to complain about midwife (internal/assault)(274 Posts)
I'm sorry if this is in the wrong section. I'm in search of some opinions. This may not sound like much to complain about to some people. But this has really affected me and my marriage and I can't seem to move on.
In summary, I had a birth plan, it said no internal examinations and everything done needs to be explained to me. I thought she was doing an external examination, but instead did an internal which was very painful and basically in public view after my husband had been sent out of the room. I wish I had kicked her in the head and screamed and called the police, but I was holding my newborn baby and didn't I want to cry, I can't sleep.
I raised these issues with the som who said it shouldn't have happened an that she would speak to the midwives. Then emailed me to say the midwives agreed more communication would have been helpful to me wft
I have no idea if making a formal complaint will help. But can't let this go. Aibu to complain. The midwives were horrible and essentially bullied my husband. I guess it's wwyd? Sorry for the ramble.
yes - complain, complain, complain
I am sorry you have been through this
How do you manage a birth without an internal. Surely they need to check how far you are dilated before they ask you to push.
i had no internals during my birth - i was in the water
a good MW will assess the woman's breathing etc and other physiological signs to see how labour is progressing
Are you sure if you had just given birth she wasn't checking for damage / tears etc?
Complain, they should have respected your wishes. If they really did need to do an internal tey should have explained it fully to you. Tat is awful
Sorry that you are so upset by this hens, was this just after the birth? If it was, did she say something about checking for tears or similar?
as you were already holding your baby, i think they have to give you an internal just to check everything is ok (sorry i am not medical nor want to be graphic) but certain things need to be checked. Can you actually go through childbirth without an internal examination??? Concentrate on your lovely new baby
regardless - the OP thought the MW was doing an external exam
it wasn't explained properly - the OP was vulnerable having just given birth
a woman has the right to know what is being done, and consent given
this was post birth
THose who are saying thwy had to give an internal are not getting that the OP did not consent to it. It should have been explained to her fully what they needed to do and why. That didn't happen.
Complain hens, as the response from the SOM is not good enough.
Surely we all know a midwifes job is to check you out to see if you are Ok I doubt they do it for no reason
I'm sorry to be dense - what's the difference between and 'internal examination' and an 'internal?
It was after and I had no examinations during the birth, I was in the water. I didn't want them. She said check that means nothing to me I would have said no, I couldn't.
And no one asked me to push, my body did all the work
Complain, complain, complain. This was very wrong.
It is effectively assault, you had documented you did not want this to happen. If for whatever reason they HAD to do an examination they should have explained fully and gained verbal consent from you. Do complain, also contact PALS for advice.
I also would think you need to have a bit of counselling, sorry I'm not sure what is appropriated but I guess a first port of call would be your GP?? How long ago was this?
So sorry you have been through this, hope you get some answers and are enjoying your new baby...congratulations
I would put down a written complaint, tbh. Especially if, as you say, they bullied your husband. Really stress the importance of how this has affected you post birth.
It's important that this is talked through with you by someone in charge, and that you get a satisfactory closure.
Thank you, I think I'll call pals then. I really don't feel like I can go to my gp. I don't feel that I'd be supported or understood. I'm sorry I'm just blubbing now
Forgot to say, if they didn't explain what they were doing and didn't get your consent then it is effectively assault. They have to have consent.
If it is assault then why ha there been effectively no action from the som. I'm so confused
It is assault.
Don't stand for it. Complain until someone listens, to anyone you can. Write, phone, whatever you need to.
It was expressly written in your notes you didn't want one and wanted everything carefully explained. The person supposedly caring for you after one of the most emotional and physically draining experiences, did this to you, while you were in a very vulnerable position (post birth, holding newborn)?!
It's not something I had a problem with but there was a thread just a week or two ago and I know a lot of MNers have had the same horribleness happen to them so I hope they are along soon to offer more direct advice. I am really considering whether I would want internals with a second child now too, as the first time I just presumed they were necessary (but uncomfortable emotionally and physically).
A good midwife is trained to recognise other signs that a woman's labour has progressed and does not need to conduct an internal, nor do they NEED to perform one after birth, especially if they haven't gained consent ( I had one at the start of a 23 hour labour and was left to it thereafter). Complain.
Call PALS. They should be able to help.
You wished you'd kicked her in the head? I wouldn't lead with that in any letter.
definitly complain and also head over to the maternity rights thread also currently in AIBU.
For anyone asking about a labour and birth without an internal, yes it's absolutely possible. An internal examination only tells a midwife what stage of labour you are at at that exact moment. Nothing more, nothing less.
A good midwife can assess what stage a labouring woman is at through a few different indications. One of which is the dark purple line that appears at the top of the bum crack.
The noises a woman makes can help too. There is absolutely no way you MUST have an internal.
Hi I'm sorry your feeling so awful about this. I didn't have any internals when I gave birth but they did give me a good check when all was done so they could decide on stitches. I had a home birth. When you say assault did it hurt?did she purposely try to cause you pain? do you feel violated?like did she check you and feel you up at the same time? Just trying to understand what kind of examination it was.....
I'm really sorry that this has upset you OP, and agree that if you are unhappy with the response to your complaint to call PALS. Childbirth and early motherhood can make you feel extremely vulnerable and the various medical interventions can feel really invasive.
I promise I am not being provocative - this is a genuine question (not necessarily for the OP, but in general) about the difference between an internal examination for progress of labour (which as many people have said can be managed without) and a check for damage or other genuinely 'medical' investigations during labour or post-birth.
I've had one labour and while it was progressing naturally I think the midwives only did an internal examination twice, both times with my consent, which I admit I was OK with but they were very clear about reasons etc. Once I was moved on to the track of emergency forceps delivery on the obstetrics unit I didn't have a clue what was being done (as I couldn't feel anything from the chest down, for one). This included an episiotomy, stiches, managed removal of the placenta goodness knows what else. I was also given several drips that I was unaware of until I got up to the ward. No one asked my consent for any of it.
I had assumed that all of this was normal practice, even though it was very dehumanising.
Because she felt assaulted Annabelle.
Good luck Hens - remember your main purposes taking this forward - perhaps to talk it over, to get an apology, to receive some counselling, and/or to make things better in future for others.
Just think about what will help you most moving forwards after the birth with all its experiences, good and bad.
sweetie if someone sticks there hand inside you without warning explanation or consent then it is assault regardless of whether or not it hurt.
It hurt, I was breastfeeding at the time. I was bullied into it with my husband sent away by the me. I was a piece of meat
The som actually said to me that it was because i didn't have any pain relief, and that usually I wouldn't have noticed .. And that they weren't used to examining women who hasn't had drugs
Medical procedure performed without consent is assult, even if patient is unable to object consent is sought from husband or next of Kin. So yes complain. If it was deemed necessary op should have been informed. A food outcome doesn't excuse it.
I don't think there is enough information here for anyone to be able to answer your question. There a are so many things that could have been happening (for example bleeding heavilyt and pressure being applied to the leaking blood vessel - a potentially life saving intervention) that it would not be right for anyone here to say. But if you are not happy about what happened then of course you can complain so that it can be investigated by people who can look at the full facts.
I am feeling sick at the thought of how many post-birth, drug addled new mothers they may have abused in this way without consent. they basically said "It would have been better if you were too out of it to notice"!
There was no emergency, to check for grazing apparentlyl?
see the link to the assault thread in labour.ICBINEG has it.
we were discussing this topic just yesterday and you are most defiantly not alone and she was wrong not you at all.
your consent should have been asked for. it wasn't.
Yeah because midwives must love sticking their hands up a women's fanny.Ffs they are just doing their jobs and imo if an internal is needed then you put up and shut up.Assault-really?
Am so sorry you felt disrespected as well as assaulted, so soon after giving birth as well.
Clearly they should have talked to you about any medical examinations considered advisable, sought your consent, and conducted sensitively at an appropriate time (such as not whilst breastfeeding your newborn)
Hope you find taking this further brings some helpful conversations (and an apology) and helps you with moving on after such an unpleasant experience.
Put up and shut up Pinpup REALLY? Wow you really sound like you have no respect for your own body or what happens to it.
Put up with it?
No one touches my vagina without my express consent. Ever. Medical profession or not.
Pinupgirl even if its necessary they still need consent, otherwise it is deemed assault. As with any other procedure.You may be happy to go through with it but many are not. Just that extra moment of consideration can make all the difference.
Wow shut up and put up. I'm not sure what to say to that
I really just wish I could, I really just want to erase it from my mind and move on and I've tried. Tried ignoring it. Tried to talk about it which is not easy. I really want to move on and wish someone could just tell me how. I had a problem with this before birth hence it being in my birth plan now I just can't stand the idea of any hcp touching me in anyway at all
Yeah because midwives must love sticking their hands up a women's fanny.Ffs they are just doing their jobs and imo if an internal is needed then you put up and shut up.Assault-really?
Nice and insensitive there.
How about I shove my hand up your vadge during a medical appointment, without telling you I'm going to do it and without your consent and then tell you to put up and shut up?
Pinup, hope your not a midwife?
disgusting attitude and post.
Bloody hell I would much prefer a midwife to do her job and check that I don't need stitches rather than walking away with a second degree tear.
Come on ladies seriously?
Yes limit the number of unness internals during labour and if clearly documented in notes fair enough but the midwife was just doing her job - she asked if she could 'check' by the sounds of it which personally I thought would have been self explanatory seen as you've just had a baby and yes it was painful - because you have just had a baby.
I'm sorry that you feel that you weren't given enough information to fully consent but I think you are being pretty unfair on the midwife who at the end of the day was doing her job and making sure that you left the hospital healthy - imagine leaving the hospital with a tear that became I infected because she hadn't
Ok I'm still a but confused at why this is been called assault.... So it dosent signs good that she sent your husband away while she did this to you... Are you feeling that this is linked and she wanted him out of the room in order to touch you? Some one has said that she stuck her hand up you is that what it felt like? Can you explain what she did? I don't know what she did that hurt? When I gave birth I didn't have any drugs the examination was not sore after.... I can't understand why it was sore what on earth was she doing? Her reason for it been sore is rubbish and I wouldn't accept that.
Ohh, Hens. I'm thinking maybe having some counseling to talk it all through as much as you feel able to/ want to might be the most important thing to do.
And alongside this you can take the complaints process further and hope that that will bring more closure eventually too.
I think this is an area of maternity care that definitely needs further clarity and improvement in practice. I think they should always make it clear that you can ask them to stop the examination at any time if it becomes too uncomfortable, painful, or difficult as well. That would help in many cases too I think.
Pinup, thats what I did in my first labour, assumed they were necessary. They weren't and it wasn't until a little while ago that mumsnet made me aware that they weren't. I would not have allowed them if anyone had said to me that I had a choice. My birth and post-natal care all went very smoothly and I think they were an unnecessary intrusion at a very personal, physical level at a very personal and vulnerable time.
Of course sometimes internals are needed. But the HCP needs to speak to the woman, explain what they want to do, why they feel it is needed and ask the woman if it OK for her to do that. Not just day 'I'm just going to have a look' and then exam a woman internally. You need to ask me if it OK and explain what you want to do. It is then up to me whether I take you up on that offer. 99% of the time I imagine women will be fine having an internal if they had been consulted and spoken to like a person rather than an object, but it is not up to the midwife to just decide that this needs doing and then do it. It is my body, I am the one having the baby, I am the one who gets to decide who can touch me, and where.
pinup how many men do you think have fingers shoved up them without consent to check their prostates during a medical exam? I'm sure if this was happening to men, there would be a huge outcry. A midwife may feel that a check is necessary but she is still obligated to seek consent before conducting it.
