The role of medical health providers in existing cultures cannot be dismissed. Such providers include nursing practitioners, pharmacists, physicians, and midwives. In this case, pregnant women have always been known to seek the services of midwives who offer personalized care and in some cases are more preferred as they assist in delivery at home and not just on a labor ward in a hospital (Benatar, Garett, Howell & Palmer 2013). It is in this respect that the paper discusses the functions of the midwives as they pertain to surrogacy in contemporary British culture.
First, this assignment will critically evaluate the relationship between surrogacy, midwifery and the relationship they have with ethical and legal-based principles in the United Kingdom. Next, the assignment will provide a discussion of the statutory legal framework and regulations by explicitly focusing on the United Kingdom. The objective is to demonstrate the relationship between surrogate mothers and midwives by concentrating on the ethical principles and legal principles.
According to Bhatia, Martindale, Rustamov, and Nysenbaum (2009) surrogacy is an agreement whereby a woman provides her consent to bear a child for the entire pregnancy for another couple or woman. The obstacle associated with surrogacy is that the woman carrying the child must surrender the child after it has been born (Marshall & Raynor, 2014). Furthermore, the comprehension of the surrogacy-based law in the United Kingdom and the co-relationship between ethical and legal perspectives of the subject depends on a critical evaluation of the actions related to surrogacy (Benatar, Garett, Howell & Palmer 2013). For instance, according to Horsey and Sheldon (2012), there are many reasons why individuals in parts of the world including the United Kingdom, find it convenient to use surrogacy. However, the primary factor is that a couple may not be able to have children on their own (Benatar, Garett, Howell & Palmer 2013). For example, same-sex couples may use surrogacy (Benatar, Garett, Howell & Palmer 2013). Besides, it is also essential to consider other medical reasons that may contribute to finding surrogacy as an option. The most common medical based reasons why women or couples may decide to go for surrogacy may be because the woman may not be fertile (Benatar, Garett, Howell & Palmer 2013). Griffith (2014) adds that the other reason may include the fact that the woman may have undergone numerous miscarriages and as such, it would not be in the child's best interest for her to carry the pregnancy. Complications stemming from a hysterectomy that is caused by carcinoma may also contribute to the need for using a surrogate mother (Griffith, 2014).
In this respect, Horsey and Sheldon (2012) argue that it is imperative that clinicians and midwives provide the surrogate mother with similar attention and care as they would to a non-surrogate mother. Provision of equal care to women is essential in ensuring that all women receive necessary treatment depending on their situation. It is this equality that enhances cooperation and good relationship. Professional behaviors such as impartiality and honesty are very critical in the women-centered care to promote equality in handling the women. However, in the United Kingdom, surrogacy is unique as it is illegal to conduct surrogacy whereby the surrogate mother is compensated financially (Horsey & Sheldon 2012). As such, the United Kingdom only recognizes the altruistic form of surrogacy that is voluntary, and which acknowledges the mother of the child being the surrogate mother, compared to the appointing parents (Horsey & Sheldon 2012). The laws are devoted so much to the welfare of the women, and they are stipulated to assist where necessary to better the condition of both the intended and surrogate mothers. This virtue ensures that the child being surrogated is protected from any harm that may erupt. However, the intended parents may seek ownership of the child based on them obtaining the relevant parental orders, so that they do not infringe on the rights of the surrogate mother nor be in breach of the law. Burell and O'Connor (2013) emphasize the need for planning, particularly during prenatal care. Arguments rendered by the National Childbirth Trust (2018) conform to Yoshida and Sandall's (2013) whereby they reiterate the need to ensure that community midwives, as well as the intended parents, are present. Burell and O'Connor (2013) confirm that the reason is that a community midwife will be competent in assessing the needs of both the proposed parents as well as the surrogate mother. It can be difficult for the intended parents to make decisions that are in the best interest of the surrogate mother and as such may influence a midwife's decision (Burrell & O'Connor, 2013). Burell and O'Connor (2013) say that it is also at the time, of antenatal care that the community midwife must inform the maternity matron, which will facilitate meetings with various professional teams to discuss the plight of both the intended parents and the surrogate mother. According to Bhatia et al. (2009), the meeting should also include other parties such as a senior midwife, a safeguarding midwife, the consultant obstetrician and the labor suite and ward sisters. This is very important to ensure that there is no breaking of the existing surrogacy arrangements. When everyone involved is present, coming up with lies to favor the self-interests becomes avoidable thus the outcome must conform to the laws and what is expected as the right thing to do.
