Consent in birth

[Greyhorses]

Hi,
Sorry I am way to early to be asking anything about birth as I am only 13 weeks but I had a conversation with a friend and it's been playing on my mind and I had to ask!

I know I am going to have to give birth, I know it's going to hurt a lot...I have a pretty open mind with this sort of thing however I am struggling with some of the things I have been told regarding consent. I hate not being listened too, I am able to have most medical procedures done knowing if I can't cope I can ask them to stop whatever it is and I know they will. I know you can't stop labour but the feeling of no control is scary!

One friend told me she was cut without permission. She begged not to be and they cut her anyway.

Another told me she had manual removal of placenta and was screaming at them to stop but they wouldn't. She said the doctor literally wouldn't remove his hand despite her screaming in agony.

Someone else told me that she refused forceps but was pressured into it and aggred but they did not use any anaesthetic and she said this was horrific. She suffered post birth injuries due to forceps.

I know every birth is different but it scares me to think I could say no to something or be in lots of pain and they won't stop doing whatever it is they are doing?

How likley is this to happen, is it common or do they listen to women?

Also I really really don't want forceps due to risks of incontinence and injury, can I refuse this alltogether?

Thanks everyone I'm sure you all get sick of people asking over and over

I had a C-section without consent with DS5 after I told the dr I didn't want one. But to put it into context that was a life or death situation. In my 5 labours that was the one time they did anything without consent. When there was time to discuss things beforehand, they did.

DS5's birth was incredibly traumatic but the dr said to me afterwards when everything was calmer that he was sorry that he'd had to operate when I'd said no but there wasn't time to have a discussion about it, he had to come out. In my notes it just says that the C-section was done but if you read between the lines you can tell it was without consent because with everything else it says "with consent" afterwards. TBH although it left me traumatised I'm still glad they did it because it would have been a lot more traumatizing if DS5 had died or had been starved of oxygen. As it was, it took the neonatal nurse and the paed 40 minutes to stabilize him.

Personally I think childbirth is like flying. Most people fly in planes and have uneventful flights. But when you're planning on flying somewhere there is always someone who feels the need to tell you all about some plane crash they've heard about.

Genuinely wondering what happens if baby is in birth canal, or head is coming, and they need to cut, what would happen if you said no and they didn't do it? Could you die?

Not trying to scare you op, just genuinely confused about this. Surely being cut is better than loosing baby/your own life?

wicked depending on circumstances, one of 3 things would happen

1. you tear instead of being cut
2. baby gets stuck, goes into distress and eventually dies (although I would imagine either the mum would consent to being cut, she'd tear naturally or the drs would cut without consent before it got that far).
3. c-section, although that would depend on how far down the birth canal the baby's head is.

In an emergency a dr can go against the mothers consent to save a baby's life. It's rare but it happens.

I attended NCT classes with my 1st.

3 births later DH is convinced NCT classes should consist of simply giving the couples a list of local doulas and then all going out to lunch/to the pub for the rest of the time.

Get a doula. Midwifes don't have the time to get to know you as an individual and with the best will in the world might make a decision on your behalf that doesn't suite you best.

wicked If you have it clear in your birthplan that you will not consent to instrumental delivery, you increase the chances of your care up until delivery being tailored towards avoiding that becoming a necessary outcome.

You also increase the chances of if it becoming inevitable, of having the reasons explained clearly to you so you can remain in control of the decision-making. Essential for good mental health surrounding an anxiety.

I think there is a difference between the doctor/ midwife doing something which you have explicitly told them not to, which is totally unacceptable, and what happens to a lot of people which is that there is an emergency situation where they do not have time to explain to you fully the risks and benefits and you end up consenting to something which you wish in hindsight that you hadn't. In the latter case I think the best thing you can do is write a birth plan which focuses on what happens if things don't go smoothly, so that you have done your research in advance and don't need to think about it on the spot.

zzzzz Yes, exactly that. I wouldn't throw a horror story at them but give them advice to help them physically and mentally. A mother's mental state after childbirth is forgotten about too much, it's not always PND.

There are horror stories, and I truely feel for women who've gone through them. However for balance and hopefully to calm your anxiety my births:

1. Long long induction, respected throughout, pain relief good. Cut in a rushed way which was a bit short on full consent but tbh it was a relief to get stuck baby out in panic, talked through well after and pain relief to repair.

1. Prem labour, 1 ve with consent

1. Quick labour, 1 painful ve, consent was rechecked and she withdrew her hand when I found it obviously painful. Finished without any further ve.

Three hospitals, all very medicalised but no piece of meat scenarios at all.

Thank you to everyone who has replied.

Obviously first and foremost I want the baby to be safe

However I also have to live the rest of my own life with possible long term injuries and that what scares me. Not so much short term but more long term effects.

It's nice to hear some of the more positive stories!

The idea that you have to follow Drs orders or baby will die is false.

Have a look for the BRAIN acronym.
Benefits (what are the benefits of X action?)
Risks (what are the risks of x action?)
Alternative (what are the alternatives?)
Intuition (what do YOU want?)
Nothing (what happens if we do nothing?)

Also check out if there's a Positive Birth Group near you. They're free, friendly and discuss things like this (and it doesn't matter what type of birth you want, just that you have the information to make your experience the best it can be, whatever happens).

To me there is a fine line between doctor/midwife knows best and letting them do whatever they want. My own experience is that if you do not ask (even though you might not know what to ask), you might not be told.

I have to say I'm happy to see other posters have had the best management of their birth, with staff constantly consulting with them.

Staff not keeping you informed is sadly common on this thread. I agree with others that you need a birth partner who will gently but assertively ask what staff are doing and why. Being in labour is a vulnerable state and you should prepare for the most extreme scenario where labour is so intense that your awareness is impaired and you need to rely on someone to clarify things and ask questions on your behalf.

