Paternalism is “the policy or practice on the part of people in positions of authority of restricting the freedom and responsibilities of those subordinate to them in the subordinates’ supposed best interest.”
In the United States, paternalistic healthcare is abundant, ESPECIALLY in Obstetrics and Gynecology offices, and Labor and Delivery rooms. Nurses, OB’s and Midwives, alike, can act paternalistically. This means that they go against autonomy of a pregnant person, and bestow a treatment or intervention upon them, without their informed consent, because of the more educated (HA) and authoritative position, they feel they are in.
An example of paternalistic practice in a labor setting would be the nurse starting a Pitocin drip without expressly asking a mama, because she is not progressing fast enough, or as a preventative measure for assumed postpartum hemorrhage. An autonomous version of this practice would be asking the mama if she would like something to speed her labor up, or if they can start Pitocin to prevent postpartum hemorrhage, then telling her about the risks and benefits either way. Another example would be, a provider claiming they are doing a simple cervical check, only to go in and actually sweep the mother’s membranes and break her water, in attempt to move things along.
The practice of paternalism is completely unethical, but legally, it is a grey area, and when an expectant mother signs those hospital intake papers, she unknowingly strips herself of ALL her rights to informed consent.
If you find yourself in a situation in which a doctor is not granting you the right to autonomy in pregnancy and birth, or you are a birth worker supporting a woman with a provider that seems to want to practice in a paternalistic manner, you can gently (or firmly, who are we to judge?) remind them that AUTONOMY is one of the four principles of medical ethics and was described in-depth in The Principles of Biomedical Ethics, a required reading in many medical schools. Also included in these principles are beneficence, which is mercy, kindness, and a moral imperative to do right, non-maleficence, non-harming or the least harm possible to reach a beneficial outcome, and justice. It seems that MANY providers have forgotten their ethical principles, but that’s what birth workers exist for, right?
The idea of paternalism, is that the patient has no idea what the best interest is for themselves, and while that may be the case for someone who is maybe… in a coma, it is certainly not the case for a woman in the delivery room, fully in-tune with her body and baby, that knows exactly what she wants from her birth. Paternalism is absolutely toxic in Labor and Delivery, because birth is not an emergency nor a medical event.
Paternalism is most prominent is communistic or post-communistic countries, Croatia is currently transitioning from paternalistic healthcare to autonomous healthcare practices, and having great success, and many people are astonished that they did not start this a long time ago.
I am here to remind you, that this is a democratic and free country, for the most part (my woke-folk followers will understand that joke, LOL). Just like all providers are required to follow HIPPA, they are required to follow their ethical standards, too, and if they do not, they should be reported!
If you find your provider to be paternalistic in your pregnancy, I strongly advise you to fire that provider and SWITCH! It does not get better in labor, I promise. If you are a birth worker and have a client with a paternalism oriented style of practice, PLEASE let the mama know her options, and encourage her to ask the doctor LOTS of questions. The provider works for the mama after all, not the other way around, and you, as a birth worker, are not there to please the provider, you are there to help the mama and baby (or babies) have an autonomous, happy, and healthy birth.