Health Advocate: An Obstetrician in Doubt—Coping with Ethical Dilemmas and Moral Decisions

  • Harry B. M. van de Wiel
  • K. Marieke Paarlberg
  • Sylvia M. Dermout


All healthcare professionals are regularly faced with the following question: “What is the wisest course; what is the right thing to do in this case or with this patient?” An inherent part of this kind of dilemma is that it involves pros and cons that are difficult to weigh against each other; evidently there is a broad spectrum of arguments. These arguments refer to interests or values that are usually associated with rules for conduct and actions—what we call standards. Ethics is an area of study that can help those professionals to deal with dilemmas of this kind and find answers to their questions regarding the right course of action and how to implement it.


Health advocate Ethical dilemmas Cesarean section on demand Informed decision-making Medical ethics Professional guidelines Personal opinion Values Assessment CanMEDS competencies 



Based on the thesis of the third author: Dermout SM. De eerste logeerpartij, hoogtechnologisch draagmoederschap in Nederland. University of Groningen (RUG), The Netherlands; 2001.


  1. 1.
    Bolt I, van Dijk G. Ruimte voor gewetensbezwaren is beperkt. Medisch Contact. 2015;7:300–2.Google Scholar
  2. 2.
    Fernando RJ, Sultan AHH, Kettle C, Thakar R, Radley S. Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev. 2006;3:CD002866.Google Scholar
  3. 3.
    Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. A comparison of the long-term consequences of vaginal delivery versus caesarean section on the prevalence, severity and bothersomeness of urinary incontinence subtypes: a national cohort study in primiparous women. BJOG. 2013;120(12):1548–55.CrossRefPubMedGoogle Scholar
  4. 4.
    Leijonhufvud A, Lundholm C, Cnattingius S, Granath F, Andolf D. Risks of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth. Am J Obstet Gynecol. 2011;204(1):70.CrossRefPubMedGoogle Scholar
  5. 5.
    Dietz HP, Steensma AB. The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG. 2006;113:225–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Royal College of Obstetrics and Gynecology (RCOG). UK National Institute for Health and Care Excellence (NICE) clinical guideline on Caesarean section (CG132). 2011.
  7. 7.
    ACOG Committee on obstetric practice. Cesarean delivery on maternal request. The American College of Obstetricians and Gynaecologists; 2013 Apr. Report No.: 559.Google Scholar
  8. 8.
    Macarthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, ProLong study group, et al. Faecal incontinence persisting after childbirth: a 12 year longitudinal study. BJOG. 2013;120(2):169–78.CrossRefPubMedGoogle Scholar
  9. 9.
    Smaill FM, Gyte GML. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2010;1:CD007482.Google Scholar
  10. 10.
    Dutch Association for Obstetrics and Gynecology. Dutch Guideline on Pregnancy after previous Caesarean Section. 2010.Google Scholar
  11. 11.
    World Health Organization. WHO statement on caesarean section rates. Geneva: World Health Organization (WHO); 2015.Google Scholar
  12. 12.
    van de HB W, Wouda J. Communicatie in de palliatieve fase. Houten: The Netherlands: Bohn Stafleu Van Loghum; 1999.Google Scholar
  13. 13.
    Het imperatieve karakter van de medische technologie en de betekenis van geanticipeerde beslissingsspijt. Nederlands Tijdschrift voor Geneeskunde. 2015;131(26):1128–31.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Harry B. M. van de Wiel
    • 1
  • K. Marieke Paarlberg
    • 2
  • Sylvia M. Dermout
    • 3
  1. 1.Wenckebach InstituteUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
  2. 2.Department of Obstetrics and GynecologyGelre Hospitals, Apeldoorn LocationApeldoornThe Netherlands
  3. 3.GynaecologistGynaecological Centre Dermout and AlbicherAlkmaarThe Netherlands

Personalised recommendations