we explain how this requirement of serious risk can be used to guide ethical decision-making about maternal immunisation. (shrink)