By Jill Arnold
This report by the FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health titled Ethical guidelines regarding interventions for fetal wellbeing has been available online since August 12, 2011.
1. Most women will make choices to improve their chance of having a normal birth and healthy baby if they have access to the necessary information and support.
2. Extending care to the fetus by giving the pregnant woman the support she needs provides the best hope of enhancing the wellbeing of both the fetus and the mother-to-be.
3. Although the fetus may benefit from health care, it is completely dependent on the mother, and any treatment must be through her body.
4. While the majority of women act in a way that provides a healthy environment and are usually ready to take risks on behalf of their fetus, there may be situations where their interests do not coincide:
• The mother’s behavior may create risks for herself and her fetus (e.g. use of drugs, tobacco, and alcohol; not attending appropriately provided prenatal care; failure to take available HIV therapy).
• The mother may choose not to accept diagnostic, medical, or surgical procedures aimed at preserving fetal wellbeing, including cesarean delivery for fetal indications.
5. The medical team has a responsibility to fully inform the mother, to counsel her with empathy and patience, and to provide such support services as are needed to achieve the best maternal and fetal outcomes.
6. However, no woman who has the capacity to choose among healthcare options should be forced to undergo an unwished-for medical or surgical procedure in order to preserve the life or health of her fetus, as this would be a violation of her autonomy and fundamental human rights.
7. Resort to the courts or to judicial intervention when a woman has made an informed refusal of medical or surgical treatment is inappropriate and usually counter-productive.
8. If maternal capacity to choose for medical decision-making is impaired, healthcare providers should act in the best interests of the woman first and her fetus second. Information from the family and others may help to ascertain what she would have wished.
9. The wishes of pregnant minors who are competent to give informed consent regarding medical and surgical procedures should be respected.
SOURCE: International journal of gynaecology and obstetrics [0020-7292] Dickens yr:2011 vol:115 iss:1 pg:92.