MNHQ here: are you interested in the issue of medical consent during childbirth?

[RowanMumsnet]

Hello

One of the charities we work with, MASIC, is holding an event in London (sorry!) on Thursday 29 November to discuss the issue of medical consent in childbirth, and how that issue ties in to obstetric anal sphincter injuries (third or fourth degree tears that damage your anus, with often life-changing consequences) and the provision of elective caesarian sections.

It's a day-long event (9.15 to 4.30) with panels and debates on topics including:

an explanation of the Montgomery vs Lanarkshire ruling (a landmark case that established a legal standard for women's right to information about risk in childbirth);
a panel on anal injuries in childbirth and what the risk factors are (and what might be the effect of offering more caesarian sections by maternal request);
a panel entitled 'How much do we inform mothers beforehand without scaring?' [imagine there will be some strong MN views on this one...]; and
a panel called 'does consent mean anything when you're exhausted and in pain?'

Throughout the day, people who come along will be able to contribute and ask questions and generally make their views known.

Tickets are £40, or £25 for students or women with obstetric anal sphincter injuries. You can book tickets and see more info here.

We thought this would be of interest to some of you - and of course the issues being discussed are likely to interest lots of you whether you can attend or not - we at MNHQ are thinking about doing something in this area (what does it mean to give meaningful consent to procedures in childbirth, and what's the best way to ensure that women have all the information that they need to give meaningful consent) - so as ever please let us know what you think.

A member of MNHQ will be going along to represent your views, so give us a shout if you buy tickets and would like to have a coffee on the day.

Thanks
MNHQ

[TestingTestingWonTooFree]

The other related issue is sterilisation. I was offered it the day before a planned section, with no previous mention.

[RolytheRhino]

A very important issue. My midwife scared me into pushing without a contraction, which I believe caused my tear, by saying 'I'm just going to cut you now, Roly.' In what universe is that an acceptable thing to say? I was doing fine and the baby was not in distress, labour had just slowed a bit (which apparently is normal). I said something along the lines of, 'No you're bloody not' and promptly forced DD out. Totally unnecessary, but I only realised that and got annoyed about it when I thought about it afterwards.

[Mickhasnotorso]

Not to sound insensitive but I have to ask, how do you prove you're eligible for the cheaper ticket...

[IVEgotthePUMPKINS]

I didnt think pushing the baby out without a contraction was possible roly?

[AllTheWhoresOfMalta]

This feels pertinent right now as my poor sister in law has just had some horrific birth injuries from what was definitely crap medical care. I’ll be interested in what comes up.

[JohnnyMcGrathSaysFuckOff]

Pumpkins

It is if the baby is low enough. I pushed DT2 out under my own steam with no assistance and no contractions.

[RowanMumsnet]

@Mickhasnotorso

Not to sound insensitive but I have to ask, how do you prove you're eligible for the cheaper ticket...

I don't know - I'll ask!

[Dinosauratemydaffodils]

The consent form my first emergency section after 75 hours of back labour, 2 hours of pushing and failed forceps vanished from my medical notes. I have no issue with the fact that I scrawled something on it but given the state I was and the refusal of anyone to discuss c-sections/forceps before hand, there is no way it was informed consent. I was quite literally seeing snakes by that point, with a fever and dehydration. I tried to raise the fact that I thought he was stuck hours earlier and was essentially patted on the head "it's your first isn't it love". He was stuck. My waters had been gone for 81 hours when he was finally delivered. He went to NICU and I had a psychotic break but hey...we both had a heartbeat by the time they finished separating us so I had nothing to be upset about apparently (thinking I was "caring" for a doll in an incubator doesn't count).

When I had a debrief, they told me telling women about the bad outcomes would scare them and it's a tiny percentage so we just need to suck it up. I complained and got a "sorry you are upset, we'll do better next time" letter from the chief executive (to be fair, they did much better the second time) but it wasn't particularly helpful at the time. Our NHS ante-natal classes also refused to discuss assisted birth or c-sections and when someone said they already had a section booked for health reasons (heart issue), they were commiserated by the midwife.

I think we deserve honest information given at a point where we are capable of understanding it ideally tailored to individual factors.

The other related issue is sterilisation. I was offered it the day before a planned section, with no previous mention.

That's unacceptable as is the other side in which I asked at 32 weeks whilst planning an elective section aged 40 (2nd child) and was told no chance. The consultant wouldn't even discuss it with me, instead she said we can talk about it after number 3.

[SophiaLarsen]

It's a great question about informed consent when you are exhausted and in pain. I was pressurised into consenting a trial by forceps after 79 hours of labour. I consented but it was not informed as they decided to withhold the fact that DD was in distress. If I had known that I never would have consented and said go straight to CS. They knowingly put DD in danger but did not inform me of the situation and the risk related to that situation. My fear of forceps was getting a prolapse and incontinence issues which transpired.

They told me afterwards it would be much better because I would be able to give birth naturally again whereas if I had a CS I wouldn't which is not true and also the damage they caused means I won't ever get the chance to have another child.

I hope the conference is informative and action taken. Unfortunately I am not able to go.

[Bearfrills]

The other related issue is sterilisation. I was offered it the day before a planned section, with no previous mention.

During the pre-theatre check with DC4 where I was literally sitting in a cubicle outside the door to the operating theatre while they went back over my planned caesarean consent form (name, date of birth, do you know what procedure you're having, etc) I was asked "do you want us to do a sterilisation while we're in there?"

How can that ever be considered to be informed consent? It's a lifelong decision given that reversal is of a low success rate and not available on the NHS. There was no time to consider it properly, no discussion of the risks vs benefits, literally just "do you want it done?".

