The Challenges of Seeking to Avoid Over Diagnosis and Over Treatment: Exploring Defensive Medicine in Maternity Care
Background: The increasing prevalence of over diagnosis and over treatment in healthcare has raised concerns about the risks of excessive medical interventions, which may not always benefit patients and could cause harm. Defensive medical practices, driven by fear of litigation and professional scrutiny, further exacerbate this issue, particularly in high-risk areas such as maternity care. The complexity of childbirth and systemic pressures within the UK’s NHS make maternity care an ideal context for examining too much medicine and defensive practices.
Aim: This study explores midwives’ and obstetricians’ experiences within the NHS, focusing on how they navigate the challenges of over medicalisation and defensive practices in maternity care. The research seeks to understand the factors driving these behaviours and the barriers professionals face when attempting to reduce unnecessary interventions while ensuring patient safety.
Methods: A qualitative methodology grounded in a constructionist epistemological framework was used. In-depth semi-structured interviews were conducted with NHS midwives and obstetricians, and data were analysed using a Grounded Theory-inspired constant comparison approach. This method facilitated the identification of critical themes, ensuring the findings thoroughly reflected the participants’ lived experiences. Ethical considerations, including participant anonymity and confidentiality, were prioritised throughout the research process.
Findings: The study revealed a complex dynamic between systemic, cultural, and individual factors driving over medicalisation and defensive practices in maternity care. Fear of litigation and professional consequences led healthcare professionals to follow protocols rigidly, sometimes at the expense of patient-centred care. Participants reported frequent overuse of interventions, including C-sections and inductions, even in low-risk pregnancies. They advocated for a balanced approach to care, emphasising informed consent and shared decision-making, but acknowledged significant barriers to implementing this approach.
Conclusions: This research highlights the influence of fear-driven practices in maternity care. Recognising the value of patient-centred care and shared decision-making is essential to mitigate unwarranted interventions.
History
Supervisor(s)
Natalie Armstrong; Tracey ElliottDate of award
2024-12-09Author affiliation
Population Health SciencesAwarding institution
University of LeicesterQualification level
- Masters
Qualification name
- Mphil