Studies show that compared with white women, racial and ethnic minority women are less likely to receive epidural analgesia for labor, and are more likely to undergo unscheduled cesarean delivery. Racial and ethnic minority women are also two to three times more likely to die from pregnancy-related causes than white women. A longitudinal study (1999-2002) of women who underwent cesarean delivery found that Black women are significantly more likely to receive general anesthesia compared with white women. This finding is important because of the inherent increased risk when anesthesia is provided during cesarean delivery and the decreased benefit available to the mother for immediate bonding and awareness recall of the birth.You are the only anesthesia provider in labor and delivery. A 30-year-old African-American woman is in labor, and things are proceeding well. You have assessed the patient and believe that the call is to place an epidural; however, the call is for an urgent c – section. Although the patient is refusing the c – section, other providers are actively encouraging the woman to proceed. The c- section proceeds, and a healthy baby is delivered. The obstetrician tells you that you can now sedate the patient, which you do. The OB then proceeds to do a tubal – ligation (to tie her tubes), but the scrub technician reminds theOB that the patient did not consent to such a procedure. Proceeding anyway with the non-consensual procedure, the OB asserts that the patient has too many babies she can’t take care of and she is going to continue having babies.Assume that the obstetrician believes wholeheartedly that the procedure will benefit both the patient and society in general. Recognize, too, that as the expert gatekeepers of medical treatments, physicians tend to have authority over their patients. In response to the non-consensual and discriminatory decision made by the obstetrician, what are your options, and how do you proceed? How do the disparities reflected in the actions and judgments of the other providers affect the trust of minorities in healthcare?
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