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From “Not Allowed” to “This Is My Body”: Reproductive Justice Demands Supporting Informed Decisions for Labor After Cesarean

Zabec, Joie Li'en (2021) From “Not Allowed” to “This Is My Body”: Reproductive Justice Demands Supporting Informed Decisions for Labor After Cesarean. Master's Thesis, University of Pittsburgh. (Unpublished)

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Determining the approach to delivery after a prior cesarean is an ethically complex and nuanced issue. This thesis analyzes the personal and external conditions impacting the decision-making process surrounding a chosen birth method that follows a previous cesarean delivery through the lens of both patient and physician. Patient birth narratives identify the individual, social, and systemic barriers to vaginal birth after cesarean (VBAC). After providing a historical context for the medicalization of pregnancy and the role of medical racism, this thesis argues that medical authority must be examined through the critical lens of history. Forced interventions and coercive obstetrics practices, long part of an established historical legacy of dismissing women’s concerns in medicine, especially women of color, are documented and examined.

This thesis is critical of the maternal-fetal conflict (MFC) framework because it misrepresents the conflict that occurs when a pregnant woman goes against medical advice perceived to benefit the fetus, justifying violations to the mother’s bodily autonomy for the sake of the fetus. Additionally, the MFC harmfully perpetuates normative expectations of maternal sacrifice, validating morally weighted language and blame against the mother. Patient autonomy, conceived as only respecting medical choices or expanding options, does not translate into enhanced reproductive autonomy for women. Given the lived experiences of disrespect and mistreatment in obstetrics practice, providers must recognize the added relational dimensions of autonomy and center the lived experience of pregnancy through the lens of reproductive justice.

This thesis argues that health providers are responsible for empowering pregnant women to make informed medical decisions, achieved by placing value in birthing experiences and actively seeking to understand the mother’s choice. Labor after cesarean counseling that is inclusive, understanding, and respecting of the mother’s experience, has the potential to replace a harmful adversarial relationship with one of mutual trust and respect.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Zabec, Joie Li'enjoie.zabec@gmail.comjlz350000-0002-3875-9907
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairKeown, Bridget
Committee MemberTerry, Martha
Committee MemberGross, Marielle
Date: 3 May 2021
Date Type: Publication
Defense Date: 12 March 2021
Approval Date: 3 May 2021
Submission Date: 27 March 2021
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 81
Institution: University of Pittsburgh
Schools and Programs: Dietrich School of Arts and Sciences > Bioethics
Degree: MA - Master of Arts
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: reproductive justice, labor after cesarean, vaginal birth after cesarean, relational autonomy, medical authority, medicalization, pregnancy, birth, maternal-fetal conflict, decision-making, bioethics, storytelling, narrative ethics
Date Deposited: 03 May 2021 15:34
Last Modified: 03 May 2021 15:34


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