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

I also would like to know what’s wrong with @InvisibleDragon comment. This is a classic rock and hard place situation. Judges don’t want to deprive adults of their liberty but sometimes it actually is necessary for their own well-being and safety. The alternative is to let her give birth at home (even though this isn’t an informed decision) and hope to god things turn out okay. After listening to evidence from medical professionals, the judge came down in favour of requiring the birth to be in a hospital but it’s clear that this wasn’t an easy decision.

She obviously has family support and a partner so I doubt the child is going to be indoors permanently until adulthood.

Of all the bizarre comments I have read on MN in the past few days this is by far the most bizarre and least informed.

Can you explain what you mean by this? What is the problem with what I have said?

I'd like to know, too!

Please do feel free to share the good outcome which gives nobody any discomfort

It's nice to think that of only the judge was less misogynistic or the medical team understood capacity better that the situation could be resolved in a more pleasant way, but sometimes there really isn't. There's only bad and worse.

Of all the bizarre comments I have read on MN in the past few days this is by far the most bizarre and least informed.

^Like I said at the very beginning. If she has a high risk pregnancy then sedating her, getting her to hosp for immediate CS, keeping her on morphine/ sedated until safe to go home (24 hours sometimes round here), and getting her home again would seem a good option.

In this case the judge talking about reasonable force to get her to hosp sounds all wrong. How much force is reasonable on a heavily pregnant woman who is terrified and struggling etc? That statement from the judge is awful.^

What makes you think that something like this wasn't suggested? A pregnancy-safe anti-anxiety medication or gas and air and a trip to the hospital? What if she said no? They she wants to stay at home.

The impossibility of safely sedating a pregnant woman for a trip to the hospital was described earlier in the thread.

You asked "How much force is reasonable on a heavily pregnant women who is terrified and struggling?"

The answer is a whole lot less than the amount of force that would be needed to forcibly restrain and medicate her. Sedating her against her will would involve pinning her down on the floor or a bed and injecting her. Which I don't imagine is the outcome you were imagining.

It's not an outcome the Judge wanted either. According to the Guardian article

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”.

The whole thing sounds grim to be perfectly honest. I don't envy anyone involved in this whole miserable situation who has to weigh up a selection of imperfect and unsatisfactory options. But the thing is that grim situations with no good options arise and someone had to make the decision hide too deal with them. It's nice to think that of only the judge was less misogynistic or the medical team understood capacity better that the situation could be resolved in a more pleasant way, but sometimes there really isn't. There's only bad and worse.

Not sure why it quoted that post!

Reasonable force is lawful to use against anyone being restrained/transferred somewhere due to their MH. Police often assist ambulance/MH teams in restraining and transporting people who are being sectioned or if they require care elsewhere, many of which it's very traumatic for. If people are so shocked in this case I'm curious what they think about the rest of the MH system..

It’s also worth pointing out that the doctors’ determination of her lack of capacity to make this decision was upheld by a judge.

I thought the ‘natural birth is always best, let’s get all women out of those nasty medicalised hospitals’ thing had died a death since the Telford and Wrekin scandal. Apparently not.

Maybe some doctors don’t have enough expertise on patients who lack capacity but they have a lot more expertise than the posters on here. Therefore I am more inclined to believe that they are probably right here and I also note that the woman’s family agrees with the doctors.
Some women need medical intervention to give birth and sometimes this is known from the outset. Few women with mental capacity would go ahead with a home birth when the doctors say this is not a good idea. The women who do opt for home births usually do so with support of their midwife and where complications are unlikely. That’s why outcomes are generally good. If you want to go back in time to when everyone gave birth at home, the stats aren’t as great.

As others have said, faith placed in professionals without question in cases like this revolving around their skill or experience in determining capacity to consent will sometimes be misplaced.

HCPs to a ‘significant’ extent don’t always know much about assessing patients around capacity and therefore making determinations around the patient’s ability to consent. This is according to academic research pointed to by Birthrights blog:
www.birthrights.org.uk/2021/04/07/blog-agoraphobia-and-mental-capacity-a-new-obstetric-intervention-case/

See pubmed.ncbi.nlm.nih.gov/32647042/
‘Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do.’ Journal of Medical Ethics, July 2020.

