Agoraphobic mum-to-be forced to go to hospital for the birth

This is so so difficult. I'm just glad to read the post script.

It was good to read that the hospital were trying to be as accommodating as possible of her choices- offering a choice of induction or c-section- offering the choice of c-section under GA. That to me shows that every effort was being made to respect her and help her feel in control where possible.

I don't know about the judgement. I'm torn. But I do believe reading that, that they really were trying to act in her best interests. It was noted that the mother very much wanted to have a healthy baby. If something had gone wrong, that would have also caused an unbearable amount of trauma for her.

I don't think there are easy answers. I just wish her and her baby the very best and am glad that it appears to have turned out well.

I read that too. It seemed balanced and the decision the judge had to take was based on the fact that the Official Solicitor (representing the mother) agreed that a hospital birth was in the mother's best interests, so the only point of contention was how to manage the journey.

It seems entirely sensible to have everything planned in advance as an emergency court hearing while the mother is in labour is clearly not desirable.

I am very glad everything turned out well and no intervention was necessary.

I read that with horror. The balance of risk to a physically healthy young woman and baby - likely to have a highly unremarkable home birth against the distress and risk of forcing her to hospital did not seem to be taken into consideration.

Surely they should have pushed for as safe a home birth as possible.

Does that mean woman is not allowed a home birth a certain distance from a hospital in case she can’t get there in time for emergency intervention? What is the practical difference.

Re capacity - they wouldn’t have forced heart surgery in that case - but women’s autonomy doesn’t count.

Postscript.

The judge was later informed that on 22 May 2021 the mother went into spontaneous labour at home. She contacted the hospital and travelled there with the support of her partner and mother and the community midwife. While still at home, she received 2mg of Lorazepam orally. Although initially resistant, she was guided by staff and her family into the ambulance and no restraint was required or used. A few hours later she was safely delivered of a healthy baby boy with a good birth weight. She returned home with the baby within the next day or two.

Very best wishes to Mum and Baby.

I think this is the judgment, if anyone is still interested?

www.bailii.org/ew/cases/EWCOP/2021/33.html

So what is the issue here? Many women want home births but go to hospital if there is an emergency. She’s saidshe will go to hospital if their is an emergency. This is really wrong.

At a guess, psychiatric medical professionals understand that when someone says yeah sure I will, it doesn't mean they will. Pregnant women are sectioned against their will for MH reasons already, guessing they will use the same proportionate force if required.

Agreed. Just because someone says that they will do something, it doesn't mean that they will. And what is an emergency to medical staff may not be an emergency to the woman.

Additionally, by the time there is an emergency it may be too late - the woman in question apparently lives in a remote location so it could take some time to get her to hospital.

So what is the issue here? Many women want home births but go to hospital if there is an emergency. She’ssaidshe will go to hospital if their is an emergency. This is really wrong.

At a guess, psychiatric medical professionals understand that when someone says yeah sure I will, it doesn't mean they will. Pregnant women are sectioned against their will for MH reasons already, guessing they will use the same proportionate force if required.

Gag I misread the second paragraph. Not enough coffee.

I’d be interested to know how they plan to restrain a heavily pregnant women. I know medical professionals used to push my mothers hands inwards towards her wrists when she was committed and trying to escape. I wonder if they will use this method..

It is awful and I’ve been thinking about it. Could she actually be put in restraints on the bed if she tries to leave? Will she sectioned afterwards? Will this encourage PND? Will SS be involved afterwards? What systems will be put in place if she is traumatised and need help?

Justice Holman said any restraint should not include “mechanical restraint”, the use of a “prone restraint position” or any techniques which would apply “pressure to the diaphragm or abdomen”

So what? People will be pushing down on her chest or stomach to keep her lying down. What madness is this?

She wants a home birth - unless there is an emergency. But the NHS wants her to have the baby in a "planned way" in hospital, due to the increased risks if she gives birth at home - BBC

So what is the issue here? Many women want home births but go to hospital if there is an emergency. She’s said she will go to hospital if their is an emergency. This is really wrong.

Oh and I just realised you said delivering a baby.

She's to be taken to hosp before due date so could be in hosp for weeks. That would be just. Cruel.

Unless by deliver you meant CS? You say you wouldn't fancy it. You're a midwife or a surgeon?

You didn't read my original post did you.

That was a precis.

Round here you go home after a CS after 36-48 hours. And morphine was certainly administered after a CS round here. And that does indeed make you feel... Fuzzy. Sort of unconcerned.

So now we have the idea that

Not only is it better to use physical force on a woman who it's presumed from the fact it was specifically mentioned suggests she will put up a fight.

