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• W2048580834 abstract "I was one of 35 Swedish anaesthetists who attended the 2006 OAA Controversies in Obstetric Anaesthesia. This was the first time I had attended the meeting and I enjoyed it very much. At their best, pro-con debates are a very efficient mixture of teaching and entertainment, and even if things are not all sorted out, at least confusion reaches a higher level. The proposal that Women need to be told ALL the risks before regional techniques are performed was very well argued by Dr Ruth Landau – and equally well opposed by Dr Vicki Clark.[1]Landau R (proposer), Clark V (opposer). Women need to be told ALL the risks before regional techniques are performed. Int J Obstet Anesth 2006;15:301–5.Google Scholar The vivid discussion after their presentations was summarised by the moderator Dr Wendy Scott. Unfortunately I do not remember her exact words, but the message was something like “I think we all agree that many of today’s women are autonomous, well informed, capable of retaining relevant information and making rational decisions. They have the right to know.” Such a statement cannot really be contradicted – and I most certainly won’t try. But it carries within itself a hint of an argument against always giving all information in the delivery room that I tried to put forward, but unfortunately we were out of time. Having read their excellent presentations in the International Journal of Obstetric Anesthesia I now do so in writing. Agreeing that autonomous, well informed, rational mothers seek good information and are able to make relevant decisions, it is evident that they all have some nine months to seek that information, evaluate its meaning, perhaps seek professional advice – a midwife, an obstetrician and/or an anaesthetist – to clarify further any difficult passages and then make their decision. (Great Britain seems a decade or two ahead of Sweden when it comes to information available for mothers-to-be, but we are eagerly trying to catch up.) If on the other hand mothers have chosen not to seek such information during their pregnancies, for autonomous people that is also a choice, then they have chosen to stay ignorant. This, I think, is crucial. Arguing that all women should be told all risks etc. in the delivery room turns the idea of their autonomy and rationality upside down. Suddenly they are mysteriously transformed into ignorant, helpless patients who need the lesson from page one – in a situation of pain, anxiety and stress! To me, this is a logical somersault – a kind of paternalism the other way around. I wholeheartedly support the idea of structured information during pregnancy, aiming towards well informed mothers (and fathers) – although Dr Landau’s description of the French situation, in which every mother meets an obstetric anaesthetist during her pregnancy, is Utopian by current Swedish standards. We already have a shortage of doctors, which will get worse before it gets better due to large pension retirements, so there is a practical side to overcome to reach this excellent goal. Whenever a mother in the delivery room starts asking questions about risks and benefits of an epidural block, I find it my non-arguable professional duty to give her the best information I can, but 25 years of professional experience tells me that this situation is extremely rare. On the contrary, I really recognise myself in the situation described by Dr Clark, where the patient impatiently says: “Stop nagging and get on with the epidural!” So I have done that, cut the preparatory interview to a minimum, performed the block and, usually, soon thereafter left a very happy couple of parents. If that is paternalism, they at least seem very satisfied with it." @default.
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• W2048580834 date "2007-07-01" @default.
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• W2048580834 title "Always all information in the delivery room – paternalism the other way around?" @default.
• W2048580834 cites W2102748712 @default.
• W2048580834 doi "https://doi.org/10.1016/j.ijoa.2006.12.003" @default.
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