Hen i feel for you, you should complain, no one obviously paid attention to your wishes, and to not tell you or ask either, is just horrid.
When i have a smear test, i knew what the nurse was gonna do and i was ready, i still jumped when she touched me.
So for you completely unaware must have felt terrible.
If it was documented on the notes then she wasn't doing her job.
She should have read the notes and then explained that she need to do an internal check. OP said she was fine with external examinations, I'm guessing she assumed when the MW said 'check' she meant an external examination and that she had read the notes - 'check' could mean anything.
Either way, the MW should not have put her fingers inside of OP w/o explicit consent, it's that simple. No ifs, ands or butts.
When I gave birth I didn't have any drugs the examination was not sore after.... I can't understand why it was sore what on earth was she doing? Her reason for it been sore is rubbish and I wouldn't accept that.
I gave birth naturally and it was agony when the MW examined me afterwards, not all birth experiences are exactly like yours funnily enough.
I told her it was painful and she made no acknowledgement and didn't stop. Oh god I'm a total mess over it really
sweetie it's assault because someone inserted something into her without consent. There doesn't need to be violence to constitute assault.
FFS, are some people on this thread terminally thick?
It doesn't matter WHY the midwife did it.
It doesn't matter if it was really important and medically necessary.
No one has a legal or moral right to put their hand inside your vagina without your consent. Doesn't matter if they have a uniform and a name badge. Doesn't matter if they are married to you. Women still have autonomy over their own bodies.
The OP expressly did not consent to internal examinations. The midwife did not attempt to gain consent. Therefore - assault.
I think I had DS with no internals either before or after birth and it was a definite improvement, especially declining the sweep a second time, which was offered as overdue with both.
I'd actually written down no internals so thought I was safe
I think I've probably asked too many questions that you might feel uncomfortable to answer so I'm sorry. Dont answer.... You need to concentrate on your baby now your healthy now but continuing down this road of unhappiness and crying because you had an internal is going to make you Ill and you've got to be strong for your baby. The baby is healthy and happy yes? Get some counciling ASAP for yourself that will ell you come to terms with this. You said it was a problem for you before birth so you maybe need to look at the bigger picture. Child birth can be straightforward but tough after and I was traumatised after mine just the shock of it! So please look at your baby and be glad your both herr and healthy that's the important thing. The midwife was probably a limitless rough and maybe she didn't read your birthplan and she should have but it sounds like she checked you to see if you were ok rather than assaulted you.
No one has a legal or moral right to put their hand inside your vagina without your consent. Doesn't matter if they have a uniform and a name badge. Doesn't matter if they are married to you. Women still have autonomy over their own bodies.
'I wish I had kicked her in the head '
I think you would have found yourself in jail!
Hen, this happened to you, you did not consent on the forms, she did not ask for consent and it caused you unnecessary pain.
If you will you want to complain over your treatment, then you are well within your right too.
Sweetie you don't have a clue
majaoo terminally thick? Really? Everyone here trying to help OP along here no need to resort to insults it's a sensitive topic.
Hen it's the second thread sweetie has tried to explain away a medical assault, I say the counselling is a good idea but complain too.
I know someone who had a traumatic experience when she had a termination at the hands of doctors and nurses, she complained and wrote a detailed letter about her experience. It was read out to all the doctors and nurses and they made changes based on it, she said it helped her immensely to know that they knew what it had done to her.
Right! Did she actually put her hand in your vagina?
sweetiepie - if a man at a party stuck his hand up your vagina without gaining your consent because he thought you would like it, would you feel that was assault? What about if you'd just told him you don't like being touched? Or maybe you'd just drop it - think he had good intentions and you are physically fine now so no need to make a fuss?
but rowtunda if it's your first birth and you have had a water birth with no interference and were busy with breastfeeding you wouldn't necessarily equate a little check with an uninvited hand up the fanjo. By using the words a little check she is deliberately downplaying what is about to take place. After birth checks IME have always been painful
It is assault simply because she did not know what was happening and she didn't agree to it
I kicked a doctor who was giving me stitches without anesthetic in the face, no jail time here.
thread moved on lots of cross posts
As someone who has lost 3 dc in late pregnancy I welcome any advice/examination from a trained medical professional that might assist in my taking home a live baby. I couldnt give a shit who stuck their hand up me if I thought it was helping either myself or my baby.Im sorry you were upset op but trying concentrating on your lovely baby.
Sweetie she gave her an internal examination, she put her fingers inside of OP without consent. That's assault.
Thanks bunny, you get it
maja00 that's a stupid comparison. The midwife wasn't doing anything like a man sexually assaulting someone and it's a ridiculous comparison to draw.
That's not to say you don't feel violated OP, but what if she'd asked, and you'd said no, and something had been seriously wrong? What if something had been so wrong that you'd been left incredibly poorly or with extreme problems in the future? I don't doubt you, at that point, would have been saying that she hadn't done her job properly.
Look at it this way, and I know it's probably not much comfort, but she wasn't trying to hurt you. She was trying to help you and make sure you were okay. She did not assault you, as she did not have the appropriate mens rea to assult you. She was probably busy, as is the case in overstretched NHS maternity wards, and hadn't had time to give the notes of every woman she was helping thorough scrutiny. Her job will be largely routine to her and this was part of it.
"Wished I'd kicked the midwife in the head"
Wow such gratitude for someone that's just safely delivered your baby!
Makes me sick, all the staff are under so much pressure and you're complaining that she examined you?
She should have gained verbal consent and explained what she was doing but maybe you were busy bonding with your baby!
Pinupgirl - sorry, but that is a horrible attitude that seeks to silence women. You have to put up with any kind of horrible and degrading treatment, even being assaulted, and then should be grateful to have a live baby.
Of course, women who don't want to be treated like a piece of meat are just thinking of themselves and don't give a shit about their babies
Amazingly enough, it is actually possible to deliver a healthy baby AND be treated with respect.
nurseneedshelp - do you see gaining consent as just some optional extra? Nice to get, but women should just be grateful for whatever treatment they get.
CONSENT is required for any examination or procedure.
that's the law.
doesn't matter in any way who is doing it or for what reason or however laudable their motives.. it's assault without consent!
majoo yes that would be assault and it has happened to be and I think everyone on here would agree that that would definitely be assault as I would be a party. This case went straight to court and I won. Yes that was assault! A midwife did a check A CHECK to see if OP had torn needed stitches whatever. Are you saying what happened me is the same as a midwife checking a woman after she's given birth? Can someone more articulate than me please explain this to majaoo
"Right! Did she actually put her hand in your vagina?"
You sound a bit aggressive here yourself sweetie, especially as you say it's a sensitive topic.
I think you need to back off from the OP a bit, she doesn't have to answer that question. She's not on trial here.
I delivered my baby, she had nothing to do with it. Thank you for the supportive comments, I will call PALS and hopefully get some closure. I want to move on. I really need to. X
I'm disgusted by this thread, what a surprise.
She should have gained verbal consent and explained what she was doing but maybe you were busy bonding with your baby!
Ah, so that's fine, as long as she was bonding with her baby, perfectly justified to shove her hands inside her without consent then.
ballinacup - why is it a stupid comparison? Putting your hand in someone's vagina expressly against their wishes with no attempt to gain consent is pretty clear cut.
nurse, assume like me you are/were a qualified nurse?
I never assaulted a patient. I assumed that was not my role!
A midwife did a check A CHECK to see if OP had torn needed stitches whatever
Without getting informed consent, which part of this are you NOT getting, honestly.
It's not bloody difficult.
Don't stick any part of your anatomy inside a woman unless she TELLS you you can.
And what happens when medical professionals start disregarding consent forms? Do you think that they should just be able to do whatever they like whenever they want? There are any number of reasons why people refuse treatment or ask for alternatives. Religion, fear, previous trauma, inability to understand fully due to language barriers or learning difficulties. It is not ok to just go and do it no matter how "trivial or harmless" the procedure is deemed to be.
The baby had been born already. There was no threat to the baby or ops life and it would have taken five mins if that to look at notes or actually speak to the patient.
op absolutely should complain. Imagine who else the midwife has done this to.
OP you don't have to answer anything asked of you here.
You were given an internal examination without your consent, something you had expressly stated you didn't want in your birth plan.
Nobody should be making you justify why you feel assaulted because of that.
I know where you are coming from Hens I very rarely talk about it with anyone as I get similar responses that you have done here.
I ended up with severe PND and diagnosed with PTSD (mine was from repeated attempts at a foetal scalp monitor with three different people trying with just gas and air).
All I can say is a can empathise with you 100% I wrote a letter of complaint but never had the guts to post it because I couldn't face going over it again.
With time (DS1 is 5) I have got better and no longer have flashbacks. I was also able to have a smear done for the first time without a panic attack this year.
Those of you who are saying "put up with it" clearly have no idea how the OP or anyone else this has happened to are feeling.
Please pm me if you want to talk.
I hope you can come to terms with it some day (instead of being told to "get over it, you have a healthy baby" like I was).
The midwife has just safely delivered the womans baby!
There would be an out cry if she'd not examined her and the baby died! Then you'd all be asking why hadn't she been examined properly!
Ffs you lot want to try working in such a high pressured job when you're trying to save lives with minimum equipment and the threat of constant litigation!
You haven't got a clue!
She was doing her job!
nurse - the OP delivered her own baby. Does being an HCP entitle you to stick your hand up a woman's vagina without their consent?
Does "saving lives" mean you can do what you like regardless of the patient's wishes?
Is assaulting your patients part of your job?
The baby had been born and was breastfeeding. Checking to see if the mother had a graze/tear was not a life threatening emergency
I am shocked how many women think it's okay for a person to touch them without their permission.
It is actually a legal requirement that a medical professional must ask for consent to perform any procedure . any procedure at all.
not to is assault, even if it doesn't hurt.
there's no implied consent either - the person must ask and obtain express permission.
so, yes hens - complain officially and have it followed up.
Your name is incredibly appropriate.
You certainly need help if you think anything makes touching a woman without her consent acceptable.
She wasn't doing her job PROPERLY she didn't read OPs notes and she then assaulted her.
You don't have a clue, love.
maja00 you're insulting any woman who has been assaulted sexually. Just stop it, you're making yourself sound sillier by the post. There is a world of difference between a man doing that under sexual motivations and a midwife performing a post birth check for tearing etc.
ballinacup - sorry, I disagree that motivation is the big division. Consent is. Without consent, against the women's wishes = assault.
"The midwife has just safely delivered the womans baby!"
No, she hadn't.
"There would be an out cry if she'd not examined her and the baby died! Then you'd all be asking why hadn't she been examined properly!"
This makes no sense. The midwife examined the OP to prevent the baby from dying? How does that work?
"Ffs you lot want to try working in such a high pressured job when you're trying to save lives with minimum equipment and the threat of constant litigation!"
Makes it all the more important to read notes and ask permission and explain things to patients and ask permission before you do something so traumatic to them.
"She was doing her job."
nurse - the baby was already out FFS.
how would examining OP make any difference to the baby's life or death?
But doing her job involves seeking consent and ensuring she looks at notes do as to be aware of these things. If she had asked and op said no then that's down to her. Staff would have to accept that those were her wishes and explain the consequences. Once a disclaimer is signed surely all responsibility falls to the patient.