But also that also assuming no complications she should be ? treated differently to other women? And definitely it's a bad idea to give her anything to reduce her reaction which could be, well anything really.

Why is there this certainly, knowing so little about it. That there's definitely no way to make this easier. And removing a woman who is at term, by force if necessary, then (CS? Or just keep her there till she goes into labour? We don't know). And then giving her any kind of medication to lessen her reaction to all if this.

Anyway you can read my posts if you want. About going home etc.

But nope nope. Any of that is s terrible idea. Using force against a heavily pregnant woman who could be panicking and doing whatever she can go stop them is definitely the only option.

You will have a C-section and we will keep you sedated and have someone come and look after you at home. You won't even remember leaving.

I can't think many doctors would be happy to deliver a baby sedated up to the eyeballs to that degree, or to guarantee that the mother would be kept in that state until ready for discharge. She'd come home wholly unfit to care for her child and herself and possibly dependent on something or other.

So I hope that particular option wasn't on the table.

Zzelda there's no need to give hypotheticals- the case in point has plenty to discuss.

Human I suppose my point is that.

We know very little about it.

The idea of using any level of force on a woman who is refusing to leave and is at term sounds really sort of escalatory.

The anticipation that she will refuse and physically resist is obviously seen by the judge as a given. And he says ok reasonable force.

But women who are at that stage of pregnancy are incredibly vulnerable physically. Not to mention her mental state.

So realistically. Ambulance turns up. She says no. She's got major MH issues, hasn't left the house in 4 years. Chances are she'll be terrified and panicking. She'll try to get away/ not be removed. I mean it's all speculation obviously. But the judgement including forgeable removal sounds like it's anticipated.

So how much force is ok to use on a woman who is due if she puts up a fight? What will the mental health impact be of her knowing this is going to happen and she can go quietly or be removed.

It really bothers me.

There must be something they can give her to calm her, to relax her, to make her woozy, to soften it. I can't believe that of all the drugs in the world there is literally nothing that can be given to just take the edge off this experience. And that is stated firmly in the absence really of any info about her physical health, what other drugs she may be on etc etc. And that physical force etc is the less risky option (which is a guess, who knows how she will react).

The other thing I just realised was I didn't see any comment from whoever is looking after her MH etc. She's had scans at home so she's obviously being supported. What were the MH people comments? We don't know.

Similarly it could say she'll be zoomed in, section, kept drugged until able to go home, zoomed home.

I mean none of us know.

I like to think that when it says get her to the hosp whatever before her due date it's a planned section but it doesn't say that. If that were the plan then it's a trivial thing to add.

The info we have from the story just makes me feel worried for her.

It may be fine it may not. None of us know.

I don't understand the posts being so definite though. She won't be able to care for the baby. The judge will have definitely made the right call. People with MH issues have force used on them all the time what's the problem. Thinking that her mental state might lead her to do something desperate is pure fantasy.

We don't know. Many of the posts here seen focussed on the baby. A pp said how could the woman be seriously harmed or die from this. She has severe mental health problems and from the little we know she's about to have a really traumatic experience. What effect that has on her could be, who knows. But it could be anything.

I'm just worried that's all. On what's reported it sounds potentially horrific and possibly dangerous for her.

That's where I'm coming from anyway.

That's really interesting human, thank you!

The bit about using doses which are too high for the patient was really interesting.

Love a bit of info!

*Do we have sedationists on the NHS- I never knew! What settings are they in? Maybe dunno. Secure mental health facilities? Genuinely interested!

I was always sedated by the anaesthetist.*

“Sedationist” is a general term to mean the person giving the sedation. In dental surgeries and in endoscopy or bronchoscopy suites for example the person administering sedation is most likely not an anaesthetist and sometimes not a doctor. (Gasteroenterologists historically gave their own sedation for out-patient scopes, and cardiologists for elective cardioversions - but sometimes nowadays nurse endoscopists might give the sedation for their own procedures under a patient group directive).

It’s also used particular in the context of “operator-sedationist” in a scenario where one person is simultaneously giving sedation and performing a procedure. Eg in p20 of the guidance below)

The Academy of Medical Royal Colleges publish comprehensive guidelines on Safe Sedation which might be of interest

www.aomrc.org.uk/wp-content/uploads/2016/05/Safe_Sedation_Practice_1213.pdf

Gerbil agreed and thanks.

It is off topic but I agree chatty.

In this case she'd have to go to hosp in the very unlikely circumstance that was her decision. And so she wouldn't do that because it would still mean leaving the house.

