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'm not sure. Why can't the woman be expected to take full responsibility for her decisions?

I perhaps have a different opinion though because I believe medical staff overriding mothers preferences and consent damaged my child. It is impossible to prove in large part because my notes had considerable parts of them missing.

So in subsequent births I preferred to chance it. My preference for them was for any potential damage to have been caused by me and not medical staff. Isn't that my right? My human right?

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.

That is not what the law says. The law is pretty clear on this. From the NHS:

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected. This still stands even if refusing treatment would result in their death, or the death of their unborn child.

Whether or not anyone should be refusing treatment if their life or their baby's life is in danger is a whole separate issue, but legally: no, they cannot just ignore you.

Consent in child birth? IME, you are at the mercy of the MW and doctors. Their aim is to get you to give birth to a live child. They will do whatever is necessary to achieve their goal.

As a midwife I don't see stuff beingdone without consent. I'm not saying it doesn't happen, people say it does so it must. But Id like to think it's a small minority of staff, still shouldn't happen though.

Ive seen emergency situations where life was at risk but the woman declined consent for stuff to be done. So we didn't do it even though we were worried the baby might die. Obviously we told her we were worried the baby might die and tried to,persuade her to let us deluver the baby. She said afterwards she felt pressured/blackmailed by us. Sometimes you can't win, if we hadn't (truthfully) told her the baby was at risk of dying and the baby had died she would quite rightly have been furious with is for not telling her.

Ive twice seen a Dr carry on with a VE after a woman had said stop. And both times I told them they needed to stop and they did immediately after I told them to stop. But they should have listened to the woman, not carried on for a few more seconds. I'm a bolshy old midwife who will tell the Drs, guess not every midwife would? But they should do, one of the midwives main roles is to be an advocate for the woman.

OP, WHEn you're in labour tell the midwife your worries right at the start.

stoppingbywoods. That's why it's really important for a midwife to try and build up a relationship with the woman as quickly as possible on labour ward so she trusts the midwife.

Ive certainly been in situations where the woman has said no, and very quickly as a midwife you have to take their hand and connect with them and tell them they need to say yes. Like you say I think most women would regret refusing consent afterwards if it was a poor outcome and we realise it's often fear making them say no. But we can't plough on regardless. But it's a thin line between making them realise how serious it is and bullying them into saying yes, when every second counts. Id certainly never shout at someone to do something, but I would beg.

Whothefuckissimon I don't envy the job of midwife or obstetrician at all. So much responsibility on your shoulders.
I think drs consider it far easier to repair a vagina than a brain damaged child that is why they are so keen on intervention and if she refuses maybe she isn't in the right frame of mind?
Not a responsibility I envy at all!

I think something that would really help is being given more honest and impartial information about the pros and cons of interventions and situations where they might be required during the pregnancy. I am also keen to avoid forceps if possible and discussed it with the OB registrar at my last appointment. She was great and talked me through how they would make the decision to use different interventions and why some are better/worse in different scenarios. Whereas previously I had just thought I would totally refuse forceps, now I will know what to ask about if they suggest it in labour and understand better the potential implications of the decisions I make e.g. when asking for a section would actually be worse than forceps, or situations where forceps are likely to do the most damage.

Obviously an emergency situation is not really the time to either be giving or processing this info, so more needs to be done ante-natally, rather than women's concerns often being brushed aside.

I think the thing is as well, sometimes you don't really know what you're agreeing to. I had an episiotomy and straight after DD was born I said to DH "I don't think they asked my permission for that". Apparently they had (he heard them) and I agreed but I don't really remember it.

But, on the flip side, I remember every other thing they did and they did seek consent for all of it. So I've no reason to doubt them asking my consent for the epis. I made it very clear on my birth plan that they were to gain permission before each examination etc and they did.

OP, I was terrified too after reading on here about cases of consent not being sought. It's why I was so explicit on my birth plan. The advice I would give to you is to do your research in advance. The more you know the better. And ask questions during your labour if you don't understand something.

WhoTheFuck ...if we hadn't (truthfully) told her the baby was at risk of dying and the baby had died she would quite rightly have been furious with is for not telling her.

