How much should women be told about complications in labour or birth?

[Flomaba]

Hello I am a midwife who does ante-natal classes and am studying medical law. I would really appreciate any feedback on whether or not women think we should tell them all of the risks all of the time, some risks all of the time, or any other variations so that women can choose whether or not to take that risk. Many thanks and best wishes.

Anyone think going through different scenarios (ie one like ValiumQueen's) in AN classes might be useful to get women and partners to think about it well ahead?

flomaba that took you seconds to explain that. Why does nobody give us that time? Surely if you are trained it is not that hard to do an individualised risk assessment!

Yes that's my big concern that consent can be on very dodgy grounds

Last comment was about the big baby risks.

No I don't think going through different scenarios is helpful because in labour you're not likely to remember them. I think what would be helpful is perhaps having a discussion on consent and on how much control the woman has in labour to bring it home to women that they and they alone can decide what happens to them and that they are entitled to absolute clarification before anything goes ahead.

Oh yes and some midwives need training on consent. "I'm going to do an episiotomy" does not equal obtaining consent FFS.

What comoforted me and whjat i would suggested is going at it from the angle of what can be done about risks. SO maybe mentioned what medical help can be given to beleeding women, how episiotomy scars heal, what care is given to C section patients etc.

lots of info about choices that may need to be made and consequences to Mums and babies.

I would never ever ever had ac section.... untill they said it was shti for me but would save DDs life. B

Those scenarios will do no good unless all medical staff are prepared to listen and act on the mother's wishes.

It's useful to think about possible outcomes and assign yes/no/maybe but this is why there should be some kind of grid for birth plans bit the risky washy ideal scenarios most people think they are. Drawing up a birth plan should be a process of research, evaluating possible outcomes and deciding on preferences for a variety of situations. If you've done the thinking beforehand (and written it down) you're better able to consent/make an informed decision when it happens.

Yes it's amazing we measure your bump, send you for a scan if it's bigger than 3-4cms then don't tell you that you can't have a CS and still have to go through labour even though we know it's risky - I work in it and can't get my head around the 'reasoning' alot of the time.

I knew I wasn't prepared to go anywhere into induction after having had my first 'textbook vb'. But despite making this clear at booking in and subsequent appointments it was only when I went overdue that there was a flurry of panic and phone calls and grave 'looks'.

Luckily I went long enough overdue to get passed around enough to arrive at a senior and absolutely fantastic midwife who understood that my fear of labour was nothing of the sort. It was a fear of being 'manhandled' during labour that was the real issue, which is why I could never give consent to an induction.

Oh fat fingers.

but this is why there should be some kind of grid for birth plans not the risky wishy-ideal scenarios

If they even looked at the birth plan it might help. I went to hand mine to the MW and she said 'oh that all goes out the window anyway'

My experience is that women are treated as if they are completely stupid for the entire pregnancy. I can't get any sense out of my midwife, she talks to me as if I am a 2 year old. Thankfully she is not the person that I have to discuss VBAC vs second c section with, but it gives me little hope of having a reasonable conversation with anybody when my appointment comes up. I fully expect to have to ask a great deal and not be told much.

That's the main issue, in my opinion. It means that women are not informed fully, or treated as if they have a paper cut when asking for pain relief in labour.

Worth writing something in the birth plan that in such and such a situation you definately will not consent to X but will consent to Y. They are so twitchy now about women who think they may not consent to a blood transfusion in a life-threatening situation (Jehovah's Witnesses and some non-JW's) that we have to refer for a consultant appt at booking to clarify and fill in a massive consent form not to receive blood so I think if you flag it up big in your birth plan the midwives and docs should address it with you. If they don't point it out to them as soon as you go in. Helps to write it in bright colour such as green or red - can't miss it.

The MW on the post natal ward laughed at my birth plan because I asked if I needed stitches etc could the do it without stirrups for my spd. And that I wanted to avoid lying flat! Apparently that's an urban myth that labouring on all fours is better!

Interested in the grid birth plan

We suture at home without stirrups!!

You need to labour in whatever position is the LEAST uncomfortable for you. Most time it won't be flat on your back.

I have been thinking about this exact subject alot recently. I'm 34 weeks with first DC and feel I am being drip fed info from all over the place (NCT, NHS, mumsnet, magazine given by a friend etc etc) which I am then investigating and relying on google for clarity.

My community midwife is prickly unfriendly and very political on certain subjects which doesn't exactly help!

Personally I think withholding information is patronising, patriarchal, and immoral. I know that sounds abit extreme but for eg, I found out about forceps & the possible / probable implications for the mother, only after someone said that that use of forceps was one of her reasons for wanting to avoid an epidural.

I also read terribly sad thread on MN whose sex life / relationship with DP had been by long term effects of damage from childbirth.
Now I know I definitely do not want forceps unless it's really life or death and feel that the NHS avoid mentioning these affects as they don't want to do more c sections (££££££....)

I feel that the worry about cost means that certain subjects are avoided and suspect that potential reconstructive surgery is downplayed for the same reason, someone who's been through it can correct me if wrong!

This is slightly off point, but kind of related. I read an earlier post of the OPs where she asked a question concerning women who had had a 'textbook' VB. One of my particular bugbears is how and when it is decided and who decides whether or not births are 'successful' or not. In my own case I had a VB - started off in the MW led centre, then transferred to the consultant led unit when I wanted an epidural. This was the only intervention. No forceps. No ventouse. 'Only' a 2nd degree tear and a slightly larger than usual blood loss. For a 39 year old primip I'm sure everyone chalked it up as a massive success - my doula certainly did. Yet I sustained a garde 3/4 degree cystocele, grade 3 uterine prolapse, grade 3/4 rectocele, bilateral detachment of puborectalis, disruption to coccyx and moderate/severe PTSD. 2 years post birth I am still not done with surgery to repair things. How would any of this get tied up with the labour ward stats?

I think this is really important. If MWs are telling women about risks of VB, ELCS, etc, this will be informed by their own impressions of clinical practice in their unit. Yet, if those impressions are erroneous because they do nto take into account all the facts, how can they engage in properly informed debate?

But flomaba I was a silly first timer who didn't know anything! They don't look at the person behind the bump at all in my opinion. I was scared, they saw that as stupid.

I wish I could tell you differently but I think you're right. The NHS is primarily money driven. Do a bit more research and make a really strong, assertive birth plan in bright colour type, really lay out what you definately do not want (and why) and shove it under the midwives' and doctors noses. They cannot force you to have forceps. You cannot force them to do a CS. But if you refuse forceps and the baby ain't coming out they've no other choice but do a CS = duty of care and breach of it is negligence. Also, although you can't force them to do a CS and you say you want it they have to refer you on to a doctor who will do it. I know it all sounds really stupid and contradictory but that's the law.

I am sure if men had the babies all this would have been sorted out many moons ago. Then again, the human race would have died out long ago.

I was annoyed that my consultant had assured me I could have a section, yet the junior doctor would not even call the consultant to discuss it.

Glai - Sorry didn't make it clear my !! was directed at the s**d midwife not you

But no-one pays the slightest attention to birth plans until you are past 40 weeks.