Doing your job means sticking to the protocol no matter how much you agree or disagree with it. Patients are free to refuse anything they wish.
I wish I had people like maja00 and ANormalOne around me when it happened to me. You both get it.
The body- yep I too am a nurse, a nursing sister with 20 years experience in a very busy A+E department.
I've obviously never assaulted any of my patients but I've sometimes undertaken procedures that they've fought against and been too ill to consent too.
Its called being their advocate and providing care that's within their best interests.
Clearly the op wasn't in this situation but I'm quite sure the midwife hasn't assaulted her or done anything unnecessary!
And it is only an "insult" to people who have been sexually assaulted if you believe "medical" assaults are trivial, not really a problem, not an assault at all in fact - which I don't. I don't think the women who are left traumatised by assaults by medical staff think it trivial either.
a major part of being an HCP is making sure everything is followed to the letter.
that's because it's such a high pressured environment that it's minimising anything going wrong and being blamed if it does.
Nurse you are the reason the VHS terrifies me I hope you we reported and sacked
nurse - they've been too ill to consent to - i would assume that you'd then get next of kin permission?
the one that in the OP had been deliberately sent out of the room so he couldn't object...
I experienced it myself at the hands of a doctor lying to me about medical treatment and treating me incredibly roughly, including stitching me without adequate anesthetic to the point where my DM stepping in and stopped her because I was screaming in agony. As a rape survivor, I'm still traumatized by my birth.
Just doing her job though, don't you know, they're all so under pressure and that means it's okay.
nurse - when you say you have done procedures on patients who have not consented and have fought against it, do you mean people lacking mental capacity? Some kind of court order in place?
This obviously does not apply to the OP - she had the capacity to consent or not.
ANormal that's awful. I'm sorry that happened to you.
I don't understand how they can ignore somebody screaming like that (I was too after about the sixth time someone had their entire hand inside me). Where has their empathy gone?
OP I'm so sorry this happened. I do think you should complain, and also seek some counselling for yourself.
I don't really get the posters who are giving the OP a hard time? I don't get how this is not assault? How fricking easy is it to say, "I just need to examine you now and that includes doing an internal, is that all right with you"? Which is exactly what the midwives said to me after both my kids were born. Each time I had an internal I was asked beforehand and told what they were doing and why. How hard is it for a HCP to treat the patient like a human being and not a piece of meat? I'm sure if someone stuck a finger up your arse without telling you you'd have something to say about it, so why the fuck is it any different if it just happens to be your vagina?
I am so sorry this happened to you and fully understand that you feel violated.
The midwife would have wanted to examine you for vaginal/pernineal trauma (tears or grazes). the examination is important as if you had for example an undiagnosed 3rd degree tear it could lead to problems with continence.
however the midwife should have explained to you what she why and how she wanted to examine you and under no circumstances should she have done this without consent. If you declined consent - and I imagine you would have - she would have been obliged to document this clearly in your records (and no doubt you would have had a more senior midwife/Dr then ask you again etc)
I wonder what would happen if someone refused an internal and bled to death due to post labour complications or had some sort of internal damage that was not picked up and that was discovered at a later date.
Sorry to sound insensitive but I do think people need to be aware that it is highly likely that you will need to be examined internally during labour and prepare yourself for it beforehand.
I am also not quite sure what you mean by being in public view? Was you in the corridor or in a room with other people present who were not part of the medical team?
Eh? Reported and sacked for what???
Providing emergency care for dying patients!
Think that's very unfair as you don't know me!
I was stuck at work for an extra two hours last night dealing with a fatal stabbing so don't start coming out with shit like that op! I'm one of the most dedicated sisters in our department.
Sorry that the NHS terrifies you and that you had a bad experience, speak to PALS.
Off to bed as I've got another 12 hour night shift to do!
I can't believe some if the responses on this thread!!
Whether or not Hens needed the examination or not is NOT THE BLOODY POINT!!
The midwife didnt ask consent or make it clear what was about to happen. OP obviously had an issue with this beforehand so tried to protect herself from this exact situation by having it noted in her birth plan. The Midwife didnt check this.
I have never been pregnant but I can still understand why the OP feels as she does. Complain OP and please try to get some counselling.
Madamecastafiore - you are allowed to refuse medical treatment even if it would lead to your death. The HCPs need to share as much information with the patient as possible to allow them to make an informed decision, but they can't impose their views of what is best.
I wonder what would happen if someone refused an internal and bled to death due to post labour complications or had some sort of internal damage that was not picked up and that was discovered at a later date.
Nothing would happen. The patient has the right to refuse medical treatment, and as long as the complications are explained to her and she knows them, it's purely her decision.
Pinupgirl, I'm very sorry for your loses, I can't begin to imagine what you've been through. However, your experiences, and your happiness to consent, does not mean that all women have to consent, or that they should just accept what was done to them.
ballinacup, as a woman who has had experiences of both sexual assault, and having a medical procedure I did not consent to, during labour, I can assure you, maja is not making me feel insulted in the slightest. For me, the medical procedure was actually more disturbing. It was the surrealism of it. I was in a hospital, where I should have been safe, surrounded by people who claimed to be caring for me. Both my husband and I were so shocked neither of us could react.
OP, you are not over reacting, and I'm so sorry this happened to you.
FFS the midwife asked if it was ok if she could check her - this is probably the terminology she uses dozens of times a day. The midwife may have been busy and not fully read the notes and therefore not realised that she had to explain in detail the examination she was about to carry out - probably as she does this 'check' dozens of times each day. If you ask the midwife I'm sure she would feel she had gained consent.
I am a HCP and I can imagine using the term 'shall I check down there' etc and esp in the immediate post birth environment I would have thought this would have been enough for consent.
Whilst I feel for OP that she didn't realise what she was consenting to I feel it is unfair to describe this as assault, at the end of the day the midwife was doing her job to make sure that the patient was healthy and her perineum was intact - a vital part of the postnatal care surely. Not great care I agree but not worthy of the massive out pouring of indignation directed towards the midwife
nurse you sound very lucky not to have been sued so far if that is how you carry out your job.
Completely agree with maja00 and others. The analogy with a man sexually assaulting you it is perfectly valid. Neither are with consent. And as we can see from the OP both can leave you feeling violated. Not sure why different motivations matter. Not gaining consent is not gaining consent.
Women are human beings, with valid feelings and bodily autonomy and integrity. No-one has the right to touch you where you don't want to be touched. No-one.
rowtunda - I don't think the midwife being lazy/inaccurate in her wording is an excuse. It is her responsibility to gain informed consent.
The midwife didn't gain consent, didn't read the notes, as an a result of her actions left the OP hurt and traumatised. Assault is perfectly accurate.
Hopefully the OP's complain will result in this midwife getting some training on what consent means. Maybe you will reflect on your practice too?
I agreed to an internal during my last labour, and while she was in there the MW did a sweep - which I hadn't asked for, didn't want and didn't consent to.
She told me after she'd done it while I was requesting an epidural and about an hour from giving birth. I said isn't that to speed things up? (was having ctx about every minute) and she said yes, and I said I didn't want it to speed up, I can't cope and wanted an epidural.
I didnt complain to anyone but the more I think about it the more fed up it makes me. She had been fobbing me off about having pain relief for ages already.
Yes she should have explained fully and sought explicit consent. I am a HP and cannot condone what she allegedly did but do understand why, in a busy, oversubscribed, underfunded and under pressure unit these things happen-that a Midwife might think that asking to do a 'check' would be adequate and convey what she meant to do.
And I am not condoning her actions, merely trying to explain why these harried/hurried oversights happen before the MN attack dogs are set on me.
Sending husband out? Ask why this happened.
But the claim that internals are unnecessary and that there is nothing that can be detected via an internal alone that vigilant observational Midwifery cannot is not true (made by previous poster).
The start of my own cord prolapse was detected via digital examination where no outward signs of it had manifested.
I understand that you were newly delivered OP but beware of absolute statements about what can/cannot be detected via each specific intervention. Go to PALS and write down as objectively as you can, what happened, where and when. You can explain the reasons for your distress and the effect it has had upon you in another part of your statement to them.
I have had midwives say they want to "just do a little check" and then actually perform a sweep in one case and attempt to break my waters in another. Using something vague like "little check" to do whatever you feel is best is not a substitute for gaining informed consent I'm afraid - even if it is quicker/more convenient for the HCP.
And they wonder why there is a shortage of midwives! Surely if you are giving birth you expect to be examined down there both in and out if necessary. I can't imagine a midwife does it when it isn't necessary - why would they?
If the midwife had found a perforation resulting in saving your life I suppose the internal would have been excusable?
frog - it doesn't matter if the internal was justified, not gaining consent isn't justifiable.
It's a surprise how many HCPs on this thread see gaining informed consent not as an absolutely basic part of providing care, but as an optional extra that can be dispensed with if they are busy.
RE what Nurse said -
a patient admitted with hyper/hypo Glaycaemia can be combative until emergency treatment is carried out;
a patient with a head injury can be combative and confused until emergency treatment is carried out;
a patient who is severely toxic can be combative and confused until treatment is carried out;
a patient hit by a car and semi conscious at the roadside, combative and confused until emergency treatment is carried out;
and ditto ad nauseum. 'Restraining' in these contexts involvees protecting a patient from further harm. Blocks used to immobilise the head are 'restraints'. would you prefer we waited until hopefully a patient regains full consciousness until we apply them? Honestly....
Would those outraged at Nurses comments suggest we leave these patients to die unless they have conveniently brought along a relative to consent on their behalf? Or until they can consent lucidly?
Why do people think that it's acceptable for HCPs to not bother asking for consent?!?
The need for consent is there for a reason. If patients are informed and refuse then they can sign a disclaimer to say that they refused. Buck stops there. However if examination is done and there are complications of some kind and its discovered consent was not given then that's when there's trouble surely?
Nurse I can assure you none of those conditions applied to me I was perfectly able to hold a conversation and make my own decision. Or would you have held me down for that examination? Because YOU felt it was in my best interest?
maja00 - I just don't get it though. I truly don't. I would be grateful for a midwife to do anything to make sure that everything was ok and through my experience an internal is necessary for that to pick up things that can't be known from the outside. It could be life saving.
If you do something many times a day, day in and day out, in stressful conditions, surely wording something slightly vaguely can be forgiven. Surely we should be grateful for midwives and be thanking them, not beating them with a stick.
If a doctor stopped beside me in a car crash and did a check on me without my permission that could potentially save my life I would be grateful, not damning. Surely child birth is a little like a road crash in that it can be very dangerous and things can be unpredictable and damage unseen.
mignonette - nurse didn't give any indication about whether the patients she didn't gain consent from had the capacity to consent. Obviously in the OP's situation she was completely capable.
mingon none of those examples are at all comparable to a woman who is fully conscious and not in a life threatening situation. OP was perfectly able to make an informed decision on whether to consent or not to consent to an internal examination, she was never given that choice.
mignonette, in the examples you have given the patient would be unable to give informed consent for necessary treatment in an emergency situation. The OP was breastfeeding her newborn, there was NO emergency. She hadn't had pain relief and was lucid, so informed consent was entirely possible, but was not gained. The two types of situation are so different you cannot possibly draw those kind of conclusions.
frogwatcher - it's fine for you to consent to anything you want. It's not fine for HCPs to do things to other people without their consent.
