Informed consent in pregnancy and during childbirth: Mumsnet and Birthrights survey findings

[RowanMumsnet]

Hello

Some of you will remember that we asked MNers for their thoughts about the process of giving informed consent to medical procedures and choices when it comes to pregnancy and birth.

We're pleased to report that today (after a VERY long COVID-related delay) we're publishing the results of a joint survey with Birthrights outlining the experiences of women who've given birth at least once.

You can see all the details here but the headline results are:

14% say their opinions and decisions when planning for giving birth were overruled
11% say there was an attempt to overrule their opinions and decisions
In total, 24% of the mothers surveyed say their decisions and opinions about their care were not respected
30% say their decisions and opinions were not sought at all
74% say they were given the opportunity to discuss the benefits of a vaginal delivery, but only 42% said they were given the opportunity to discuss the benefits of a caesarean section
61% say they discussed the benefits of giving birth on a hospital ward, but only 38% said they were given the opportunity to discuss the benefits of giving birth at home

Survey respondents were given an outline of the legal position – ‘An expectant mother is the primary decision maker about her care, and the midwives’ and doctors’ role is to advise her’ – and asked whether it reflected their own experience. Less than half (45%) said it did, while 42% said it did not.

There's some evidence that things are getting better: among women who gave birth in the past five years, 47% (compared with 42% of all respondents) said they were given the opportunity to discuss the benefits of a caesarean section. And when asked whether the description of the Montgomery standard reflected their experience, 50% (up from 45%) said it did, while 37% (down from 42%) said it did not.

We hope you'll agree this is a really important issue and interesting findings. We're on a mission to ensure that all pregnant women are aware of their legal rights to be the primary decision makers in their own care - best facilitated by having discussions with midwives and obstetricians during pregnancy, in which each woman's individual risk factors are assessed and she's supported to make the right decisions for her.

As ever would love to know what you think and do please share widely. If you're on Twitter and would like to RT this tweet we'd be very grateful.

We're going to be publishing a guest post next week by Nadine Montgomery, the woman who took her case to the Supreme Court and won, helping to cement pregnant women's rights in law - so please look out for that.

Thanks
MNHQ

[RowanMumsnet]

The BBC have put up this film about c-sections - it's prompted by an academic study showing some women end up feeling 'guilty' about having sections because they feel they have to defend themselves against accusations of being 'too posh to push' and all that nonsense. They use some of our stats from our survey and our very own @annacmumsnet is going to be on BBC Radio London today to talk more about what we've found out about how pregnant women are informed about their birth choices.

If you'd like to call into the show and share your experiences of having a c-section and how you felt about it, you can give the Radio London team a call on 0800 731 2000.

[Wick4land]

Having my first baby changed the course of my life.

[RidingMyBike]

This does echo my own experience - no mention of the benefits of CS and I had to fight NOT to give birth in the MLU, which I didn't want! Far too much coercion to have a natural birth rather than be able to access the pain relief I wanted. Which is ridiculous considering I was high risk and highly likely to end up with intervention.

I feel the same about postnatal - a lot of promotion of breastfeeding but no mention whatsoever of the risks of it (it made my baby seriously ill resulting in a hospital admission). A complete lack of balance in the info about infant feeding - I had no idea formula could be lifesaving, as all we were told antenatally was it was unnecessary!

[PrivateD00r]

@RidingMyBike

This does echo my own experience - no mention of the benefits of CS and I had to fight NOT to give birth in the MLU, which I didn't want! Far too much coercion to have a natural birth rather than be able to access the pain relief I wanted. Which is ridiculous considering I was high risk and highly likely to end up with intervention.

I feel the same about postnatal - a lot of promotion of breastfeeding but no mention whatsoever of the risks of it (it made my baby seriously ill resulting in a hospital admission). A complete lack of balance in the info about infant feeding - I had no idea formula could be lifesaving, as all we were told antenatally was it was unnecessary!

