Perspective maternelle de la consultation anténatale pour travail préterme : une approche relationnelle
Women at risk of preterm labour experience a highly stressful situation for which they are often hospitalised to receive the medical care required to delay their baby’s birth or to improve his outcome. Professional medical associations have published guidelines encouraging consultations with a neonatologist in these contexts. These emphasize informing parents about prematurity’s potential complications and outcomes. However, they are based on expert medical opinions, and little is known about parents’ perspectives of the antenatal consultation for preterm labour. This thesis proposes to elaborate a clinical model of a physician-patient relationship, grounded in mothers’ experiences and expectations from the antenatal consultation for preterm labour. In order to offer a comprehensive analysis of this clinical and ethical issue, both empirical data and a normative feminist bioethical framework were used. An empirical quantitative research project was first conducted to explore women’s experiences and their expectations regarding the antenatal consultation. Participants hoped to receive more than information from the antenatal consultation for preterm labour. Indeed, they hoped the neonatologist would strive to understand their unique and distinctive situations. They wanted the physician to develop trusting relationships, in which they would be enabled to ask questions important to them and in which many topics could be discussed – such as their roles as mothers of a premature baby. A feminist theory of relational autonomy was then used to examine this data. An approach to care responsive to women’s experiences is suggested, which considers not only their individual needs, but which is also critical of the many power imbalances inherent to the clinical setting that influence patients’ health and autonomy. This approach emphasizes the importance of relationships in the physician-patient encounter; it offers a striking contrast to consultation models that endorse a minimal conception of patient autonomy, in which the simple transfer of medical knowledge and data is believed to uphold the legal doctrine of informed consent. This relational model suggests practical and tangible means for physicians to engage in relationships with their patients and to consider the influence they have on their patients’ relational autonomy.
Neonatology Prematurity Clinical ethics Feminist bioethics Autonomy Relational autonomy Shared decision-making Informed consent Physician-patient relationship