See. My baby's life was at risk. Not once did they tell me. They just panicked. One ran out. Doctor stormed in. I had no idea what was going on. Would they have told me if I didn't consent? Or do they strictly just not tell you anything ever?
I think subconsciously I could sense there was something they were concerned about but didn't know what. Not even a hint. They didn't tell me what happened afterwards, so I was left feeling as though there was absolutely no reason for them to interfere for 3 years! Then I realised I needed answers from a debrief. I feel that it could have been handled a lot better than it was. I only needed to know why they were so desperate to rush me rather than me developing PTSD.

Ohmakemeover I wasn't told either that the baby was distressed.. One minute I was pushing the next minute there was a doctor between my legs telling me she was going to cut me ...
The midwife told me afterwards and tbf she was a very nice midwife but it seems they don't tell the women what's going on at the time.. Perhaps because they think we will panic too?

I haven't had chance to read all the messages here so apologies if someone else has already said this, but I'd recommend you did some Natal Hypnotherapy to get rid of some of your fears - i have found it amazing (though 40+3 so haven't put into practise yet but I feel really relaxed and not scared about the upcoming birth...). It also gives a big role for your birth partner in being the advocate about making sure your birth plan wishes are fulfilled. We're planning a home birth and they can't cut or use forceps at home, so that would be one way of trying to avoid. I'd recommend a book called 'Effective birth preparation' by Maggie Howell to see if you like the sound of NH, and the there are CDs and courses if you do x

This was touched on in my pre-conception appointment. The doctor who took my appointment was female, had three kids on the NHS, and said that you should never refuse drugs because she did for her first and there wasn't time for any later (she got cut, torn, and had forceps! But the doctor only gave her anything afterwards to stitch her up). It scared me and my husband enough to research private options lol but found they use the same guidelines as NICE.

Yes I understand maybe not saying at the time but surely afterwards, just 2 minutes, there were 3 of them there...
I was crying and wondering what had happened, no one answered. They just did the stitches and shoved me on the ward.

Yes they should have told you afterwards.. That is poor midwife care indeed.
I remember the doctor sticking her finger up my backside afterwards with no warning.
Fortunately I had already read about it on here so it wasn't a complete shock.
Next time for me I want an elective .. No more emergency births for me.

That's exactly what they did to me afterwards! I didn't know she was doing / checking / stitching, nothing! I wasn't expecting the internal exam after or anything. That's why it all left me distressed, felt like my body was theirs for ages. I asked my mum what they did when she was sitting with me on the postnatal ward! Surely THEY should have told me. I had a training nurse too that I wasn't told about, I thought she was a shit midwife!

I was terrified of a lot of these things. Ended up being induced, ended up with an epidural (best thing ever), baby was delivered with a spinal block using forceps by a surgeon, who gave me an episiotomy. I consented to all of this though I barely remember it - I'd been in labour for 65 hours at that point (since first tightenings) and was away with the fairies and utterly exhausted, to the extent that I was struggling to push. What I would say though is that I recovered very quickly (I was up and walking about as soon as the spinal block wore off) and well (no lasting effects of any of the interventions). I just wanted my baby out!

So don't rule out anything on the basis of internet scaremongering - I was totally against instrumental delivery because I'd spent too much time on messageboards, but it was the right thing for me and baby in the end.

Hi Grey horses, I haven't read the thread in detail as it's all a bit emotive for me but I don't know if some of the following may help.

At the end of the day, a lot of your birth experience will come down to luck, but I think the better informed and more open minded you are the easier it will be to cope with how it turns out. I was of the 'lalala I can't hear you' school when it came to listening to others experiences beforehand and i really don't think it helped me. But at the same time, you cannot always be in control of how this pans out and I would be wary of anyone who says otherwise.

So, expect the best. Do your research and then choose epidural / waterbirth / hypnobirth or whatever you feel you would prefer given your medical history, local options etc. But be open to the fact that things may change at short notice and without time for a full discussion prior to consent. And that medical staff will act in the best interest of your baby and in my experience they may well place this above your wishes if there isn't time for discussion.

Be aware that if you go without pain relief from the off, if the situation changes it may then be too late to request it and you may end up with assisted delivery with no pain relief. That isn't nice. However, without complications arising I would have had a lovely drug free waterbirth and would probably be telling you about how empowering and wonderful it was. It's a gamble. Don't go with anecdotes, look at statistics, your own local hospital record and your own personal feelings.

