Psychology of Childbirth

Psychology of Childbirth - Key Notes

Learning Objectives

• 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).

The Georgia Case: Jefferson v Griffin Spalding County Hospital Authority (1981)

• 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.

The Pennsylvania Case: Amber Marlowe

• 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.

Understanding Ultrasound Technology

• 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.

Electronic Fetal Monitoring (EFM)

• 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.

Fetal Heart Monitoring Interpretations

• 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.

Cognitive Biases in Childbirth Contexts

• 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.

Misconceptions Around Cerebral Palsy (CP)

• 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.