So it's totally irrelevant to this thread.

Oh that's a term I've not heard before!

Do we have sedationists on the NHS- I never knew! What settings are they in? Maybe dunno. Secure mental health facilities? Genuinely interested!

I was always sedated by the anaesthetist.

Was it this?

Other poster

'
To sedate someone to the point that would be needed to take them to hospital, you need IV access - at least two cannulae, in case one falls out. You need heart, BP and oxygen saturation monitoring. You need to protect their airway by putting - at the very least - an airway support device into their mouth, and you may need to place a tube into their throat. How do you think that's going to go, if the patient is resisting?''

Me

'I never had all that when I was sedated. Dentists don't do all that.'

You're right that isn't clear. It's two points.

1. I've never had that when sedated (intubation cannula etc)
2. Dentists don't do all that either

I can see how that got confused.

Since it’s been mentioned, and though it’s off topic, I support safe, legal, accessible abortion, as early as possible and as late as necessary. On demand and to term in theory is OK by me- and which would be vanishingly rare in practice. Women and girls don’t have abortions for trivial reasons.

So far as other consequences- what about living with the fact her actions may have resulted in death or serious injury for the baby?

'You have mentioned several times that you’ve had sedation for dental procedures, which is why I’ve drawn the comparison.'

I'd be surprised if I have because as far as I can remember i haven't. I'll read back and check if I gave the wrong impression anywhere.

As a midwife this horrifies me. No matter how high risk her pregnancy, labour and birth are it’s her choice. The baby has no legal right to life until after birth so that should not be a consideration and women are perfectly able to refuse medical treatment for whatever reason they want. Agoraphobia does not mean she lacks capacity to make a decision and I hope there is more to this story as what has been published is a huge breech of her human rights. As to the partner agreeing with the judges decision. Maybe he should have considered this event before impregnating someone with a long-standing fear of leaving her home. He surely saw this coming!

I fully agree with you that it is possible to have sedation without a cannula.

I disagree with you that the scenario we’ve been discussing is directly comparable with dental sedation - for many reasons, which I’ve outlined above.

I think that because sedation is a complex area of practice, people who are thinking of having it should discuss their personal circumstances with a sedationist - and the message taken from this thread should be neither “all sedation requires intubation” nor “you don’t need intubation and / or a cannula for sedation”. It depends on many things.

I don’t call people names on the internet (or in real life), You have mentioned several times that you’ve had sedation for dental procedures, which is why I’ve drawn the comparison.

Just to reiterate my previous post, with italics for new emphasis

14/05/2021 07:31 humanitariancisis

So the whole cannula / intubation thing then is incorrect. You don't need to do that to sedate someone.

For the sake of clarity, in a general sense, you do not need a cannula or intubation to give “sedation”. In the same way that you do not need to go onto cardiopulmonary bypass to have an “operation”. But if you are in a situation where you need to have a complex cardiology operation, going on bypass would be necessary, and it would not be safe or appropriate to use the same anaesthetic and surgical techniques that would apply to someone having a dental extraction.

Sedation is a spectrum of altered consciousness and the drugs, monitoring and interventions required to make it safe depend on a combination of the patient’s own risk factors, the level of sedation required and the reason for the sedation (including the likely duration, how easy it would be to stop halfway through or convert to GA etc). ^As I said in a previous post, women at term have additional risk factors for sedation and anaesthesia, particularly those who are significantly overweight. These risks include difficult airway management, difficult intravenous access, and a significantly increased metabolic rate and therefore oxygen consumption. The average time between “conking out” for a GA and desaturation to a point of hypoxia in a woman at term is in the region of 30-120 seconds, and that is after pre-oxygenation.

You might get lucky and be able to give this lady a guesstimate slug of either oral or IM drugs and hit a sweet spot of conscious sedation, and have the good fortune that she does not need re-dosing en route and / or if she does she maintains an airway and doesn’t aspirate. Or, you could be unlucky and cause a hypoxic cardiac arrest in the back of an ambulance. Whatever your anaesthetic plan is needs to be something you can justify in coroner’s court in the worst case scenario - it would be difficult to justify uncontrolled sedation in a home setting to a depth that would facilitate predictable cooperation with a long road transfer to a pregnant woman with additional health risks without at least a cannula^

This scenario is very different to elective dental surgery in a cooperative patient without risk factors.

If you need to have a procedure, and sedation is being considered, whether you are pregnant or not, you should discuss this directly with the person who would be giving the sedation so that you can give informed consent to it, in light of your health and the proposed sedation technique / procedure