Ethics and etzev

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I am not a professional ethicist, but in my line of work I encounter various ethical questions. As part of my MS in Nursing studies, I took an elective class on medical ethics, and I have presented talks on "midwifery, ethics, and the law" in a few settings. I have tried to educate myself in the field, because many of the questions I encounter are not well-covered in the standard books.
My initial training in medical ethics was strongly influenced by situation ethics, and it has been only gradually that I have come to realize just how pervasive this misapplication of ethical thinking really is.

I was taught that dilemmas could be best resolved by balancing four basic principles - autonomy, beneficence, non-maleficence, and justice. In other words, respect the rights of each individual to make decisions, do good, do no harm, and be fair to everyone. These are lofty and often worthy ideals, but without concrete standards, they are meaningless. A house built on sand will eventually fall. I eventually realized that ethics without religion is basically an exercise in mental masturbation.
Our religion has given us standards of behavior from which to derive right choices. We do not need to depend on revelation to see what is right and true, although revelation makes it easier! God wrote down the ways in which we are to behave when he created us, if we can but read the book of his natural laws. Violation of natural law has natural (and sometimes supernatural) consequences. Sometimes the trouble is in deciphering the natural law. (That is where revelation helps). In my field, I deal with the reproductive health of women. Now there is an area charged with tension.
Today, I want to focus just a little on birth choices as ethical dilemmas for Catholic Christians. Our current culture of birth is extremely schizophrenic - it supports absolute autonomy for women to choose elective induction of labor, elective cesarean birth, heavy anesthesia, small families - and yet threatens and derides women and their families who choose home birth, vaginal birth after cesarean, vaginal breech birth, large families, etc.
I work from a basic premise. God made us and He saw that it was good. Even after the fall, when Adam and Eve were cast out of the garden, children were seen as a blessing not a curse. Adam was told that in toil (etzev) he would work the fields to feed his family. Eve was told that her desire would be to her husband, and that in toil (etzev) would she bear children. The man is to toil to bring forth fruit from the earth - the woman is to toil to bring forth fruit from her body. Hard work, pain especially if one has not prepared and conditioned the body for labor (farming or childbirth!), potential for accidental injury, suffering, or even death - yes, they are all there. But God made us to function and generally we do.
Every thing in life carries a modicum of risk. One (specious) argument that is made in favor of contraception (and abortion, too) is that even the riskiest contraceptive (or abortion) is less risky than pregnancy to a woman's health and life. Elaborate statistical analyses 'prove' this to the satisfaction of the population planners. Pregnancy and childbirth, however, is a natural risk. It comes from being human. I have a bias that says a natural risk is morally superior to an unnatural risk, especially when there is a reasonable (natural)alternative to that unnatural risk.
Cesarean childbirth carries a greater risk to the life and health of the mother than normal birth (anywhere from 2 to 7 times greater risk of death, to say nothing of 'minor' complications). In some cases (probably between 5% to 10% of births), the risks to the mother's health and life from this major surgery are balanced by the risks to her, or her baby's, health and life from a normal birth. Choosing a route of birth then becomes a prudential judgement. Part of the responsibility of an expectant parent is to seek good counsel from a midwife and/or physician who understands and supports the culture of life. Another part of that responsibility is to cherish and care for that unborn child to the best of one's ability through healthy behavior, including prayer, nutrition, etc.
The same can be said for choosing the place and other circumstances for giving birth. Because of the complex intertwining of body, soul, and mind, the safest place in which to give birth is probably in the environment where the mother feels the safest and most secure. I have found that an important contribution to a good birth environment is being surrounded by prayer. This can be very difficult to achieve in the typical hospital setting, but is by no means impossible. I recommend memorizing some short Bible verses and prayers. A favorite of mine is Phil. 4:13, also the Glory Be. My friends that are Chassidic Jews pray psalms (tehillim) in labor, offering up their pain and prayers on behalf of infertile women.
Sometime later, I want to get into some of the moral/ethical questions that I have been posed by real people. Examples include choosing to have or refuse drugs and anesthesia, when is it acceptable to induce labor or schedule delivery (by cesarean or induction), and many others that assume the mother and the baby's needs are in conflict. If there are other questions that you would like me to tackle, send me an email or drop a comment in the box. I may answer your question with questions of my own, though!


Very interesting, thanks. You already know what my issues are -- VBAC, homebirth, HBAC. I'll eat up anything you have to say on those. I don't assume that my needs are in conflict with the baby's, as much as I accept that I may be trading a very slight increase in risk of some unlikely bad outcomes which could be a lot worse for the baby than for me, for a high likelihood of many important benefits for both of us.

What you say fits quite well with what my priest said. We're pretty much decided on going for HBAC with the information I have and under the circumstances I expect, but of course I haven't stopped listening to input.

P.S.: The idea that where a birthing mother "feels" safest may be safest, as new agey as it sounds, seems to have good evidence behind it, and is part of what makes me think HBAC may be safest even in terms of risk of the worst outcomes, though I can't statistically prove it.

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This page contains a single entry by alicia published on September 9, 2003 7:40 PM.

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