Psychology of Childbirth

Understand various legal cases regarding childbirth, including moral and legal issues tied to fetal rights.
Learn the operational principles and implications of ultrasound technology and Electronic Fetal Monitoring (EFM).
Explore the use of EFM in legal contexts, particularly regarding claims of brain injury.
Discuss cognitive biases, such as counterfactual reasoning and hindsight bias, as they relate to childbirth events.
Analyze misconceptions regarding the causation of cerebral palsy (CP).

Background of the Case:
- Jessie Mae Jefferson was the patient.
- She had a religious belief that she had been healed by divine intervention regarding her childbirth.
- Medical concerns: Complete placenta previa identified via ultrasound, with a 99% fetal death rate and a significant maternal risk (50%).
Court Intervention:
- The hospital sought a court ruling for a cesarean section against the mother's wishes.
- The court ruled against the mother's autonomy, prioritizing the unborn child's right to life over the mother's religious freedoms.
Outcome:
- Jefferson delivered a healthy baby vaginally, despite earlier assessments.
- The second ultrasound revealed that the placenta had moved, negating the initial need for surgery.
Implications: Key takeaway on autonomy and legal rights concerning childbirth.

Initial Situation:
- Marlowe went into labor in 2004, and ultrasound indicated fetal size over 13 pounds, suggesting a cesarean delivery.
Legal Trouble:
- Marlowe sought to find another hospital after expressing confidence in her ability to deliver vaginally based on prior experiences.
- The first hospital's lawyers obtained legal guardianship over the unborn child to enforce surgical intervention if necessary.
Resolution:
- At a different hospital, she successfully delivered naturally, experiencing no complications.
Implications: Highlights the conflict between medical authority and maternal autonomy.

Function:
- Utilizes high-frequency sound waves (>20,000 Hz) to form images of fetal development.
- Principles involved: Sound waves reflect differently based on tissue density, which is known as acoustical impedance.
- Limitations: Challenges include acoustic absorption, leading to potential false positives and missed diagnoses.

Overview:
- Widely used during labor, EFM is present in approximately 85% of hospital births.
- It was introduced with a promise of reducing risks such as cerebral palsy, intellectual disabilities, and perinatal mortality.
Concerns:
- EFM interpretation can be subjective, with experts often disagreeing on readings.
- High rates of false positives (>99%) for fetal distress have been documented.
- Increased C-section rates with EFM usage have not correlated with improved outcomes.

Types of Changes:
- Acceleration: Abrupt heart rate increase, signifying fetal well-being.
- Variable Deceleration: Abrupt heart rate decrease, which can indicate fetal distress if severe or repetitive.
- Late Deceleration: Gradual decrease post-contraction; often a concerning sign.

Counterfactual Reasoning: Examining what could have occurred if a different decision was made during labor.
Hindsight Bias: Believing that past events were more predictable than they actually were, affecting judgments on pregnancy outcomes.

Causation Myths: It is important to dispel the myth regarding the association between CP and obstetric mishaps, emphasizing multifactorial causes of CP rather than attributing them solely to childbirth procedures.