Prolonged intrapartum refusal of cesarean delivery and eventual consent: A case report on the ethical boundaries of maternal autonomy in obstetrics

This case from Saudi Arabia describes a 27-year-old woman at 39 weeks and 6 days of gestation in spontaneous labor, who had had two prior cesarean deliveries and no previous vaginal births, but declined cesarean delivery despite worsening fetal heart tracings and labor dystocia. Repeated counseling was provided, and an ethics consultation was done as the intrapartum refusal persisted. After approximately 12 hours of labor and no cervical changes, she consented to cesarean delivery. The neonate was born with metabolic acidosis related to three tight nuchal cords. This case illustrates the ethical conflict between maternal autonomy and fetal beneficence in the context of the trial of labor after two cesarean deliveries. It emphasizes the importance of clear communication, early antenatal counseling, and the application of culturally relevant ethical framework, including Islamic bioethics, to support balanced and safe decision-making.