Clearly formula milk does not need promoting - it is advertised everywhere, most times you are in a cafe you will see a baby drinking from a bottle, baby clothes have bottles on them, the majority of people with older babies use it. Everyone knows about it. Breastfeeding is not so prominent so does need promoting. Breastmilk does not make babies seriously ill, a lack of milk however does. This is why discussing bf is vital - to explain signs of effective feeding, signs baby is getting enough, signs baby isn't getting enough, how to deal with that etc.

Breastfeeding is not 'risky', however a lack of support for breastfeeding mothers IS risky. So education around it is essential.

[PrivateD00r]

Thanks MNHQ. I would be keen to know more about the demographics of the women responding to the report, such as the part of the UK they are from. I would also like to know how the survey was presented to women, was it simply about experiences of maternity care, or did the title immediately mention issues around consent? Because that would potentially have led to sample bias as women who have concerns around consent will obviously be more drawn to it and more likely to reply.

[RidingMyBike]

@PrivateD00r Breastfeeding IS risky and it doesn't help women to deny it. It has a natural failure rate, which tends not to get mentioned in advance. It nearly killed my baby - who became so seriously ill with hypernatraemic dehydration she had to be readmitted and tube fed formula to save her life. This could easily have been avoided if HCPs weren't so keen on their EBF stats. At the moment BFing is only promoted in terms of its benefits, there is no mention whatsoever of any of the downsides/risks of it. Maternity, children's centres and GP surgeries are plastered in posters promoting it, with zero information available about formula. I would have much preferred to receive info antenatally about safely using formula than be thrown into having to use it (which I had no idea we'd need to as I'd been told all women can BF) with no info available at all and HCPs refusing to support it. No wonder people end up turning to formula companies for advice because you can't get it anywhere else!

To be able to make an informed choice about infant feeding families need access to all the information - that includes the benefits and risks of both EBFing, EFFing and combining them. That includes things like risk factors for milk delay and low supply so families can prepare and how to safely supplement early on to increase chances of success if families decide they want to BF. I'd also like to see the risks/benefits quantified and subjective ones made clear (eg BFing wasn't free for me, it cost double the price of formula, neither did I find it convenient, and it didn't help us bond - BFing promotion was all about the amazing 'liquid gold' 'elixir' that was free, convenient and a magical bonding experience! ).

As with a lot of things related to maternity, women need access to good quality information about their options and likely risk factors.

[PrivateD00r]

You appear to be disagreeing with me, yet actually we are both making the same point; that education is vital to ensure a mother knows if her baby is receiving enough milk. It is however incorrect to insist that 'breastfeeding is risky'. As I previously said, the risk comes from baby not getting enough milk.

Insisting that breastfeeding is risky is much like saying 'eating is risky' because it caused someone to become anaemic. The eating did not cause anaemia, lack of eating enough of the right foods did.

There are many signs of this before it reaches the stage of hyponatraemia, which thankfully is rare. Generally women receive information on the signs and what to do if baby is not receiving enough milk. Clearly you did not, but the answer to that is not pushing formula. It is breastfeeding education. The instructions for making up formula are freely available, including on the side of the tin. Most women don't require significant assistance with that, but most do require significant assistance on getting breastfeeding off to a good start.

Anyway this is derailing the point of the thread, so I will leave it there. I do hope that you and your baby are well now.

[RowanMumsnet]

@PrivateD00r

Thanks MNHQ. I would be keen to know more about the demographics of the women responding to the report, such as the part of the UK they are from. I would also like to know how the survey was presented to women, was it simply about experiences of maternity care, or did the title immediately mention issues around consent? Because that would potentially have led to sample bias as women who have concerns around consent will obviously be more drawn to it and more likely to reply.

Hi Private. You can see one of our recruitment messages about this survey here - you'll see we flagged it was about taking decisions in pregnancy and birth, but we didn't talk specifically about consent. We know that flagging survey topics too clearly can lead to bias when it comes to recruiting respondents, but with sensitive topics like this we try to give a little bit of info about the topic area so that women who really don't want to 'go there' because of past experiences can give it a swerve.

In terms of regional demographics - 21% in the North of England and Yorkshire, 22% in the Midlands and East of England, 38% in London and the South of England, and 13% in Scotland, Wales and Northern Ireland.