There are things you can't control (size, position of baby, strength of contractions, heart rate etc) but you can minimise the risks of instruments. Choose a midwife-led unit to give birth and don't have an epidural (that one is easier said than done ).

To minimise trauma to the perineum (tears and/or episiotomy) generally, do perineal massage in the last weeks of pregnancy, do pelvic floor exercises, have a first baby before you're 35 (hopefully that's the case) and again, don't have an epidural, when pushing follow midwives' instructions not to push/push, don't lie on your back to give birth (that's the bit the epidural will guarantee) and stand up, walk, squat instead (these positions maximise pelvic space for baby's head).

Hi OP, I did hypnobirthing which I highly recommend, for dealing with the worry in advance as much as having a calm and painless birth.

I agree with everything 53rd said above, childbirth is not a reason to override your autonomy. In my first birth the delivery stage was slow, a lovely midwife was with me giving encouragement. A doctor came in, said it was going too slowly and she was going to cut me - not even addressing me. The midwife argued saying I was on the way, and baby was not in distress. I sat up and loudly said "I do NOT give consent to an episiotomy at this stage!" . DH then chucked out the doctor and various others who had wandered in (I remember him telling them that this was a calm fucking delivery room not Liverpool fucking Station ) and I gave birth naturally, no tearing.

My advice would be, read up on NICE guidelines on advance - I quoted them a lot when refusing induction; write a birth plan and refer everyone to it; brief your birth partner about backing you up; remember you have rights and can exercise them. And do hypnobirthing!

Ooh yes, perineal massage too. Also my second was a water birth, amazing.

You actually have a decreased risk of a 3 rd degree with an epidural though...
Personally i think the only way to avoid instruments is an elective c section.
When it comes to instrumental deliveries they are not all the same mind.
Lift out forceps and ventouse are not such worse than a normal delivery in terms of damage.. And if you do tear or cut a dr will stitch you up instead of a midwife so the repair maybe better .I think the real damage happens when the baby is stuck high up or midway. You really need to know the position of the baby and ask for a c section if it looks like they may have to pull hard to extract baby.

"You actually have a decreased risk of a 3 rd degree with an epidural though..."

What - despite the increased risk of forceps?

I'm not sure if the increased forceos risk negates the benefits of the epidural.
Essentially an epidural means you normally push less hard which is better for the
Old pelvic floor and means usually a slower delivery of the head.
But as you push less hard then forceps are more likely.
The thing is you will never know if a women who needs an epidural because of increased pain perhaps because of the position and size of the baby would have needed forceps anyway.

Stairway Could you give your sources please?

This doc for example goes your way
www.birthtraumaassociation.org.uk/publications/epidurals.pdf

However most of the info I read does discourage having an epidural.
See Hold it Mama - The pelvic floor and core handbook for pregnancy birth and beyond by Mary O'Dwyer

If the evidence is uncertain about epidurals, my view would be that the NHS tells you the evidence is uncertain. As far as I know that is not what they do. Who knows?

53rd, IME, the woman's bodily autonomy is always overridden in childbirth when the baby's life is at risk. Say, the baby gets stuck during pushing, the heart rate drops and does not recover, and despite best pushing efforts from the mother, the head is not descending. This is a situation in which intervention is needed, or the baby will die. What doctor will accept a mother's no to intervention? If he does respect her wishes and the baby dies, would the doctor be safe from prosecution for manslaughter?

You can refuse all intervention in your birth plan, but if the baby's or your life is in danger, your lack of consent will be ignored. This is a fact.

Thanks everyone for all of the advice and opinions! It's very interesting (and scary!)

So if baby was in distress would I be able to say no to forceps but yes to section or would the option be taken away?

Can you say yes cut me but I want anaesthetic, or yes manually remove placenta but I want GA/pain relief?

Or would they just do whatever way they liked once I had consented?

^ That's what happened to me, though baby was fine as I reluctantly consented. Then got no explanation for her barging in on me! Like pinguina said if you don't know what to ask, you wont get told. But they are meant to be there to inform you, right?

My sister had 5 babies. Epidurals for all but 1. No problems. No tearing, no cut, no intervention and no stitches. How she was so lucky, I have no idea. And she probably doesn't even know what she potentially escaped as none of her births were quick either!

zzzz

I'm sorry to be inquisitive but would you mind explaining how your first birth was magical despite the third degree tear? Was it just that it was wonderful up to that point whilst the birthing pool one was more painful throughout?

You can scream 'I demand a section, if any damage is done to me from not following this request I'll sue your backsides, please write that in my notes with the names of all in this room as witnesses!'

I hate the idea of a woman's consent being overridden. I can't even watch One Born because they're all so bloody patronising. But at the same time, I was present at a labour recently where a shoulder got badly stuck and it was all very hairy. The woman labouring didn't want any of the interventions on offer and she did want pain relief (which there wasn't time for). She wasn't in a state of mind of say 'actually yes go ahead' although I know now she would be devastated if they hadn't carried out the interventions that saved the baby's life. (My baby's life, actually - I would wash this woman's feet if she would let me.)

I just don't know if medical staff are in an impossible situation with this one, given what most women would consent to with the benefit of hindsight. When DS was receiving CPR for minute after minute and the nurses faces were white, it felt like every second he had been struggling may have cost him his life. If the outcome for us had been different, wouldn't it be a heavy burden for a mother to bear, knowing that her choices had affected events and prevented a medical team from doing everything they wanted to? Is it fair to lay that responsibility on her shoulders when she may be affected by different medications and unaware of all the information? Isn't this slightly more complex than 'her body, her choice'?