The OP's situation wasn't a car crash, there was no emergency. There was no reason for anyone to do anything to her against her will. Being busy and doing the same things day in, day out, maybe no longer seeing the person in front of you as an individual, might be a reason for the midwife's behaviour - but it isn't an excuse.
Surely we should be grateful for midwives and be thanking them, not beating them with a stick.
Yeah, don't expect me to thank anyone who puts their fingers inside me without my consent, that's not happening and I don't care how overworked they are or how stressful the jobs they do is.
I thought op said the midwife said something like 'I am just going to check down there' or similar. Surely that is telling the op what is happening isnt it? I would have known what she meant.
Rowtunda whatever terminology the midwife uses daily, it isn't good enough if the patients don't know what she's talking about.
She might know exactly what her little check involves, but to a patient someone unexpectedly inserting something into you might not be a 'little' check at all.
Saying you want to have "a look down there" means a look, not an internal exam, a "little check" to someone who does this 20 times a day doesn't translate to "internal exam" to people who have never had this happen before.
Every one of my midwives asked permission and explained what they were doing when they examined me. It wasn't difficult for them to say things like "I'm going to have to examine you inside, it might hurt, is this okay?" Doesn't really take much more to say that than to say "I'm going to do a little check" and is far more clear for all involved.
Nurse I don't know what you are like at work but on here you sound pretty awful, and perhaps it's just translating badly but really, it doesn't sound good or compassionate. It's your job, it's their life.
No mignonette - but crucially there should be clarity around the issue of consent. If consent cannot be obtained before treatment everyone should be clear about why that is.
None of those situations are related to the OP, or the general situation of internal examinations during maternity care, where consent could have been sought but wasn't.
frog, so you think the midwife assumed the OP knew what she meant. Ok, then it's fair to say that the OP would have assumed that the midwife would have read her notes before attempting anything invasive. She didn't. If she had she would have known that the OP did NOT consent.
No Nurse didn't write an essay detailing every single aspect of each case and nor should she. It is not difficult to work out what she is referring to; she stated she is an A+E Nurse working in a high pressure environment.
I am not comparing the examples (both Nurses and mine) to OP's situation which if you re-read what I said in the context of a comment on the responses to Nurses earlier posts, that should be perfectly clear.
Bit ironic reading criticism of a MW who didn't read notes by some people who clearly do not read up thread properly or understand what a post is referring to
No, "a check" is not gaining informed consent for an internal examination, especially when the OP had expressly withdrawn consent for internals in her notes. "Can I do an internal examination?" is asking for consent.
Consent isn't an optional extra for when HCPs remember/aren't busy/feel like it. It's a basic. If some are forgetting this, then it is important people complain so they are reminded.
I can imagine what happened here. The OP said no examinations during labour - fine, that was respected. Afterwards I bet the mw said something like "Can I check down below to see if you need any stitches" (so she thought she had consent) but didn't explain that it is a) very stingy and painful after you've just pushed a baby out and b) that the fingers go slightly into the vagina. I actually wouldn't class it as an internal examination in the same way as one during labour, although there is some entrance. And in fact it wouldn't occur to me that someone who didn't want internal examinations in labour (which is totally valid) would also not want to be checked over for trauma!
Sounds like a case of poor communication.
Not that ironic mignonette, since no one reading this thread is going to put their hand inside any other poster's vagina unasked.
Jaja00 and A normal One - I could understand if the procedure was totally unconnected with the area of the body in question. Say you went for a tooth op and found that you had had an internal - that would be so wrong on so many levels.
But having had the experiences I have, and seen others with worse, I really do not think that anybody would want the internal damage that can happen during childbirth being not picked up and the only way to do that would be through an internal. If left it would be life changing or life threatening.
If she had said that, then clearly op. expected (like most of us would) that the midwife was familiar with her case notes and would only do the external exam.
I would not expect to have to repeat myself to every member of staff when there's a chart and a birth plan. They are supposed to look at charts aren't they? I mean that's what they are for, so all staff on shift can check each patient easily. You know, to avoid drug reactions and unwanted or unnecessary procedures.
Too ironic. Some posters on here cannot even read information given in posts accurately whilst sitting merrily reading/relaxing in front of their screens.
God only knows how these people would cope when reading under pressure and then being expected to act upon it.
Blue has put it perfectly. What he/she says is what I can't get.
But they could still ask frog, and bottom line is it's persons own decision which medical procedures they wish to/agree to have.
I really do not think that anybody would want the internal damage that can happen during childbirth being not picked up and the only way to do that would be through an internal.
I don't want internal damage to be missed and I don't want someone to touch me without my informed consent either. I don't think that's too much to ask for either.
If OP didn't want an internal examination that's her choice regardless of whether others agree with it - unless you're advocating we tie women down who refuse internals and examine them against their will then I'm sure you agree with me too.
But if a patient states no internals during labour, then how likely is it she wants one after?
OP, sorry you're feeling so low, you poor thing
My Dh was sent out of the operating theatre after I'd delivered my son as she joked that it was far too undignified patching me up for Dh to see. Do you think that might be why the mid wife sent your Dh out?
The other thing is you say you were examined in public view, do you mean there were other people in your room?
You don't have to answer those questions if you don't want to x
"I am not comparing the examples (both Nurses and mine) to OP's situation which if you re-read what I said in the context of a comment on the responses to Nurses earlier posts, that should be perfectly clear."
So why go into them on this thread?
The OP is clearly talking about a very different situation to any of those you have referred to or Nurse may have been referring to.
So why bring them into it to muddy the waters when what happened to the OP is clearly different.
She was not unable to consent, she was not confused or combative. She just wasn't asked properly, her notes weren't read and any consent she gave was uninformed because it wasn't properly explained to her what the midwife in this case intended to do.
Yes poor communication and it needs addressing but what support is OP getting in RL? Why won't your GP be supportive? Can you see a different one? What about your HV?
How is your mood generally? Is this becoming such a preoccupation that it is overshadowing what should be a happy time? If so then you need to gain RL support from people/groups as well as NRL.
Sorry for the questioning but there is a danger that something like this can become so preoccupying that it cancels out all that is good and memorable. It doesn't have to be this way. Consider all avenues of support because going through the complaints process is not something you should do feeling alone.
OP you are being so brave to be complaint and talking about it on here
Please ignore anyone, no matter how well meaning, who tells you to 'get over ir' and just concentrate on your baby. I felt I should be doing just that after a incredibly traumatic stay in the post natal ward, and it weighed me down adding to the guilt and shame of being traumatized.
I think good councelling might help you try and process what happened and help you to put it in the past where it belongs - but really you can only do that when you've put alot of effort and expertise into this journey of healing. Not just 'shutting up and putting up'!
I had flash backs and was really really shakey and traumatized for months, and people get 'stuck' in that state if you can't process it and come to terms with it. Its awful. It was actually talking about it on mumsnet that helped me realise quite how bad it had been and that it was ok to be feeling so bad. That was a huge deal for me, as rl people, (& myself), had been minimising it all and pretending everything was fine... Which made it do much worse.
That's why it's so important to get help, and also try and get back control by complaining and getting people to admit what they did wrong and maybe even learn from it?!
I wish I'd followed up my complaints formally, as it doesn't matter how busy / stressed / overworked people are, there is never an excuse for treating women like animals.
Anormalone - in my situation you couldn't have had both. You either would have had the damage or the internal.
I don't think we should tie women down and examine them - of course. That goes without saying.
But there has to be a limit on how difficult we make peoples jobs (and how much we complain about the care we get given that it is the best/safest it has ever been) and there are ways of doing a good job and making sure all is well, and of doing a partial job. You wouldn't go to the dentist and refuse to let him/her put an instrument inside your mouth and request that he just look from the outside - this would be akin with that. What is the point. You may as well not employ the dentist in the first place and just get a friend to check the teeth.
I am trying to understand - I just can't as all I see is that it is part of completing the job and doing a good job, and as unpleasant as it is it can be a life saver - literally.
Perhaps my experiences bias me.
Not muddying the waters. The over the top, all or nothing responses to what Nurse said deserved a response.
Since when did discussion need to be linear?
Agree with bues comment completely
But I absolutely do agree that you should be told what is happening and in that way give consent - but I think there was a miscommunication. I think from what the op says, the mw did think she had consented.
I categorically do not agree that any hcp can simply go there without telling you.
And there was an element of 'why do HCP's not feel the need to seek consent' which kind of does bring it into the conversation....
nurse you have my respect please sleep well and continue to do a great job. Thank you. OP report it and see what happens Id love to know the outcome. You may want to consider going private if the nhs terrifies you. I hope your little one isn't at sick kids hospital as much as mine, I don't know what I'd do without them. Good luck with motherhood and congratulations on a healthy baby.
Hoorah for mignonette someone who understands and doesn't think I need suing or sacking for providing emergency care that my dying patients haven't consented too!
And I quite rightly haven't gone in detail due to patient confidentiality! I'd get another flaming :-)
Blimey. I know I am not being helpful here and I can't start a thread about a thread, but all I can think of is how grateful I was to receive all the brilliant care that I did when I gave birth.
If I had (I am sure I did but I cant really remember) I was confident that it was for the good of myself and my baby.
I had wanted a home birth but thankfully decided to go into hospital, I ended up with an emergency CS. In all honesty, I could not have cared less about any examination by the midwife or doctor.
I am sorry though that you feel that way and I hope that you can get past it and enjoy your baby.
mignonette, nurse didn't explain she was an A&E nurse until one of her later posts. Most of the responses seem to be to her earlier posts, excusing the midwife for not gaining consent because the OP was bonding with her baby.
I agree with Sarah, you are muddying the waters. The situations you describe have no relevance to the OP here. Using them to explain away someone elses comments (when they themselves have seemingly drip fed about their own situation) is unhelpful. The element of "why do HCP's not feel the need to gain consent" has been quite clearly applied by most, to situations when informed consent is entirely possible, such as the OPs experience.
Op I would have held you down if you were ill and were at risk of harming yourself/me/other patients!
There's no comparison with ED nursing to midwifery!
I find it so sad that were living in such a blame culture, virtually everyone gets a CT scan these days if they come in with a headache because our doctors are frightened of getting sued! Then the patients have the audacity to complain that the results take an hour to come back!
Try living in a country where NHS care isn't available, go have your babies and see how much it would cost you!
I'm glad we live in a culture where (most) people do not think it's ok for HCPs to assault women.
Responses along the lines of 'you should be sacked' were after her professional disclosure (which was pretty clear to me)....
I totally agree and believe that HCPs need to change their views and approach regarding getting consent before doing anything to another person (including explaining what they are actually going to do).
However, I also think there needs to be some form of protection/more protection for HCPs against complaints when there are bad consequences as a result.
At the moment, its a bit like they're between a rock and a hard place. And whilst I don't agree that anything gives them the right to override consent, they are certainly highly pressured to achieve good outcomes, as well as facing lawsuits/loss of career if something does go wrong.
I wonder if having a form to sign, similar to the 'self-discharge against advice' form would help. Not just to protect HCPs but also to make them more consciously aware that actually, the patient's choice is central, and not their own targets.
In fifteen years time it is highly likely that MW's won't even exist any more in sufficient numbers. Babies will be delivered in the main by medics.
We can have a linear discussion about that one day too .
So because her health care was free she has to be grateful for the bad treatment she got? She wasn't in any danger, baby was fine and surely when working in an a maternity ward/unit it doesn't take much to realise these women are exhausted vulnerable and in alot of pain and that perhaps a few mins of explaining and an attempt to be a bit gentle wouldn't go amiss???