Bhatia et al. (2009) added that during the convening of such a meeting critical issues that may influence both parties, in this case, the appointing parents and the surrogate, ought to be addressed. First, the location and facility in which the child is to be born have to be agreed (Bhatia et al. 2009). Next, it is essential to discuss a sensitive agenda that may influence the role of the midwife, such as, if the child is born before arriving at the hospital and It is also because the midwife may not be present and as such, events that may happen in her absence may contribute to an adverse outcome of both the surrogate mother and the intended parents (Bhatia et al. 2009). Besides, Burrell and O'Connor (2013) also agree with Poote and Van den Akker (2008) when they argue that it is also essential for the community midwife to bring into motion the discussion of labor management as well as the administration of pain relief. The outcome associated with such actions must also be discussed and made aware of both to the surrogate and the intended parents (Burrell and O'Connor 2013).
According to Burrell (2012), other matters that ought to be brought forward during the antenatal care period and will prevent being in infringement of ethical directives, include the decision on the best method of feeding the child. Burrell (2012) emphasizes the consideration of the immediate care of the child should be discussed in this situation and adds that the legal parent to the newly born child is the surrogate mother and she may opt to breastfeed the child. However, the lack of a prior discussion into the surrogate mother's role after the birth of a child may render the midwife favoring the intended parents rather than the legally recognized parent, thus preventing her from breastfeeding the child (Burrell 2012).
Other ethical and legal based issues that are subject to evaluation by midwives, the appointed parents and the surrogate mother, is whether or not the exchange of the child will be based on Trust. In this respect, Bhatia et al. (2009) are of the opinion that due diligence and evaluation of both the appointing parents and the surrogate must be comprehensive to determine whether they have prioritized the interests of the child. It is also imperative that the midwives in the intrapartum care stage ensure that the surrogate mother receives the due care she deserves (Bhatia et al. 2009). According to Burrell (2012), it would be unethical for the midwives not to deliver personalized surrogate care, as well as respect to her wishes, following her acceptance that the intended parents are to be presented with the baby after it is born.
The opinions portrayed by Horsey and Sheldon (2012), are valid and are coherent with those of Parliamentary and Health Service Ombudsman (2013). It is because according to Parliamentary and Health Service Ombudsman (2013) there is a need to continue offering care to both the surrogate and the baby even after the child is born. Horsey and Sheldon (2012) added that the midwives must ensure that the surrogate and the child are not separated, regardless of the fact that the appointing parents ought to be the ideal parents to the child. According to Horsey and Sheldon (2012), it is because the surrogate mother also shares responsibility for taking care of the child. An important consideration to keep in mind is that Bhatia et al. (2009); Burrell and O'Connor (2013); and Burrell (2012) all agree that the midwives should ensure that the surrogate mother receives the necessary psychological support. The care should be provided mainly after the birth of the child after she has consented to the child being given to the intending parents (Burrell 2012). The midwives must also recommend that the surrogate mother attends additional postnatal visits (Burrell and O'Connor 2013). In this context, the surrogate mother should be left to make personal choices and exert her free will in the process.
Legal Principles Governing Surrogacy and Midwifery in the United Kingdom
Midwifery in the United Kingdom is governed by precisely stipulated enactments that ensure excellent quality of care is rendered to expectant mothers, which in this case is inclusive of surrogates. According to Burrell and O'Connor (2013) in 1985, there was a formulation of an Act associated with surrogacy which is referred to as the Surrogacy Arrangements Act 1985. The function of the regulation is to prevent the commercialization of surrogacy, particularly in the United Kingdom. This is to ensure that the laws are upheld, and the rights of the women are protected without being violated. However, institutions that are not profit oriented are permitted to advertise the practice to facilitate the linkage between surrogates and intended parents (Burrell and O'Connor 2013). Profoundly Bhatia et al. (2009) reiterate that in most cases the appointing parents may coerce surrogate mothers into believing that they are not the actual parents of the child. Besides, the absence of legal-based principles such as the Human Fertilization and Embryology Act of 2008, would lead to the infringement of the rights of the surrogate mothers mainly if the midwives did not have prior knowledge associated with the regulations. In this context, Burrell and O'Connor (2013) implore that it is ideal for all parties always to remember that unless parental orders are rendered within the stipulated six months after delivery, then the child solely remains with the surrogate.
According to Poote and Van Den Akker (2008), adherence and enforcement of the law demand that midwives offer care to the surrogate mother. In fact, Burrell and O'Connor (2013) reiterate the arguments rendered by Poote and Vane den Akker (2008), by arguing that an unborn child does not possess any legal rights. In this regard, the mother to the child must act in the best interest of the child as the midwives, and other caregivers should ensure that they offer her the best environment to ensure a safe and healthy environment for the child's birth (Burrell and O'Connor 2013). According to Burrell (2012), midwives are also required to be...
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