With DC1 I'd been pushing for two hours when a consultant came along and said he wanted to do a forceps delivery. I said no so he said he would "allow" me another hour and then discuss it again. An hour later he came back and said that it had been going on long enough and it was time for DS to come out now. I was exhausted by that point but not so exhausted that I didn't know what I wanted. He said that he was going to do a ventousse delivery, despite DS heart rate and movements being fine and showing no cause for concern, I said no so he told DH to talk to me about it and then told the MW to start prepping me while he got his team. I had not said yes. He went out the room, I told the MW to get the fuck off me as she had started preparing to inject local anaesthetic (again without asking), and I managed to push DS out before they went any further.

Pregnant women are still infantilised by large swathes of the medical profession. So many times across six pregnancies/four deliveries I've been ignored, touched without consent, had my care discussed by staff in front of me without being included in the discussion, and been told what is going to happen/be done rather than being asked what I want to do.

[xJune88]

I did 23 hours of labour and pushing and was then brought a form and told were taking you to theatre for episiotomy and forceps and possibly a section sign here.. you could loose your womb or die. Pretty much. I was in shock and just cried but had no choice to sign and get my baby out. Was horrendous.

[RolytheRhino]

I didnt think pushing the baby out without a contraction was possible roly?

I think it is based on my experience! The top of the head was pressing against the opening of the vagina by that point. I can push a jet of water out, why not an infant?

[Lcw29]

I think it's a major issue. I was pressured by one doctor who was supposedly off duty to have treatment I'd already refused. I was in itu with oxygen mask and very disorientated. I stuck to my decision but it shouldn't have happened. I was completely unaware of the issues if tearing etc... before labour. I only had a second degree however had major blood loss because of the location. They still insist natural delivery is better than planned c section for my second.

[Littlemissdaredevil]

I initially consented to my induction but after being informed and told I wasn’t in labour and denied any pain relief I told the midwife numerous times I wanted the induction stopped and the Propess taken out. It was clear I had withdrawn my consent. The midwife told me she couldn’t stop take the Propess out and walked off.

Very small example today of my wishes not being respected. Today I went for my 12 week scan and had bloods taken. I told the phlebotomist to take the blood out of my left arm as I have a nice big vein and tiny veins in my right arm. She refused as she had already set up to take it out my right arm.

[PastTheGin]

This is a really interesting issue. I “consented” to an emergency CS. At that point I was so out of it that I would have signed absolutely anything, there is no way my consent could be described as informed in any way.

[PanamaPattie]

The sad thing is that pregnant or labouring women are not treated as consenting individuals. Doctors and MW are not your friends and are not on your side. Their role is to make you, by whatever means at their disposal to deliver a "live child". They don't care about the vessel. Your consent is incidental to their policies.

[Losingcontrol]

I’d be interested too - like Past I remember a form being shoved at me for my emergency c-section whilst I was screaming in pain, alarms going off, DD’s heart rate and mine both dropping rapidly. DH tried to sign it for me and was told I had to sign and date it. I can remember trying to write the date and my hand sliding off the page as another wave of pain hit.

Obviously I’m very glad they performed the emergency CS and saved my DD but I really wasn’t in a position to think about anything. I have often wondered why they don’t get you to sign something as you arrive at the hospital or in the late stages of pregnancy, saying you consent to measures being taken to ensure the health of the baby/yourself

[gonewiththerain]

I was aware of the issues of consent whilst labour was going wrong in the late stages of pregnancy and I wrote on in my notes that I didn’t consent to forceps under any circumstances and signed and dated it. As it happened labour did go wrong and I was read the cs risks list and had to sign, I could barely hold the pen. I was fairly out of it but I do remember them saying a cs might leave me unable to have another child and thinking or saying if you don’t get this one out I won’t be living soon.
Women and their partners need to be more informed of the risks and the likelihood of things going wrong and be allowed to make an informed decision

[ABingThing]

80-odd hours into a failed induction a doctor tried to do an internal on me. I'd already refused consent for any further examinations the day before (it was recorded in my notes which I've since been given a copy of) but I was told I had no choice. He refused to stop despite my clear distress and repeated requests to stop. The midwife who was present did nothing. Afterwards she asked me if I was crying because it hurt 'and not something I did because it would've been worse if he'd stopped and tried again'.
I had to wait another 26 hours for an EMCS.
It's almost five years ago now and I still break down in tears about it from time to time.
Women deserve respect - we are allowed to say no and have that listened to.
When I had DC2 I fought for 23 weeks to get approval for an ELCS. Nothing could persuade me to risk a vaginal delivery when I know that my consent is meaningless to the 'professionals'

[IonnaS]

I hope women know that treatment of a conscious patient without consent is assault. You can report it to the police, even from the ward.

[IfOnlyOurEyesSawSouls]

Not necessarily @IonnaS - the crux is whether the woman has capacity to consent.

Some women in certain heightened emotional states may not have capacity to consent under the 2 step rule. In these cases actions are taken in the best interests of the baby & mother.

[ABingThing]

@Ionnas I only found that out a year later from the nurse who tried to get my consent for a smear test and couldn't work out why I was so distraught.

I have my notes now and I'm working up the courage to report it to PALS in the first instance.

[IonnaS]

A labouring woman will almost always have legal capacity; the test is exacting and many doctors don't bother to apply it before acting. There is no likely excuse for an internal exam without consent (and especially not when it is against the patient's express wishes).

[IonnaS]

Good luck, @ABingThing. It is not easy to pursue things like that and I think doctors have tended to be complacent because they know patients are usually desperate to forget about it.