You can't compare emergency situations with one where the mum was there and able to consent.
I never said I condoned assaulting patients nor the non seeking of explicit consent.I have to be very careful and explicit with my clients because of the field i work in and the nature of my clients problems.
I don't condone an intention or thought of violence towards a HCP either.
I'm glad we live in a culture where HCPs generally are still prepared to do what they need to do. As the blame culture gets worse this will stop and care will get worse. There will be more back covering than caring and nobody will want to step in and do something a little risky in case they get complained about or sued.
I feel sad that the op is sad and understand that for some people it is more important that things are explained. I can understand the op a little as I struggle to go to the dentist due to circumstances that made the mouth a no go area for me. However, I do still go and bear it even though I need a drink before hand and I do like to get the low down on everything they are going to do. But they don't explain everything prior to doing it. Last time they cleaned my teeth without telling me they were going to and I was almost sick with fear. However, I wouldn't complain or think of it as assault even though for me the mouth is far more personal than anywhere else. I have to tell myself that they are doing it for me.
There was another thread recently where a poster wondered why women allow themselves to be assaulted in labour/postnatally - "why don't they just kick the HCP in the face?"
Anticipating many crossed posts, but still...
OP, congratulations on your baby, I'm so sorry that the happy event has been overshadowed in this way. I do hope you're taking care of yourself and will seek RL help if you feel you need it. Does your husband understand how you're feeling?
I am absolutely disgusted by some of the responses on this thread, both as a woman and an HCP.
Consent is vital. What the OP describes is assault. She has been very clear that this was not an emergency situation and she was competent to make her decision. The MW may well have felt that she obtained consent - so at the very least making a complaint should result in some specific retraining in what taking informed consent actually entails. I am very clear about what I am asking a woman's consent to do - and even in an emergency situation (perhaps, especially in an emergency situation) it is important to do so - it's not time consuming to state that you want to examine internally FGS!
Yes, to properly check for tears one does need to examine a woman internally (there can be vaginal/cervical trauma without external tears). If this had been properly explained she could have chosen not to consent, or to consent to a limited exam and the MW (again, not acting in isolation) should have respected and documented this. She would have had nothing to worry about had anything have "gone wrong" in the future.
I wonder if the responses would have been the same if the HCP had been a doctor? A male one? If a complaint like this was upheld by the GMC what do you imagine the outcome would be??
In an emergency situation, yes, it may be necessary to go against a patients wishes - but that is not one person acting unilaterally in an otherwise empty room. Making a best interests decision to act without consent involves senior members of the team -not just one individual- and I hope this is what Nurse is describing. This is obviously right and defensible. Perhaps the MW did feel she was protecting dignity by sending DH out of the room - but it wasn't her decision to make - it was the OPs.
And fwiw, relatives connot give consent on behalf of a patient except with enduring power of attorney etc. If a patient doesn't have capacity to make a particular decision then it's up to the healthcare team do act in their best interests.
As a former HCP I'm hoping a lot of people on this thread are just keyboard warriors When people share experiences like this you need to take it as an opportunity to reflect on your own practice and make sure there's no room for catastrophic miscommunication of this sort, not minimise and try to justify shoddy practice.
There is no excuse for not explaining to someone you're doing an internal! I used to work in gynae and "check" does NOT mean internal to me. Some women cannot tolerate internals for various reasons, it's possible to arrange light sedation for example which allows some women to relax enough for vital exams.
OP, I'm so sorry this has happened. Please see if you can access some help, might you have PTSD? Where I live there are specialist midwives for traumatic birth, maybe a chat with someone like that would be a good starting point? And keep complaining, I don't think that's quite adequate from the som.
Why wouldn't you complain frogwatcher? I find it very odd that you would just accept any treatment dished out to you, even though it made you "sick with fear" when it could have been easily avoided by the dentist taking 30 seconds to explain what was happening/get consent. It really isn't too much to ask.
god there are some depressing attitudes on this thread.
the midwife should have got the ops informed consent, it does sound like miscommunication inthe midwife said 'she was going to check' but the op didnt realise that meant an internal examination. but the midwife has a responsibilty to make sure her patients do understand and are giving informed consent.
seems to me that when it comes to preg and childbirth there is still a put up and shut up attitude and you should just let hcp do what they want and be grateful to get a baby atthe end of it. consent is often not sought and i had numerous drs state what would happen, when i questioned if something was necessary ie a sweep/internal/induction etc etc they seem suprised and at times annoyed.
informed consent shouldnt be too much to ask for!
I hope AlanMoore and DoingTheSwanThing's post inspire a bit of confidence that some (most?) HCPs do take consent and basic rights seriously.
Hens I realise I am somewhat late to the debate you've sparked off here but I wanted to lend my support to you and agree you should complain in an official capacity.
I was lucky enough to have fabulous midwives when I had my first baby recently. I had no birth plan etc but at no point did I feel like I wasn't fully informed about every step and procedure. This is how a labour and post-birth experience should be, so I wrote a letter thanking the midwives for this experience.
However, I did end up writing a letter of complaint too as something happened to me during aftercare which almost ruined the whole experience. A midwife who was supposed to help learn to breast feed used such awful accusatory language when it wasn't going positively that I was in tears, before snatching my baby out of hands claiming he looked jaundiced and took him away to another room. I couldn't move quickly because of my stitches and felt totally helpless. My baby had been checked by the paediatrician a few minutes before so I knew he wasn't jaundiced. That experience led to me being extremely over protective of my baby and I felt like a failure due to difficulties with breast feeding.
My (rather long winded) point is this: being in hospital should be safe and you should come out feeling cared for. Do complain - you should have known exactly what was going to happen before you were examined. If there had been an emergency you still should have been informed or more senior staff would have been called. The response to your initial complaint was wholly inadequate due to the wishes already stated in your medical notes.
I hope you are able to move forward and enjoy your baby.
maja00 - I wouldn't complain because I am lucky that I have a lovely NHS dentist who actually is pretty good. They are just doing their job and generally explain everything they do. I slip up in my job and accept that others do too (and do not believe anybody who says they don't on a daily basis however small) and I forgive mistakes. If they were deliberately neglectful or malicious that would be different.
"I wish I had kicked her in the head and screamed and called the police" and
"you are the reason the NHS terrifies me. I hope you were reported and sacked"
go a long way to removing any sympathy/credibility you have. You simply sound vindictive and not someone looking for a good way forward. What do you want? Someone's head on a platter?
Its not exactly the case that HCPs have nothing to worry about in a case of refused consent though.
They also have to be able to show that the patient was informed of possible risks/consequences of not having the intervention/treatment.
Which means it wouldn't have been enough for the midwife to have accepted "No" for an answer, she would have needed to go through the potential consequences (which may also come across as bullying/coercion - ie. if you don't do this, this could happen).
I don't like the system the way it is (used to work within healthcare, although not midwifery), but I do think there is not enough backup for HCPs about how they can accept a 'No' whilst still protecting themselves. Perhaps even leaflets (giving pros/cons of not having an intervention) or simple opt-out forms would make a difference.
its not a small slip up when they fail to gain informed consent tho. its a major failing and should not happen.
A similar internal examination saved me from a massive haemorrhage after child birth. I remember being vaguely confused and very irritated when a nurse quickly followed by a doctor gave me internal examinations.
I went on to lose so much blood - massive clots and I think the medical professionals were just doing their jobs and trying to assess.
By the way, I am also a mother with a couple fairly traumatic birth experiences under my belt, and by no means think all HCPs are angels (nor devils, just human). And agree that there is no excuse for bypassing consent.
Am really trying to think of practical solutions, unpick the 'why' of the situation a bit more.
I think it's fine, and very necessary, for an HCP to go through the risks of refusing something (and the risks of accepting it!) when gaining informed consent. "Do as you're told or your baby might die" is coercion and bullying, "I want to do X because of Y, if I don't do it then there's a very small risk/50% chance/likelihood of Z happening. The other alternative is ABC" is giving someone enough information to make their own decision.
Right, if op had refused the examination, the mw would calmly explain to her why it was so important and see if there is anything that could make it easier. If op still said no mw would get senior staff involved. If still a no then a no. All clearly documented and at the patients own risk.
It's not a rare occurrence for patients to decline treatment!
It really does depend on the culture of the hospital/ward you're in AlanMoore (having rotated around quite a few myself).
Not all senior staff are willing to come to the bedside, and in some places I've been unfortunate enough to witness a very heavy-handed top down approach (I don't have time for this, just get it done, etc.)
It absolutely shouldn't be that way, and I do think a lot of old-fashioned practices are essentially passed down to the newer graduates by force/bullying, again which shouldn't happen... but does!
I think empowering junior staff to be able to deal with "No" better, would be a good start.
Relatives can give consent especially with regards to children. and not all parents are lucky enough to be at the bedside when decisions have to be made and consent sought. And many elderly patients do have EPoA and similar legal setups in place. In MH the issues around consent are even more complex- I have had to wearily explain time and time again why HCP's cannot use the MHA to enforce physical treatment upon somebody with a MI. So I am aware that HCP's are not 'Angels' (yuck to that term-an excuse to pay poorly and treat like shit when you get into vocation speak). However should the OP have kicked the MW in the head, it'd have been blamed upon the birth process as opposed to appalling attitudes/behaviour. Doesn't excuse the lack of seeking explicit consent and failure to make crystal clear why every procedure/interaction is being suggested.
And yes, it is a team discussion re consent and medical/nursing actions required. That much should be implicit within the setting that Nurse and people like us work in. That kind of doesn't need to be said really....
How much detail do you feel you want when consenting to procedures? Totally genuine question to everyone here.
It sounds like the whole attitude of the staff was the problem too. You can't be like that even you are working with pregnant /labouring or post natal women. (Shouldn't be like it with anyone obviously but there's no denying that the very nature of pregnancy and birth does make women extremely vulnerable)
If you can't be kind , considerate and respectful then you are in the wrong department. I don't buy the " busy or rushed excuse either I had many an internal examination during pregnancy and even at midnight in a&e when it was busy and she appeared to be the only dr available to anyone, there was one dr who I had a few times who never ever failed to be kind gentle and explain everything despite looking exhausted and frazzled. So it is possible. Just a shame the maternity ward staff weren't more like her.
You just can't treat people the way the op and her husband were treated. It's wrong.
I'm thinking of a small A5 or so sized card with 3 Pros/Cons/Alternatives columns.
At the bottom circle 'I do' or 'I do not' consent, plus signature.
Again, just trying to visualise a system that would work better, and might help remove the fear/lack of information to hand that might be driving some staff (especially junior).
I would have loved to have a simple bit of information presented to me like this when I was being pressured into an epidural in my younger, more naïve days.
I am a qualified nursing sister though haven't practised in last few years.
however I have never ever not explained any procedure to a patient, unconscious or otherwise. I have never ever presumed consent to anything.
the only time I have ever helped to restrain a patient was a very drunk man who had punched the attending doctor and that was self defence.
in my experience people react very well to warm, calm, full explanations and also in my experience people 'kick off' in hospital because they are scared and vulnerable and do NOT need restraint or assault they need kindness and care.
op please complain.
Glad I'm not a midwife. Kicked in the head. Charming.
Many illnesses/symptomatology can cause confusion and aggression totally unresponsive to reason (cerebral oedema for one).
