Wiebke Paulsen¹, Irene Hirschberg², Nora Ryback³, Corinna Klingler⁴

¹ Institute of History, Theory and Ethics of Medicine, University Hospital RWTH Aachen

² Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School

³ University of Applied Sciences, Vienna Campus

^{⁴ Institute} for Ethics, History and Theory of Medicine, Ludwig Maximilian University of Munich

Pregnancy, childbirth and the postnatal period are not only sensitive stages in a woman’s life, but are also subject to timeframes that are difficult to plan for. Unless a planned caesarean section is intended or becomes necessary, pregnant women, unborn children and healthcare staff are compelled to adapt to the naturally determined, individual temporal progression of pregnancy and childbirth. The calculated due date (DD) is used in an attempt to contain this unpredictability and make the ‘chaotic temporality’ of birth more controllable. The DD appears to be an important tool for reducing potential risks to mother and child, such as post-term pregnancy and the risk of stillbirth. For instance, the S2k guideline on ‘Induction of Labour’, which expired in 2025, recommended induction if the ED was exceeded by 10 days.

Whilst the ED supposedly reduces uncertainties for those involved, it simultaneously gives rise to legal, ethical, social and medical consequences: for pregnant women, the ED and any possible deviation from it are accompanied by (external) expectations and consequences. This can cause uncertainty, stress and psychological strain. For healthcare professionals, the ED—whether calculated using a formula or determined by ultrasound—can be a useful tool for estimating the expected timeline of the pregnancy and the birth. However, it can also impose constraints on action that give rise to discrepancies between the actual and the calculated timing. Midwives and doctors alike must support the decision-making process for or against inducing labour. In doing so, they must not only weigh up the risks to mother and child for themselves, but also support the pregnant woman communicatively throughout the decision-making process. The challenge here is to uphold the woman’s self-determination whilst navigating a system that favours defensive treatment decisions out of fear of legal consequences. Furthermore, cultural factors also appear to influence the calculation of the ED, which could manifest as variations between healthcare systems. This underlines the importance of a critical examination of the ED and the associated practices.

In this lecture, we therefore aim to explore the ethical dimensions of the ED as a mechanism for regulating temporality and to reflect on the constraints and opportunities for action faced by those involved in the birth process.