Conflict Transformation Lesson

Optimal management of pregnancy and birth means that both patients and care providers feel that they used strategies to minimize risk while maximizing integrity (12). Care providers and patients may approach risk and integrity in birth differently. For pregnant people, maximizing integrity means preserving their ideals and values about birth, whereas for care providers it may mean upholding their beliefs and principles. Minimizing risk also includes attending to feelings of psychological risk. Concepts of risk and integrity are influenced by complex relationships between personal experiences, research evidence, and local healthcare cultures. A mutual understanding of these variables can improve communication, experience, and outcomes. 

Although client-centered care and PCDM have become standard goals in healthcare, care providers are sometimes reluctant to put these principles into practice because they feel ultimately responsible and accountable for decisions made in labor. There is a perceived fear of negative professional consequences if the decisions made lead to adverse outcomes. Some patients put complete trust in their care providers to make decisions, resulting in more anger and litigation when the outcomes turn out differently than expected. This imbalance in decision-making needs to be addressed to ensure patients are truly involved in their care (13).

An example of the tensions that exist surrounding birth and choice can be seen in the standard use of electronic fetal monitoring (EFM) in hospital births with uncomplicated pregnancies. EFM remains a standard practice despite robust evidence that it does not lead to benefits in healthy pregnancies. Routine use of EFM highlights the tensions between best practice, provider interests in protecting themselves from litigation, a pregnant person’s ability to make informed choices, ethical principles of beneficence and autonomy, and the health and safety of birth parent and newborn. Some providers may practice within a context of  “defensive medicine”, but this motive is not often communicated with pregnant people when obtaining informed consent (17).

Effective collaboration is contingent upon various cultural and organizational factors (14). The individuals who are collaborating together need a mutual understanding that each one remains autonomous to make independent decisions (18). Collaboration can be undermined when the responsibility of leadership at any point in the case is not clearly designated (19). Interprofessional miscommunication and lack of role clarification are challenges that affect collaboration (20). Traditional hierarchies and gender disparities in healthcare organizational structure also influence the nature of collaboration (21).