The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We (...) propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles. (shrink)

In April 2004 the Irish Government commissioned Judge Maureen Harding Clark to compile a report to ascertain the rate of caesarean hysterectomies at Our Lady of Lourdes Hospital in Drogheda, Republic of Ireland. The report came about as a result of complaints by midwives into questionable practices that were mainly (but not solely) attributed to one particular obstetrician. In this article we examine the findings of this Report through a feminist lens in order to explore what a feminist reading of (...) the Report and the events that led to the inquiry will bring to light. We consider how sex and gender feature in the Lourdes case, draw attention to the deeply gendered asymmetries of power and privilege that existed between the men and women at the centre of this inquiry, and explore the impact such asymmetries had on this particular situation. (shrink)

The Lourdes Hospital Inquiry: An inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland, of 2006 recounts in detail the circumstances within which 188 peripartum hysterectomies were carried out at the hospital between 1974 and 1998. The findings of the inquiry have serious ramifications for Irish healthcare delivery and have implications for many professional groups, including midwives. The findings prompt clear questions about the relative position or power of midwives within maternity care. These questions are examined in (...) this article, through the analysis and application of various theoretical perspectives on power. Critical views of power focus on the socio‐political nature of oppressive structures within society and seek mechanisms to address these. Stemming from structure versus agency debates, Giddens's structuration theory examines the agency‐structure interaction and stresses the centrality of agents’ roles in the social reproduction of structures. Postmodernism, particularly drawing on the work of Michel Foucault, focuses on a fluid conception of power while also describing the nature of disciplinary power. It offers midwives a way of viewing power as productive and dispersed. Drawing on different aspects of these perspectives on power, helps us to understand midwives’ relative positions and power relations and how to enhance these to prevent future tragic outcomes such as those reported in the inquiry report. (shrink)

In the face of increasing intervention in childbirth, ‘normal birth’ is currently being promoted by the World Health Organization, national governments, professional bodies and other organisations throughout the world. This paper takes a postmodernist stance and explores the idea of the ‘normal’ before going on to analyse normal childbirth, referring to concepts of the normal and the natural. It refers to historical developments in childbearing and lay organisations along with research relating to women’s views of childbirth, to question the appropriateness (...) of using ‘normal’ to describe the very individual experiences of childbirth. It laments the way in which women have been treated and arguably continue to be ‘cared for’ in maternity/obstetric services. It adds to the current discussion by recalling psychoanalytical theory and philosophical analysis to conclude with a call for future consideration of the ‘good‐enough’ birth instead of concentrating on promoting normal birth which is very difficult, if not impossible to define in retrospect, or to prospectively promote. (shrink)