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

Brokencrayons, there isn't always a need for medical intervention. When it comes to your body and your baby you have to trust your instincts. So many c-sections are performed unnecessarily, so many instrumental deliveries when they could have been avoided. Women should be given more power in deciding on what they want to do, blind trust in doctors is medicine is not always the only right way. I think the women should be given more guidance instead.

...some doctors do episiotomies so they can hurry up and go on their break. It's not always necessary, but they've caused damage for nothing that the woman then has to recover from then live with.

'Failure to progress' is usually a load of crap too. They have dumb time scales to follow which isn't fair as they say "every birth is different" - well, piss off and leave me alone then! I bet if every woman that was classed as 'failure to progress' had a home birth, the rate of c-sections would drop dramatically.

OhMake- do you have any evidence to support your assertion that "some doctors do episiotomies so they can hurry up and go on their break"? That kind of statement comes across as sensationalist and scaremongering.

There seems to be a distinct 'us and them' attitude from some on this thread. Surely we should be working together, with the HCPs (and they with us) towards a common goal of the safe delivery of a baby.

I understand that there are some cases where the HCP appears to have behaved appallingly and there are things that could have been done better, but surely these cases are the exception and not the norm.

It's clearly an emotive subject. My advice to the OP would be to go in with an open mind as to how labour and birth will play out and without an automatic distrust of the doctors/ consultants/ midwives.

Need An OB actually admitted it in an article I read when looking at risks etc. associated with it, though I'm sure it's more in America as they don't have guidelines and the like like we do. Do I have to find it? Also some might not want to see it but... the woman that has been in the media who goes by the name of Kelly, she ended up trying to sue her doctor? (She is also in America, I believe she finally has a case)

I do think the NHS are more civil than anywhere else, but that's only going by what I've heard and read about. The best way to handle a birth is good communication and understanding from the mother's perspective.

I'm really not trying to scare anyone, that's the last thing I would want to do. I was replying to brokencrayons.

Part of the issue is that if there is an adverse outcome when a women is refusing intervention because of feral compromise there have been successful legal cases (no refs sorry) whereby the infants legal team have argued that she "didn't understand the need" for intervention and therefore the injured /dead baby is the hospitals fault not the mother's for refusing life saving treatment.

As a result many clinicians in a truly pressurised situation will err on the side of protecting the fetus...

I've read about that, too. They say women can refuse treatment, but I highly doubt that you will easily find a mother that refuses any treatment if she understands her baby is at risk if she doesn't consent. I mean, there seems to be an attitude of 'we care about the baby but the mother doesn't'... but the mother also has the baby's best interests at heart the majority of the time! What sort of mother wouldn't?
Although scary at the time, a mother would be grateful for an EMCS if the baby was in danger.

I just don't get how people sometimes get annoyed if anyone says "women have the right to choose" - they do that's why, but most of the time they will comply if they are told baby is at risk either quickly and briefly or a full explanation. If they have neither, then no, she wont consent because the only legitimate reason to intervene in the mother's eyes is for the sake of her baby.

I guess it depends on how aware the mother is of the urgency and whether the staff decide to go against her wishes or not on moral grounds. Either way they will potentially find themselves with a lawsuit if anything does happen.

Hiya, like everyone else has said on the day you'll just do whatever you need to get baby out safe, my baby boy is a week old today, my labour did not go to plan, I went in at 9cm only for them to tell me the baby was breech ( the whole time) which resulted in an emergency c section, I can honestly say I did not care how or what they did as long as the baby and me were OK! Don't listen to much to other people's horror stories as I read and listened to all the negative stuff and although my birth didn't go how I would have liked it too it really wasn't so bad and as soon as I had him in my arms nothing mattered! Good luck with everything x

Not everyone will consent even if it seems to be the right thing to do.... You also don't always have a long time to discuss things.

From my own clinical practive I got,called to assist one of my junior colleagues who had a women in the table mid LSCS whose spinal wasn't good enough. She had already been given our usual cocktail of "get you through" drugs. The next stage was a General anaesthetic.

She was adamant she didn't want one. Despite the fact that she looked like she was in terrible pain.... I didn't give her a GA but wrote a small essay in her notes about offering her a GA, explaining that she didn't hVe to put up with the pain and that she chose to refuse the GA. I documented all the witnesses and got her and one of the theatre staff to sign it.

Inadequate anaesthesia is a reason for litigation and I didn't want to leave myself exposed.... It probably isn't the best way to practice medicine but it is the reality.

For all those reading this this situation with an inadequate spinal not amenable to some supplemental intravenous painkillers is really rare. I've only seen it one other time in more than 10 years of anaesthetics.

I was 35 , held down a very responsible job and was very assertive, and, I like to think, 'together when I had D1. I also had a very supportive (and equally assertive) birth partner in DH.I'd read everything going on pregnancy and labour .
But prolonged labour and fatigue do funny things to you ......
I cannot speak too highly of the midwives who delivered both my DCs . (the first was a student and DD1 was her 37th delivery) I felt informed and involved every step of the way, but I have no recollection of their asking my permission to cut me. DH says they definitely did I and I apparently said they could cut my f***g head off if it got the baby out ( I rarely swear). DD2 had (mild)shoulder dystocia and was 9lbs 8oz to boot . I tore on that occasion (no difference in healing incidentally). Again they explained what the problem was and what they were doing .
MY DD2 is a midwife and I feel so sad when I hear of these negative experiences, as I know how very hard she tries to follow the principles laid down in her training and to make every birth a positive experience for the women in her care.
I understand that the chances of intervention( forceps) are much higher if you have an epidural, so you may want to research and consider that one OP