I have worked in MH for 23 yrs and have never been assaulted. I have felt very unsafe and threatened but never assaulted. Pointing out reasons for (not excuses) for what happened and defending a fellow professional against hysterical calls for their sacking does not mean I am an apologist for failure to follow ones professional code of conduct.
Restraint to avoid a person injuring themselves is not the same as restraint to impose compliance. There is a difference.
I'm glad you're not a midwife either viviennemary, you're failure to understand why a woman may use emotive language after being assaulted demonstrates a complete lack of empathy.
Op, it was an assault, you have every right to feel the way you feel and don't ever listen to anyone who tells you to just be grateful you have a healthy baby. It's nonsense- of course you're grateful for your baby, you're just not grateful for the assault which occurred directly afterwards and why the hell would you be!?
I assumed (perhaps incorrectly) that the kick to the head comment was a reference back to the recent thread where the OP said that she didn't understand how someone could ever have an internal without consent, surely you would just kick the person in the head and move away, or something to the effect. It was a long recent thread.
I think you've been amazingly balanced on this thread, Mignonette and think some people are misunderstanding what you're trying to say - which is that failure to obtain consent is always wrong in the situation in which the OP found herself.
You are also defending nurse, who was unfairly leaped upon for saying that she performs procedures in a&e without consent - when those situations are entirely different from the OPs.
I completely agree with everything you've said.
I am sorry this happened to you, Hen, and I completely understand how violating it must have been - particularly when you explicitly asked to have things explained to you at every step. That request should be standard procedure anyway - and the fact that it didn't happen despite you having taken to trouble to ask for it specifically is particularly awful. I would definitely complain so that midwives in that unit can get some training about what consent is.
I hope you feel better soon and that having support on here and in real life makes you feel that your feelings are valid. They are.
Yes euro hick it was a reference to that thread as I was anxious that might have been the response
I think it's fine to wish you had kicked someone who assaulted you - wishing you had physically defended yourself is quite a normal reaction isn't it?
HarderToKidnap - initially what you need is an explanation of what the HCP wants to do. "Check" is too vague if what they mean is "internal examination". "Internal examination" is not accurate if what they intend to do is perform a sweep.
Now if a woman is happy to consent to "an internal examination of your vagina to check for damage" then they might not need any more information. If a woman does not want to consent to that, then the HCP needs to explain why they feel it is important, what might happen if it isn't done, and what any alternatives might be.
harder to kidnap - I would want to know: Where I am going to be touched, how, why and whether it's likely to be uncomfortable. That is an absolute minimum.
YABVU to think that your vagina is an external resource to having a baby.
Where do you precious idiots come from?
"Your vagina is an external resource to having a baby"
Would you explain that one?
Along the same lines as "Just a little scratch"; "Just pop over here"; "Hold your breath, just a little jab"; "you won't need a local spray to ....."; "Sharp scratch now"; "Check down there"; "Have a little look"; "have a little feel" and all the other euphemisms and homilies used.
I personally do not like them but how do you tell somebody already frightened that an arterial stick may hurt like fuck for example? They'll tense up and it will hurt worse. Not all phrases have a sinister. conniving or maleficient reason behind them. Some are truly meant to ease a person through a horrid procedure. And as for not treating Women like children, we seem to absolve women of everything pre and post natally. That to me is infantilising in itself "Oh they can't help it".....Actually some violent aggressive behaviour can be helped. Not all but enough...
hmm wasn't about you Snot...Just about some of the comments here.
And yes i do know how to talk a patient through pain, how to help them cope but sometimes it does hurt like fuck and nothing can help...
My vagina is a part of my body. It is not a 'resource' and it certainly isn't 'external' (I think it may have nearly gone inside out at one point, but not sure that counts!)
"I want to take a blood sample - sharp scratch/bit uncomfortable" - fine.
"I'm just going to take a little look at your arm" and then jab a needle in - not ok.
read most of the thread
hens had given birth, her baby was fine
there was no medical emergency to attend to
she specified in writing that she didn't want any internal examinations
sounds like assault to me
(going back to re-read in case I missed anything)
Congrats on your baby OP.
Surely though "assault" would indicate a certain intent from the midwife?
While agreeing that there seems to have been miscommunication and that the notes should have been read and I do sympathise with the OP on a traumatic experience, I don't think the midwife would have deliberately wanted to cause distress?
I've had 3 babies and 4 miscarriages and would have a certain expectation of the type of examination I would need in an obstretic situation. My DS was born after a long and difficult labour requiring repeated internals, catherisation and ultimately an episiotomy and forceps delivery ,I've had a membrane sweep, I had sutures after both my DDs,I had repeated transvaginal scans to assess my little ones who didn't make it. I don't remember detailed discussions about each vaginal exam/proceedure but I trusted that the midwives/doctors were acting in my/my babies best interests.
It's unfortunate that the midwife in question made assumptions, thinking that OP understood what a "check" entailed and that it was ok to continue without further explanations. Yes,an apology is warranted, retraining should be done on good communication and and as someone else suggested written information to be handed out is a good idea but I would think to "assault" someone actually indicates malicious intent to harm rather than someone mistakenly trying to help and do their job.
I've had a whole host of invasive, undignified, painful and prolonged medical procedures in my time and never once have I felt out of control, violated or like a piece of meat.
This is purely and simply because for each one I was told what would happen first. I knew I was going to be in pain or extremely uncomfortable and, in a way, that made me panic about it less, because I knew to expect it.
I felt in control because I knew I could ask it to stop at any time. I had been talked through the procedure so knew how long it would take and what was going to happen next.
If this isn't happening to women post-birth then that is horrendous. Truly.
Very concise precis there, Glad. Don't read the thread because it'll probably only annoy you!
But "a bit uncomfortable" may be just as disingenuous as "I'm just going to look at your arm" That is what it may or may not come down to with some patients. Semantics...
Irish - actually I think the assault can be caused intentionally or recklessly, for example the midwife was reckless in not gaining consent rather than intentionally causing fear or harm.
mignonette - a bit uncomfortable vs. painful might be semantics, but surely you see a real difference between looking and sticking a needle in
Message withdrawn at poster's request.
These guidelines may be worth a read Hens. I'm so sorry you had this experience.
Of course I do but that is not the point I was making. If we say something should not hurt very much because our research both qual and quant suggests that it does not but then somebody comes along who says 'actually I was in agony' does that make us negligent, cruel, abusive etc?
Poor communication such as "see what's going on'; 'check you over/out' etc will result in these mis fires between what a patient thinks is going to happen, what she has consented to happen, what a nurse thinks etc.....And a HCP may believe she has gained informed consent when she has not. Not making excuses but finding reasons why this happens.
Ok. I've not read the whole thread but....
...clinicians need to obtain INFORMED CONSENT for all therapeutic and investigative procedures. This involves explaining what is proposed, what the alternatives are, and the relative risks and benefits. If the MW believed an internal was required, despite you having previously declined, she should have said something like "I really think I need to examine you internally as I believe you have torn inside. If I don't I might miss something that later causes problems and needs treatment. " She could then discuss pain relief, offer a second opinion from another staff member or for someone else to examine you. You could still say no, or you might feel able to go ahead. And if you still declined she would make appropriate notes that she had tried and failed to obtain consent.
So for anyone who believes that the MW was just doing her job, and that the OP would have later taken action over missed pathology, it's just not the case. The MW failed to obtain informed consent. She then conducted an examination (I believe it's called "battery"), she failed in her duty of care and caused harm (in this case psychological). You could probably sue her both for assault and for negligence. I would consider engaging a solicitor to help you deal with this.
FWIW I had several internals and sweeps that I did not consent to with DS1 (failed induction over several days). I have no background that would have made me decline them. But next time I will be demanding that I am properly informed if what is happening.
Pain is what a patient says it is and I try to offer what my patients need from me.. But no matter how sensitive we are to this, there will always be patients who have an experience that is atypical. For example IRL I have an idiosyncratic drug reaction to Benzo's. I get wildly over aroused in behaviour and the opposite of what the therapeutic effects are. Now the first time I had this reaction I knew what it was. But if I had not and had been told quite reasonably that i would soon feel calm, there is the potential for what i am saying. And being told about every rare side effects in the book for every drug prescribed would mean about three clinical interventions per shift. There has to be some common sense.
My dentist once performed a root canal procedure without my knowledge or consent. It was so traumatic I cried afterwards. I challenged her saying she should have told me what she was about to do. She then told me that she had done it without telling me because I was "a nervous patient". I had been getting better at not getting freaked out in dentist chair until then! I threatened to take complaint further but did not. I wish I had reported that bitch and got her struck off.
I'm with the OP, mw had no right to do internal without informed consent.
snot exactly they explained what they were going to do and why and continued to explaon yhroughout. that is what should happen.
i had to have a specialist stitch me up after ds2, i had an unusual and delicate tear, it hurt but they gave me pain relief, reassured me they would stop if it was too much, a midwife held my hand and comforted me and helped me use gas and air and talked me througj the procedure. they kept me calm, kept me informed and stopped when i asked them to etc. that is as it should be.
unlike the dr who examined me when preg with ds1, i had already been examined by the midwife and without saying or asking what he was going to do he examined me and gave me a sweep. i was in agony with spd, dp told him he was hurting me and the drs reply....'what does she expect she is pregnant!'
the midwife apologised once the dr had left, i should have complained but was young and didnt know any different.
I'm not against the OP. I haven't said that. But there are all kinds of issues worthy of discussion here.
And Maleficence versus Beneficence is one of them with regards to the MW conduct here. As is the state of MW service and why there probably won't be much of one in the future especially reasonably priced private MW.
Hens if you feel you need to make the complaint then you should.
Keep to the facts.
I had an experience but with a doctor (similar to 5mad) and I didn't complain and it's affected me since - possibly because I didn't complain.
Even the midwife was pulling him off due to his attitude (nasty), the fact I had said no more sweeps as they weren't working and they were leaving me in pools of blood.
I said nothing at the time as I felt this is part of birth and it was a miracle pregnancy and last chance saloon etc, and ds was two weeks overdue and in distress.
The next minute the poor lady in the next bed was going through the same thing.
Complain if it helps you heal but just stick to the facts so the department learns to up it's game.
I wish I'd complained. But in the fug of complicated birth I was just grateful for a live birth and left it at that. But it has weighed on my mind since.
I would complain OP. I learnt far too late when I gave birth that phrases like "I want to do a little check" would result in internal exams, sweeps and having my water broken without consent. Never, ever trust a midwife or HCP when they say this. Keep your knickers on as long as possible - keep them on until you are about to give birth. If a HCP asks your DH to leave the room - it's not your dignity they are protecting, they don't want any witnesses when they assault you.
Some of these stories are really awful.
With any medical procedure you have to ensure understanding so that the patient can give informed consent ! Anything else = assault the same as if someone attacked you in the street.
I think some of the ones where people try and minimise pain are just as bad too, its lying to a patient its wrong.
Ffs. Get a grip. Are you and your baby alive and healthy? Assault? Call the p
Call the police? As the mother of a xh
Child with cerebral palsy due to clinical negligence I would advise you to get a grip. Seriously.
cheese I am sorry about what happened to your child. But it does not excuse what happened just because her baby is ok.
These midwives are there for what is the happiest or most traumatic or even the most tragic time of their lives. A kind caring attitude is essential. And two minutes to explain what she was doing and why would not have killed her.
Baby had already been born , no one was in any danger. The midwife was extremely rude and presumptuous and what she did wasn't right.
