ACOG on Fallibility of Obstetric Judgment and Mode of Delivery
The following excerpt from the American Congress of Obstetricians and Gynecologists’ Committee Opinion Number 321 about how fallibility in obstetric judgment is sufficiently high as to warrant wariness in legally coercing women to consent to intervention.
Consider, first, the limitations of medical judgment in predicting birth outcomes based on mode of childbirth. A study of court-ordered obstetric interventions suggested that in almost one third of cases in which court orders were sought, the medical judgment was incorrect in retrospect (27). One clear example of the challenges of predicting outcome is in the management of risk associated with shoulder dystocia in the setting of fetal macrosomia—which is, and should be of great concern for all practitioners. When making recommendations to patients, however, practitioners have the ethical obligation to recognize and communicate that accurate diagnosis of macrosomia is imprecise (20). Furthermore, although macrosomia increases the risk of shoulder dystocia, it is certainly not absolutely predictive; in fact, most cases of shoulder dystocia occur unpredictably among infants of normal birthweight. Given this uncertainty, ACOG makes recommendations about when cesarean delivery may be considered, not about when it is absolutely indicated. Because of the inability to determines with certainty when a situation is harmful to the fetus or pregnant woman and the inability to guarantee that the pregnant woman will not be harmed by the medical intervention, great care should be exercised to present a balanced evaluation of expected outcomes for both parties (20). The decision about weighing risks and benefits in the setting of uncertainty should remain the pregnant woman’s to make in the setting of supportive, informative medical care.
Maternal Decision Making, Ethics, and the Law (Obstet Gynecol 2005;106:1127–37). November 2005.