Most important of all by far, obsess much less about the birth and much more about recovery afterwards. Ask for a debrief and explanations afterwards. Know what normal recovery times are and find out about your likely post partum experience. It sounds ridiculous now, but I actually thought I might need to take non-maternity clothes to the hospital to wear home! It's helpful to know, for example, that if you have assisted delivery you should receive physio to help you recover. That way, if your hospital fails to refer you, you can chase it up. Write all this stuff down somewhere, as in your sleep deprived state you won't remember any of it. Know that there is an organisation called the birth trauma association, that you probably won't need them but if you do you've already found the website. Know that you should feel OK mentally and physically reasonably quickly and if you don't you should ask for help.

All the best

Make very sure you trust your birth partner. I know of someone who essentially forced the baby's father to be present although he didn't want to be (they were no longer in a relationship by the time the baby was born). For the sake of this discussion, I'm setting aside the question about whether a birth partner should be present if he doesn't want to be. The birth did not go smoothly and she was told she would need an emergency C section, which she was refusing because she didn't want a scar. The medical team told her if she didn't do it then one or both of them could die. She was still refusing, when the baby's father cut in and told them to 'just kill her then, save the baby'.

Needless to say, they didn't kill her (or the baby - I think she eventually went ahead with the op), and I highly doubt a medical team would take a decision like that based on what the birth partner says....but it never fails to horrify me how many people seem to think birth is a spectator sport, that the woman's right to patient confidentiality and autonomy doesn't apply in childbirth, that everyone's got a right about who's there and what happens except the labouring woman herself. You only have to look at all the strops people throw when they can't be present at the birth.

I don't really claim to have a solution; if a woman's refusing urgent procedures because she wanted to have an intervention-free birth or something, I don't know what the right thing is to do. But having a birth partner you trust and who wants to be there for the right reasons (ie to support you - I don't give a shit about anyone's supposed 'right to see' or whatever the fuck) would be crucial.

I would agree that doing your own research about all of the possible choices that you have during labour can help you to be suitably informed in advance, and allow you to prepare a birth preferences list (rather than birth plan), and also can help you to make sure that your dp/dh/birth partner can be your advocate in the room.

I felt like I had very little choice in my prior two births so this time (I'm 32 weeks) I want to make sure that I am very clear about what I am happy with and what I'm not, but the main thing is (as someone said below) that the options are explained to me.... the BRAIN acronym is really useful, and dh is onboard too to make sure that, if I'm out of it, he can gather the information. My midwife was saying that, in her experience, the vast majority of the time, even in so-called emergency situations there is time to ensure that the woman understands the options, and consents.

I am also doing natal hypnotherapy and reading loads of positive if a bit hippy birth stories to help calm my fears (going for a VBA2C) and increase my chances of the kind of birth that I'd like.

Dh (this is his first) had no idea labour/birth could be so complicated

I had a baby 5 days ago, so everything is still fresh and raw in my memory. I was not prepared, as my due date was still a whole month ahead. Having had cramps for the whole day, which got worse at night, I came to a labour word. As soon as I entered the waiting room of the labour ward, I lost control over everything: my body, my choices, etc. I was put in a cubicle in the waiting area, strapped to a fetal monitor for 7 hours. My baby was not in distress, heart rate was fine, my baby was not in danger, I wasn't in any danger. Within that time the contractions got full blown, I was screaming in agony. I begged the midwives to take me off the fetal monitors as I wanted to walk around. They wouldn't let me, I asked to be given a room, they wouldn't give me one, I wanted to take a shower and change (I was still wearing clothes that I came in on and trainers), but they insisted on me staying put on bed in the cubicle. In the end, i was writhing on the floor in pain, I felt utterly helpless. I had to scream that it was body, that I can make my choices, and they had to respect them. Only then I was allowed to change and taken off the monitors. Twenty minutes later, I gave birth, without my partner (it's not midwives fault, of course) but instead of fighting with me to follow their way, they could have prepared me on what was coming (they gave an impression that a delivery was still a long way). Surely the intensity and frequency of contractions could have been a cue? So absence of your consent is a no deterrent if the medics are hell-bent on their ways, and won't even listen to you.

I'm sorry but I find it hard to fully understand why some women think they can just refuse a procedure and for that to be ok. They are there for a very important reason. For the safe delivery of a live baby. They don't brutalise you or ignore your requests out of Evil or for some sick kicks! Surely when it comes down to it, and things are getting a bit scary, you put your trust in your doctor and his/her experience at dealing with and making decisions during a difficult birth. I had forceps delivery btw and I've never once pissed my pants even during subsequent pregnancies, so they don't always mess up your pelvic floor.