I hope op does complain. A medical degree does not give anyone the right to force procedures on people without gaining consent first. Not when the patient is fully conscious and coherent. It was lazy and unlawful.
And the husband was sent out. For no good reason. They just witnessed their wife push out a baby puke and poo on the bed and blood everywhere. As if an examination would phase them after that. She clearly knew she was in the wrong and didn't want a witness
Really cheese? So because something worse might have happened to someone else, the rest should put up and shut up?
Nursing and Midwifery Code of Conduct states:
"The people in your care must be able to trust you with their health and wellbeing
To justify that trust, you must:
make the care of people your first concern, treating them as individuals and respecting their dignity
As a professional, you are personally accountable for actions and omissions in your practice, and must always be able to justify your decisions.
You must always act lawfully, whether those laws relate to your professional practice or personal life.
Failure to comply with this code may bring your fitness
to practise into question and endanger your registration.
Ensure you gain consent
13 Youmustensurethatyougainconsentbeforeyoubegin any treatment or care.
14 Youmustrespectandsupportpeoplesrightstoaccept or decline treatment and care.
15 You must uphold peoples rights to be fully involved in decisions about their care."
It's fairly straightforward, and set out clearly in black and white. It sounds like some nurses and midwives need a refresher.
Detailes info from NMC about consent is available here. This seems the most relevant part:
You must respect and support peoples rights to accept or decline treatment and care.
"If a person feels the information they have received is insufficient, they could make a complaint to the NMC or take legal action. Most legal action is in the form of an allegation of negligence. It is therefore essential that nurses and midwives ensure that they:
share with people, in a way they can understand, the information they want or need to know about their health.
In exceptional cases, for example, where consent was obtained by deception or where not enough information was given, this could result in an allegation of battery (or civil assault in Scotland). However, only in the most extreme cases is criminal law likely to be involved."
This thread is utterly appalling and full of some extremely ignorant people who are excusing the unprofessional behaviour of doctors and midwives with this ignorance.
I would like to try and set the record straight a little in a similar fashion to Shiraztastic by stating what the law says, what your rights are and what informed consent should look like.
The following is from a DoH document dated 2009 entitled Reference Guide to Consent for Examination or Treatment
From the Introduction:
1. It is a general legal and ethical principle that valid consent must be obtained before starting treatment or physical investigation, or providing personal care, for a person. This principle reflects the right of patients to determine what happens to their own bodies, and is a fundamental part of good practice. A healthcare professional (or other healthcare staff) who does not respect this principle may be liable both to legal action by the patient and to action by their professional body. Employing bodies may also be liable for the actions of their staff.
2.While there is no English statute setting out the general principles of consent, case law (common law) has established that touching a patient without valid consent may constitute the civil or criminal offence of battery. Further, if healthcare professionals (or other healthcare staff) fail to obtain proper consent and the patient subsequently suffers harm as a result of treatment, this may be a factor in a claim of negligence against the healthcare professional involved. Poor handling of the consent process may also result in complaints from patients through the NHS complaints procedure or to professional bodies.
Unless you are deemed unable to consent under the Mental Capacity Act 2005 no one can perform a medical examination on you without your consent. It is very clear what constitutes being incapable to make a decision. If the OP was able to hold her baby, she quite clearly was capable of giving and refusing consent.
Not only that, but if there was any question about her ability to give consent, her partner should NOT have been sent away.
From the same document
For consent to be valid, it must be given voluntarily by an appropriately informed person who has the capacity to consent to the intervention in question (this will be the patient or someone with parental responsibility for a patient under the age of 18, someone authorised to do so under a Lasting Power of Attorney (LPA) or someone who has the authority to make treatment decisions as a court appointed deputy). Acquiescence where the person does not know what the intervention entails is not consent.
When should consent be sought?
The seeking and giving of consent is usually a process, rather than a one-off event. For major interventions, it is good practice where possible to seek the persons consent to the proposed procedure well in advance, when there is time to respond to the persons questions and provide adequate information. Clinicians should then check, before the procedure starts, that the person still consents. If a person is not asked to signify their consent until just before the procedure is due to start, at a time when they may be feeling particularly vulnerable, there may be real doubt as to its validity. In no circumstances should a person be given routine pre-operative medication before being asked for their consent to proceed with the treatment.
Duration of consent
When a person gives valid consent to an intervention, in general that consent remains valid for an indefinite duration, unless it is withdrawn by the person. However, if new information becomes available regarding the proposed intervention (for example new evidence of risks or new treatment options) between the time when consent was sought and when the intervention is undertaken, the GMC guidance states that a doctor or member of the healthcare team should inform the patient and reconfirm their consent. In the light of paragraph 19 above, the clinician should consider whether the new information should be drawn to the attention of the patient and the process of seeking consent repeated on the basis of this information. Similarly, if the patients condition has changed significantly in the intervening time it may be necessary to seek consent again, on the basis that the likely benefits and/or risks of the intervention may also have changed.
Withdrawal of consent
A person with capacity is entitled to withdraw consent at any time, including during the performance of a procedure. Where a person does object during treatment, it is good practice for the practitioner, if at all possible, to stop the procedure, establish the persons concerns and explain the consequences of not completing the procedure. At times, an apparent objection may in fact be a cry of pain rather than withdrawal of consent, and appropriate reassurance may enable the practitioner to continue with the persons consent. If stopping the procedure at that point would genuinely put the life of the person at risk, the practitioner may be entitled to continue until that risk no longer applies.
Advance decisions to refuse treatment
A person may have made an advance decision to refuse particular treatment in anticipation of future incapacity (sometimes previously referred to as a living will or advance directive). A valid and applicable advance decision to refuse treatment has the same force as a contemporaneous decision to refuse treatment. This is a well-established rule of common law, and the Mental Capacity Act 2005 now puts advance decisions on a statutory basis. The Act sets out the requirements that such a decision must meet to be valid and applicable. Further details are available in chapter 9 of the Mental Capacity Act (2005) Code of Practice, but in summary these are:
the person must be 18 or over
the person must have the capacity to make such a decision
the person must make clear which treatments they are refusing
if the advance decision refuses life-sustaining treatment, it must be in writing (it can be written by someone else or recorded in healthcare notes), it must be signed and witnessed and it must state clearly that the decision applies even if life is at risk
a person with capacity can withdraw their advance decision at any time.
Healthcare professionals must follow an advance decision if it is valid and applicable, even if it may result in the persons death. If they do not, they could face criminal prosecution or civil liability. The Mental Capacity Act 2005 protects a health professional from liability for treating or continuing to treat a person in the persons best interests if they are not satisfied that an advance decision exists which is valid and applicable. The Act also protects healthcare professionals from liability for the consequences of withholding or withdrawing a treatment if at the time they reasonably believe that there is a valid and applicable advance decision. If there is genuine doubt or disagreement about an advance decisions existence, validity or applicability, the case should be referred to the Court of Protection. The court does not have the power to overturn a valid and applicable advance decision. While a decision is awaited from the courts, healthcare professionals can provide life-sustaining treatment or treatment to stop a serious deterioration in the patients condition.
If an advance decision is not valid or applicable to current circumstances, healthcare professionals must consider the advance decision as part of their assessment of the persons best interests. Advance decisions made before the Mental Capacity Act came into force may still be valid if they meet the provisions of the Act.
*May I make it VERY VERY clear, that from what the OP says the midwife in question has ignored a great many of these points. It is not a simple, 'doing something in the best interests of a patient'. The ONLY person who, in LAW, knows what is best for that patient, is the patient themselves'. This isn't actually as hard to do as some people on this thread are trying to make out, especially given the information the OP stated about her circumstances.
The following is from www.birthrights.org.uk and its brilliant.
What Should Informed Consent Look Like?
If I am asked by doctors or midwives what informed consent should mean in birth care, I tell them that it could be said to consist of three parts:
1) Inform. Tell the woman about what you observe to be going on at this moment in the pregnancy or birth. Tell her about all of the healthcare alternatives that are available to her. Not just the one you think she should do. Tell her as much as you know about the risks and benefits of each alternative, and what kind of evidence exists for this information. This part of the discussion should be a transfer of objective facts, and you should leave your opinion out of it.
2) Advise. Tell the woman what you think she should do. Tell her why. This is a good moment to express the limits of your own skills and knowledge. Are you advising a cesarean for breech because you havent been trained in breech births? This is a time to mention that. This part of the discussion can be an expression of your subjective opinion about what you would counsel the woman to do.
3) Support. ^Support the woman in the exercise of a decision between the alternatives. This includes the decision not to follow your advice. It isnt informed consent unless the patient has the ability to choose an alternative other than the one that the provider recommends.^
Informed Consent is the bridge between evidence-based care and human rights in childbirth. The information is evidenceall patients have a right to be informed about the evidence regarding the healthcare alternatives available to them. The consent is the human right, the legal right, the constitutional right. Pregnant women, like all citizens, have the right to informed consent.
A yes is not meaningful unless you also have the right to say no.
OP, complain like hell. You were assaulted and a criminal act has taken place.
The rest of you defending that midwife, read the guidelines and law and learn.
If any of you can still tell me that what the midwife treating the OP is right, in any way justifiable and that she followed the DoH advice and guidance, I challenge you to tell me just how she did.
I work in a high pressure area (trauma) I still manage to gain consent before I do anything to my patients. Saving lives with minimal equipment doesn't stop me from a quick, 'I need to do this, can I go ahead?'.
The NMC code states that,
You must treat people as individuals and respect their dignity.
You must listen to people in your care and respond to their concerns and preferences.
You must ensure you gain consent before you begin any treatment or care.
You must respect and support peoples rights to accept or decline treatment or care.
The midwife performed an internal examination without expressed consent and went against the recorded wishes in the Op's birthplan. Yes it is assault and yes you should complain. PALS will be able to advise you.
Thank you, I will complain (unfortunately I think complaining an the process is going to be very difficult) I really want to try to heal now, but I'm not sure how to
Hens, if you need to know how/where to complain or to get advice/support about complaining then the Citizens Advice Bureau have a very good guide.
I had a few internals during labour, and they were painful.enough for me to insist on none in the future. I never had any post-birth - I dont understand the need tbh.
If it was a gynae examination full informed consent would be sought and a chaperone would be present. I don't know if that's the case in midwifery but I guess it's probably not but it should be be same practice in my opinion.
I know a lot has been posted about consent but as a current student nurse (a week from being a 3rd year yay) the lectures are all very fresh in my mind. There are 2 types of consent. Informed and presumed. Informed is the most common used form of consent and applies here and should certainly have been sought. Presumed is more uses in ED and by paramedics in trauma and resus situations when a patient isn't able to give informed consent ie in an unconscious patient. So in the best interest of the patient then presumed consent is used to treat them. This is where problems such as blood transfusions given to Jehovah's witnesses crop up as you tend to have no family history although very rare.
Family aren't always about to give consent in all circumstances. When I was working in resus (first day of placement) a lady came in with shortness of breathe and ended up in cardiac arrest and her only family were her 2 teenage daughters so we had to work on presumed consent.
Sorry this has happened to you. Our lecturers are always very clear to make sure we are 100% in explaining what we are doing to patients so that things like this don't happen. I think she did try to explain by saying she was checking for grazes and that to her meant an internal but to you that didn't. She should have actually said she was going to do an internal.
