Professionally responsible advocacy for women and children first during the COVID-19 pandemic: guidance from World Association of Perinatal Medicine and International Academy of Perinatal Medicine

Frank A. Chervenak 1 , Laurence B. McCullough 1 , Amos Grünebaum 1 , Eran Bornstein 1 , Cihat Sen 2 , Milan Stanojevic 3 , Marina Degtyareva 4 ,  and Asim Kurjak 5 , 6
  • 1 Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
  • 2 Department of Perinatology, Cerrahpaşa Medical School, University of Istanbul, Istanbul, Turkey
  • 3 Department of Neonatology, University Hospital “Sveti Duh”, Zagreb, Croatia
  • 4 Department of Neonatology, Pirogov Russian National Research Medical University, Moscow, Russia
  • 5 Department of Obstetrics and Gynecology, University of Zagreb, Zagreb, Croatia
  • 6 University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Frank A. Chervenak
  • Corresponding author
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Laurence B. McCullough
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Amos Grünebaum
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Eran Bornstein
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Cihat Sen
  • Department of Perinatology, Cerrahpaşa Medical School, University of Istanbul, Istanbul, Turkey
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, Milan Stanojevic, Marina DegtyarevaORCID iD: https://orcid.org/0000-0002-1769-5430 and Asim Kurjak
  • Department of Obstetrics and Gynecology, University of Zagreb, Zagreb, Croatia
  • University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Abstract

The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, “Women and children First – or Last?” was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.

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