0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
msJAMA |

The Maternal-Fetal Relationship FREE

Jane van Dis
JAMA. 2003;289(13):1696. doi:10.1001/jama.289.13.1696.
Text Size: A A A
Published online

I knocked softly. The room was dark as I slipped around the sage-green door, save for light sifting through the metal blinds and the blue-gray glow of the screen as it showed off its sandy sonographic images of the abdominal wall, placenta, and fetus. The obstetrician moved the slickened transducer across the woman's abdomen, pointing out landmarks and serving as guide to this anatomical museum suspended in amnion. "This is baby's kidney. And over here we have baby's stomach." Baby? Talking in the hallway out of the patient's earshot, my attending remarked, "The fetus appears on exam to be healthy." Although the proper use of "baby" vs "fetus" is generally not a part of formal obstetric training for medical students, maternal-fetal ethics instruction is a component of medical and resident education. A 1994 study found that the top 2 issues of interest in obstetric ethics education were "abortion" and "maternal-fetal conflict."1

Although obstetricians rarely encounter ethical dilemmas like court-ordered cesarean deliveries or pregnant patients refusing life-sustaining blood transfusions, unplanned pregnancy and drug and alcohol use during pregnancy are common occurrences.2,3 Thus it is not surprising that the pregnant woman is a focus of complex cultural expectations, moral obligations, and legal rights. This issue of MSJAMA addresses some of the constructs and tensions in the maternal-fetal relationship.

The maternal-fetal relationship is the subject of intense public policy debates. Lisa Harris and Lynn Paltrow report on courts' opinions regarding the prosecution of pregnant women for potential fetal harm. Nathan Stormer explores how contemporary biomedical images of the fetus are changing public perception of the pregnant body and fetus. Amy Salisbury and colleagues describe how researchers are attempting to measure maternal-fetal attachment and its possible implications for fetal and maternal health during pregnancy.

Although fundamental and seemingly unalterable, the definition of the maternal-fetal relationship is undergoing a rapid evolution of context, in part due to advances in imaging, prenatal diagnostics, genetic screening, and fetal surgery. While the formal principles of autonomy and beneficence provide an initial point from which to analyze the sometimes conflicting needs of the pregnant woman and her fetus, the maternal-fetal relationship is becoming too complex to rely on simple algorithms. As medical technology and innovation advance, and as cultural and political dialogues continue to influence the patient-physician encounter, physicians' knowledge of and participation in ethical dialogue on the maternal-fetal relationship will continue to be an increasingly important part of obstetric care.

References
Cain JM, Elkins T, Bernard PF. The status of ethics education in obstetrics and gynecology.  Obstet Gynecol.1994;83:15-20.
Ebrahim SH, Luman ET, Floyd RL, Murphy CC, Bennett EM, Boyle CA. Alcohol consumption by pregnant women in the United States during 1988-1995.  Obstet Gynecol.1998;92:187-192.
Henshaw SK. Unintended pregnancy in the United States.  Fam Plann Perspect.1998;30:24-29.

Figures

Tables

References

Cain JM, Elkins T, Bernard PF. The status of ethics education in obstetrics and gynecology.  Obstet Gynecol.1994;83:15-20.
Ebrahim SH, Luman ET, Floyd RL, Murphy CC, Bennett EM, Boyle CA. Alcohol consumption by pregnant women in the United States during 1988-1995.  Obstet Gynecol.1998;92:187-192.
Henshaw SK. Unintended pregnancy in the United States.  Fam Plann Perspect.1998;30:24-29.

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.