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

Is that the same case? It's a different judge and the facts are different.

[quote BettyBag]www.bailii.org/ew/cases/EWCOP/2021/18.html[/quote]
This read the full facts as far as they are public..do you want her to continue with home birth?

hours hearing that had commenced at 10.00pm with respect to GH, a 26-year-old woman who suffers from anxiety, depression and acute agoraphobia and who had gone into labour at home nearly 72 hours earlier but who had thereafter suffered an obstructed labour. Within this context, it became apparent that GH required urgent in-patient obstetric treatment and a possible emergency caesarean section. GH was, however, refusing to agree to that course of action.

Read the judgement posted below by BettyBag.
This happened over 2 months ago.
She had been in labour for 72 hours and was at risk of stillbirth, sepsis etc. She had previously agreed to a hospital transfer of needed but changed her mind while in labour.
Distressing situation but one in which the judge called it right IMO

That poor poor woman. Is she going to go quietly? I doubt it very much. Is force going to be used? Almost certainly. I hope for her sake she is provided with therapy to ease her distress and in my opinion, the judge should have ruled this.

The problem is, if the court did not make this decision and the worst happened, what would we say then? "Oh well, woman and her baby die in labour because the court failed to intervene".

It's clearly not a decision anyone involved has taken lightly.

If she wants a home birth, she can pay for it. She doesn’t have the right to insist in whatever she wants from the NHS.

Why should the NHS risk being blamed for a situation that could lead to potential harm to either mother or baby when they don’t think it’s safe to deliver the baby at home?

People need to stop thinking they have the right to demand whatever they want from the NHS just because they are pregnant. It is not a private service.

Posted too quickly, sorry. I had to be induced on the drip in the end and surprised myself with how calm I was. It was all ok and fortunately had a good birth experience.

There must be an extenuating circumstance we’re not aware of here that puts her at more risk. Midwifes were aware of my issues and had no problem in helping me try with a home birth. If it had got to the point where not only my family, my husband, health professionals and the court were ruling me as having no capacity - I would have been completely enraged. Not only that but so, so vulnerable. As if it isn’t overwhelming enough, you now have the prospect of having to face your phobia in a truly horrific way.

After the birth of my DD, it completely pushed me to go out of my comfort zones and within 6 months I was completely recovered, if not better than I was before. Still going well to this day 5 years later

So my feeling is there must have been a reason they wouldn’t allow this beyond the agoraphobia. It meant so much to me that I was supported in at least trying and the move to hospital was ultimately within my power to take myself. This lady needs some serious support to get her there, so at least she feels she’s doing of it of her own volition. To offer her anything less seems simply barbaric.

That's the case.

www.bailii.org/ew/cases/EWCOP/2021/18.html

I was suffering from agoraphobia through my pregnancy and birth. I opted to try for a home birth but still ended up with a hospita

Does she have a high risk pregnancy? Is it a multiple birth? Does the child have a health condition diagnosed in utero that needs immediate treatment?

The are a whole host of medical reasons that a hospital birth could be the best option that this mother is ignoring because of crippling agoraphobia. I doubt a judge made this ruling lightly and in a situation where there was little risk. It would be exceptional to do so.

That article simply doesn't give details, and nor should it.

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”.

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).

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.

And if a woman not detained under the MHA or judged to lack capacity, for whatever reason decides on a course of non-intervention that might allow both the fœtus's death and her own, it is her right to do so. Isn't it?

Yes - the example of JW was given above, where it’s legal for people to bleed to death rather than accept transfusion.

But capacity is important, as people say all sorts of things in the heat of the moment / without full information etc etc and if everyone who ever used the phrase “I’d rather die than x or y” was taken at their word without any exploration that would seem a little remiss.

I expect that increased numbers of people with agoraphobia may be one consequence of the pandemic. So the mum in this situation may not be unique.

What we don't have is any other information about her medical background. For some women a home birth could be very dangerous. Should her life or that of her baby be put at risk?

I've said before, I suspect the bigger issue is how she'd react to an emergency situation and whether it would be safe to transfer her if that happened.

We don't know how far along she is. My hope is that her midwives and doctors are working with her to feel comfortable to go into hospital at the appointment times. Spend some time there before the birth so she gets used to the environment. I think they'd only want to resort to this legal ruling if they have to

Being Agoraphobic does not mean you lack mental capacity, if that's the case why is she pregnant if considered vulnerable?

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

I worry that people will read that sort of thing and then avoid treatment etc.

In what situations do you intubate people who are fully conscious, no sedation or anything? When it's not been some terrible incident and so it needs done immediately?

I didn't know that happened. When I was young I was sedated before GA, and definitely intubated afterwards.

I know it can be hard to get the tube down even when the patient is unconscious.

I'm surprised to hear that in your line of work it would be done prior to sedation even and that sounds really extreme.

I hope she can get this overturned. It’s not illegal to have a home birth nor to have mental health problems. She deserves professional support and access to health care not punishment. She has mental health reasons for avoiding hospital. She must be aware of the risks she faces from giving birth at either home or hospital with her agoraphobia. I was really horrified to read about this ruling. I can only imagine how distressed she must be feeling. Where is the massive public and professional outcry over her rights?

Re sedation: benzodiazepenes are safer than mahoosive catecholamine release I would have thought (and I know you can get disinhibition and excitation, and I know it wouldn't magically make for a perfectly compliant patient trotting to the ambulance, but still...the amnesic effects alone would be worth it).

I really hope she is doing OK. I had an agoraphobic client once, who had finally braced himself to get in a taxi and take his beloved cat to the vet when she was quite ill. Poor chap it was obvious how much it had taken for him to do this, he was in a cold sweat and just about managed to keep his voice reasonably steady with a few pauses, a glass of water and a ton of effort. Before I met him I didn't really know what agoraphobia meant.

There was another case of a woman who was.. taken to hosp and it all sounded shitty.

I'll try and find it.

The midwifery and obstetric team have a duty of care for mother and baby
[leaving aside the original case in question] Until the fœtus is born it has no rights, and therefore that duty of care cannot be equal. And if a woman not detained under the MHA or judged to lack capacity, for whatever reason decides on a course of non-intervention that might allow both the fœtus's death and her own, it is her right to do so. Isn't it?
If not, what other rights are up for grabs?

Becca I'm not surprised you have no faith in them.

That's s totally rational response.

Hi Becca no it wasn't you at all! I'm sorry you got that idea.

Based on the OP I said why couldn't they sedate her bung her in an ambulance do a CS get her home earliest opportunity etc.

There was a reply that I questioned. Not you at all. Don't apologise :) x