I agree with othes that this is not assault though. It's common knowledge that internals are a part of childbirth and the midwife really should have explained herself a lot better. Yes I think you should complain as I would also feel surprised by getting an internal when not expecting on but I think mentioning assault will mean that she may lose her job when all she needs is a course in communication. Do you really want her to lose her job? We have a national shortage of midwives as it is and soon a real shortage of nurses too as there aren't enough being trained to cover those that will be retiring in the next few years.
I have just applied for midwifery so I promise I will bear it in mind for my future practice.
I'm absolutely disgusted with this thread (although thank you to the wonderful posters who understand!) but it proves what we've set Maternity Rights up for.
I had a crash section, it was a very serious situation but they managed to explain and get my signature on three different consent forms before I even got to theatre. I had a client who had a forceps delivery, another very serious situation where both she and baby were struggling, she told them to stop and they stopped until she gave them the go ahead to continue. Even in the most difficult situation there is always time to explain, even if you can't explain it all.
I managed to deliver my son at 29 weeks, in delivery for 4 days, without having VEs, amazingly we have been designed to give birth without being messed with! It doesn't take a VE to tell you when to push. I'm not saying that there isn't a place for intervention but as I said on the other thread, intervention shouldn't be the norm - that's what's wrong with maternity care, that's why all these complaints, that's why all the people here who are arguing with the OP. This is the attitude we need to challenge.
Someone used needles as an example, now I don't know about anyone else but when I've had blood taken or injections (and I've had quite a few!) you will know you are going to be getting it before they start. Most gentle HCPs
vampires will mean it when they say sharp scratch, some have managed to push me close to another TIA, I have had one once through blood draws but it was the amount they took not the nice midwife doing it.
I suffered Birth Trauma (PTSD after a birth) from a birth where no one did anything wrong and I have never said they did. Apart from one thing, no one kept me informed. They saw my requests for information as fault finding and everyone clammed up. It took 6 years to get anyone to go through my notes and explain it to me. BT isn't a competition, it's not selfish, it's just the brain struggling to make sense of a senseless situation. Why don't all soldiers suffer PTSD?
Please, can those of you who support us come and add your name to the website, tell your story or just be supportive.
I forgot to say, manners don't cost anything, so stop blaming it on budgets!
Meerkatwhiskers - internal exams do not have to be part of childbirth. Women can refuse them.
I think this midwife should be sacked to prevent other women being assaulted by her. Can you really ignore this appalling treatment of a defenceless woman just because there was a national shortage of midwives?
Meerkat, I think your confused I had expressly stated no internals, and put it in writing. And 'surprised' is very insulting.
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Meerkat I don't think it's appropriate to attempt to employ emotional blackmail and guilt tripping to try to dissuade someone from complaining about something that they experienced. The issue of national nursing and midwifery staffing levels is irrelevant background noise where professional practice standards are concerned.
I would, with respect, as a fellow nurse, recommend that you reconsider your own communication skills and develop your comprehension of the duty a nurse has as an advocate.
laGardia you would still need to open legs for an external exam! Precious? Ffs how dare you.
Any thoughts of reporting your own post for being an utterly crass personal attack holding the OP responsible for failing to prevent herself from being assaulted?
LaGuardia - would you say that if she was talking about rape? And yes, it is the same thing. Would you tell a soldier he was being precious he hadn't been injured like his friend? Same thing too.
I agree, Wheresmycaffeinedrip, if you're expecting someone to look, you're not going to keep your legs closed.
LaGuardia Sat 03-Aug-13 21:00:48
OP, without sounding crass, if you opened your legs to let the midwife examine you, then you did give your consent. I take it she didn't force your knees apart? You have no case. Stop being so precious.
No, she did not give her consent. She had a written statement which stated she did not consent to internal examinations. If the OP was to change her mind then a discussion would need to take place in order for consent to be valid - opening her legs would not constitute giving consent in these circumstances as this was not clear that the OP had reversed her decision; she had merely opened her legs for inspection elsewhere.
I suggest you read my above post.
She is not being precious. She had a reasonable expectation that the midwife would observe and respect her wishes not to have an internal examination. The midwife broke that trust. Therefore, the midwife has broken the expected level of basic professional conduct. She has also assaulted the OP.
It is not trivial and you belittling the OP and trying to silence her is crass at best.
Every person who is treated without respect for their dignity, wishes and rights being respected should be supported in complaining as it is the only way to improve care.
Oh and La Guardia, you did sound utterly crass.
Crass is putting it lightly. What she said was unforgivable tbh. Nasty as hell and extremely hurtful for the op and others on this thread to read.
I forgot to mention, I wish I had kicked the staff who dragged my legs into the stirrups. Their bruises would have healed quicker than I did. It took me 6 weeks before I could do a poo (I was in hospital that time with them giving me laxatives to try and shift it) and every time I sat on the toilet I felt like an egg being cracked on a bowl. I could barely walk without my sticks whereas normally I can do short distances I couldn't even cross the room.
Good to know that there are potential trainee midwives (and registered nurses) whose grasp of these fundamental principles is so tenuous and dismissive of patients' rights and opinions .
When I had DS last year my MW checked it was ok every time she touched me, before she even put a hand on my back or moved my leg. She was thoroughly professional and kind throughout. I hope you find some resolution OP.
Hensinthehedgerow, I am a second-year student midwife, studying in New Zealand, and first of all I would like to apologise in the name of every midwife and assure you that your feelings are absolutely valid, and that what happened to you was absolutely wrong. The midwife acted in an unprofessional way and needs to be called on it. She will benefit from going through an informed consent-informed choice course.
Second, I will try to give you some information so you know what should have happened to you. If you gave birth to your baby (congratulations, by the way in the water without pain relief, the first thing I must say if a big WELL DONE to you, what a fantastic way to welcome your baby to this world! After birth, especially when the midwife has not had a clear vision of your perineum, it is necessary to perform a perineal examination of the internal vaginal wall, labia, perineal surface and anus to check for possible damage, in the shape of grazes and/or tear, and if there is any bleeding, to ascertain the origin of this bleeding. The midwife should have explained this to you, and also told you that, after birth, that area is particularly sensitive, and often this examination is painful. After the explanation, she should have asked whether you understood, whether you had any questions (and answer them appropriately), and asked if you consented to the procedure. Only if you say "yes" then she should offer you the use of gas&air (Entonox) if you wanted, and ask you whether you were happy with your partner in the room or you'd prefer to be alone. Then she should prepare a sterile pair of gloves and some gauze and do the procedure, reassuring you that she will immediately stop if you ask her to. After the procedure is finished, she should have explained to you what she found, and how she is going to follow up.
During our studies, informed consent and choice are literally drilled into us, and yes, performing a procedure without consent, even if it's just taking a blood pressure, IS assault. Being in a hurry of understaffed is NO excuse.
I do encourage you to complain, and I personally recommend you to ask for a meeting with the midwife so amends can be made, and so you can express to her exactly how her actions made you feel.
I hope you recover from this as soon as possible and can move on and enjoy your baby
Sorry I shouldn't have put about the shortness of staff bit in there. It was very insensitive of me. I apologise.
I still have a lot to learn so I am taking all your comments on board. I do feel very passionate about midwifery though and so jumped up to defend the profession without thinking it through too much. So again apologies for my insensitiveness.
I am still not sure that the midwife should be sack but that is your call not mine. You are the one that is emotionally involved and who this happened too and obviously we do not all know the whole story as it's only what is portrayed on an internet forum.
I hope that you are able to get a suitable resolution that makes you happy and able to recover from your birth experience.
Congratulations on your baby xx
aurynne, whilst I applaud you for your post and the sentiment with which you mean it, I do have to pick you up on one important point in what you say.
Whilst this might seem petty, in the context of this thread it needs to be stressed and pointed out. The language you use is critical to how a patient understands you and whether she feels able to make a totally free decision.
You said "it is necessary to perform". This is an absolute phrase. It is not 'necessary'; it is 'advisable'.
The difference is that one allows the option to refuse whilst the other is a closed phrase that makes it more difficult for a patient to understand they have an option. Whilst it might not be sensible to refuse, it is also a patients right to and they should still feel free to.
RedToothBrush, you are absolutely right, thanks for the clarification
Firstly OP, congratulations on thw safw arrival pf tour baby and sorry that the MW has put rather a cloud know this has moved on a bit and perhaps OP has been in contact with PALS but I am genuinely confused about what the OP wants to happen post-complaint.
From her posts it seems she wants:
a) The midwife arrested and a night in the cells with criminal investigation.
b) Midwife certainly sacked and an example made of.
c) Some other physical/mental/verbal kick in the head to be delivered
d) SOM under scrutiny too for whitewash.
I'm also confused about whether the OP feels what happened was malicious or 'merely' thoughtless.
My advice (post- my own medical complaint) is to really think hard about what would put this to rest for her. If for example a face to face apology were be sufficient I would ask for that because it will get resolved much more quickly than an opened ended "Call the Police" assault claim.
Sorry first para should read
Firstly OP, congratulations on the safe arrival of your baby and sorry that the MW has put rather a cloud on it.
I know things may have moved on a bit and perhaps OP has been in contact with PALS but I am genuinely confused about what the OP wants to happen post-complaint.
I too put in my birth plan that I only wanted to be examined at the beginning and not again unless it was a medical emergency. I was examined once and that was it! I had a home water birth and was left to my own devices while my body did the most natural thing in the world.
What that midwife did was wrong, and its left to emotionally scarred so you need to complain and make sure you are heard. You need to see your GP so it's on record that you need counselling and so that they know you are serious about your awful experience.
So sorry such an awful thing happened at a time that was meant to be so special for you and your DH. Hopefully you'll get it sorted and be able to put it behind you.
OP I am sorry you have been through this - please do complain - it can make a difference.
The MW who's vile attitude towards me almost cost my second child her life is no longer working on the labour ward because I and other women complained - and I feel happy with that outcome
Do look up the Birth Trauma Ass www.birthtraumaassociation.org.uk/ for support
I am not suprised to see a few odd people seeking to minimise the OP's anger - sadly there will always be people who play down abuse
TV, the chances of any of that are happening are none existent and the police aren't going to be interested. At the moment we're not in a place where it could happen. Staff need to think "consent" be taught "consent" and be in an attitude where they know if they don't have consent they can be in serious trouble before any laws are any use. As RedToothBrush and aurynne have just proven, it's not quite there. We're not going to get there unless women complain.
OMG what is wrong with these people who keep blowing through these threads victim blaming and telling people they need to put up with whatever HCP do to them???
I just can't imagine what is going through peoples minds to tell some one who is feeling violated and vulnerable that they 'asked for it'.
They didn't. They really really didn't.
However you feel about your experiences or think you would feel about someone else's is irrelevant, they are the one that experienced and felt it. I don't feel like I gave birth to two of my children because I had a GA, other women do feel like they did but I would never tell them they didn't because it's their experience to label how they need to.
Has anyone formally complained and had a satisfactory outcome?
OP, this would be a useful (free) publication for you. Please give AIMS a ring too.
Doctors recommended that women lie their babies face down to sleep, as a result thousands died. In the 1970s the majority of women had a routine episiotomy as the baby was being born. No doubt many of those women were subjected to what was later shown to be a largely unnecessary intervention, and those women who followed the advice to lay their babies face down felt that 'they would not do it unless they needed to'. Sadly, many of the procedures that are undertaken, even today, have little or no evidence to support their use and routine internal examinations is one of them.
(that was in response to earlier posts saying that the MW wouldn't have done it if it wasn't necessary)
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