The Maternal-Fetal Dyad Exploring the Two-Patient Obstetric Model

Constructing a model of the maternal-fetal dyad as a two-patient ecosystem would restore to medical relevance the relationship of dependence and protection characteristic of the dyad. The effect of such a model would be to join the professional-patient relationships to the two patients almost as closely as if they were a single compound commitment to one compound patient. Protections associated with dependence would be reinstated and the two-patient presumption against maternal medical sacrifice averted. Within a two-patient framework, it is possible, then, to approximate the one-patient standard of obstetric care, but there is no warrant for requiring or permitting physicians to move beyond it toward a stronger posture of fetal protection. One patient or two, independent or dependent, when the various possible models of the maternal-fetal dyad are consistently applied, they converge to reinforce the physician's customary ethical stance -- working cooperatively with the pregnant woman for common, linked goals of infant, maternal, and family well-being.