Abstract:

Background: The Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors' compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors' experiences of and attitudes toward mental capacity assessment (MCAx).

Methods: This is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.

Results: Participants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001).

Conclusions: This study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.

[quote ChateauMargaux]@MissBarbary.. how many women should suffer so that one baby should live... its not an easy question...

If there is a 1 in 1,000 chance that my baby might die, compared to me making a choice to having the homebirth that means I give birth in the place that I feel safe, that is there are 999 chances in 1,000 that my baby will live and I get to feel safe therefore increasing my chances of a straightforward birth without interventions and without increased risk to me or the baby and an increased chance that my baby will be born to an unmedicated, unexhausted mother with neonatal instincts intact, facilitating natural feeding and overall reducing their risk of short and long term health impacts.. I would go for that.[/quote]
Why do you seem unable to grasp that she doesn’t have the mental capacity to make a decision? That’s why it’s been made for her. It’s exceptionally unusual for this to happen. It’s not like the courts intervene to protect unborn children all the time. Unborn children have no legal standing at all and the mother’s autonomy takes precedence. This is a rare situation where the mother cannot properly make a decision and therefore one has been made for her based on what is best for her (which actually includes consideration of what she would have wanted if she did have capacity). All the armchair obstetricians on here don’t have a clue.

"Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician."

Yeah because they only let you have one if you are low risk. If you are high risk like this woman seems to be, they will advise against it and very few women will go against that advice.

My daughter is agoraphobic and needed urgent medical care recently. I had to force her into the car and into the hospital. It was distressing but I didn't have a choice.

Although I've read many times that an agoraphobic mother will put up with extreme fear for their baby. I'm not sure if they can't see the baby then that would still be the case.

We don't know much about the case obv.

If she's that scared and has been deemed to lack capacity. Then risk of suicide, trying to induce abortion has presumably been considered.

Like I said at the very beginning. If she has a high risk pregnancy then sedating her, getting her to hosp for immediate CS, keeping her on morphine/ sedated until safe to go home (24 hours sometimes round here), and getting her home again would seem a good option.

In this case the judge talking about reasonable force to get her to hosp sounds all wrong. How much force is reasonable on a heavily pregnant woman who is terrified and struggling etc? That statement from the judge is awful.

@MissBarbary.. how many women should suffer so that one baby should live... its not an easy question...

If there is a 1 in 1,000 chance that my baby might die, compared to me making a choice to having the homebirth that means I give birth in the place that I feel safe, that is there are 999 chances in 1,000 that my baby will live and I get to feel safe therefore increasing my chances of a straightforward birth without interventions and without increased risk to me or the baby and an increased chance that my baby will be born to an unmedicated, unexhausted mother with neonatal instincts intact, facilitating natural feeding and overall reducing their risk of short and long term health impacts.. I would go for that.

rather than the team taking the time to allow her to come to an evidence based decision.

What if the woman doesn't have capacity to make an evidence based decision? The bar for being deemed to not have capacity is high, its not just said on a whim.

*"Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician."

www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/*

This paper only looks at women who met the existing eligibility criteria for home-birth (and compares them with a matched group). It therefore selects out women who had risk factors for complications of labour and delivery.

(The eligibility criteria are found in Box 1 in the paper.)

The overall evidence base is, as you say, that home birth is as safe as hospital for low risk pregnancies, but there is no way of knowing whether this paper is relevant to this woman’s situation.

@Pota2.. 'There have been home births where the baby has died or been severely disabled for instance.'

Babies also die and are severely disabled in hospital.

"Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician."

www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/

We do not know that medical staff have made an appropriate risk assessment based on the facts as presented.

Just today, I attended the post birth assessment (yes on a Sunday!) of a traumatised women and the senior OB on duty at the time said it was not an amber or a red decision but the woman is left with life long trauma because the decision on what happened was imposed upon her rather than the team taking the time to allow her to come to an evidence based decision.

Those sufferings impact own lives, their existing children, their future children, their wider families.. .. where do we draw the line.

Is it that one babies life worth the suffering of 100 women, 500 women, 1000 women.. more...

How many women should be traumatised, coerced, receive unnecessary interventions, have birth injuries against their wishes to save one baby?