Introduction
Pregnant women today face an array of decisions during pregnancy. Better understanding of embryonic and fetal development has offered insight into the effects of choices about nutrition, medications, and other substance use. Genomic and genetic innovation and improved imaging allow prenatal diagnosis that can be used to inform decisions about pregnancy termination or appropriate intervention. Fetal therapy is now an option for a variety of conditions that previously entailed certain morbidity and mortality. Finally, fetal monitoring and new surgical delivery options are changing the way pregnant women prepare for birth. This list excludes related questions about how and when to conceive and any medical intervention that might be appropriate after a baby is born.
New knowledge and technology hold great potential to improve the well-being of both women and fetuses and create new options that can raise challenging questions about whether, when, and how to employ such knowledge and technology. Therefore, pregnant women and their health care providers face an expanding set of decisions as a routine part of prenatal care when pregnancy progresses normally and an even more complex array of options when concerns arise. In this review, questions of who should make decisions during pregnancy and how those decisions should be made are explored. The role that a clinician should play in these decisions and ethical justifications for various counseling approaches are described. Finally, strategies for negotiating cultural differences are presented.
It is worth clarifying from the outset that the vast majority of these decisions are not governed by legislation in most countries (with some notable exceptions such as elective pregnancy termination). In contrast, many of the world’s religions do offer direct or indirect guidance about what a woman should or should not do during pregnancy. Religious beliefs and perspectives are therefore likely to have a considerable impact on the decision-making processes of some pregnant women. Although law and religion may inform or influence these decisions, the focus of this review is not on legal or religious considerations but on the ethical aspects of decision-making during pregnancy.