MNHQ here: are you interested in the issue of medical consent during childbirth?

[RowanMumsnet]

Hello

One of the charities we work with, MASIC, is holding an event in London (sorry!) on Thursday 29 November to discuss the issue of medical consent in childbirth, and how that issue ties in to obstetric anal sphincter injuries (third or fourth degree tears that damage your anus, with often life-changing consequences) and the provision of elective caesarian sections.

It's a day-long event (9.15 to 4.30) with panels and debates on topics including:

an explanation of the Montgomery vs Lanarkshire ruling (a landmark case that established a legal standard for women's right to information about risk in childbirth);
a panel on anal injuries in childbirth and what the risk factors are (and what might be the effect of offering more caesarian sections by maternal request);
a panel entitled 'How much do we inform mothers beforehand without scaring?' [imagine there will be some strong MN views on this one...]; and
a panel called 'does consent mean anything when you're exhausted and in pain?'

Throughout the day, people who come along will be able to contribute and ask questions and generally make their views known.

Tickets are £40, or £25 for students or women with obstetric anal sphincter injuries. You can book tickets and see more info here.

We thought this would be of interest to some of you - and of course the issues being discussed are likely to interest lots of you whether you can attend or not - we at MNHQ are thinking about doing something in this area (what does it mean to give meaningful consent to procedures in childbirth, and what's the best way to ensure that women have all the information that they need to give meaningful consent) - so as ever please let us know what you think.

A member of MNHQ will be going along to represent your views, so give us a shout if you buy tickets and would like to have a coffee on the day.

Thanks
MNHQ

[neonglow]

Women being better supported to have autonomy and their basic, legal human rights over their body in pregnancy/birth is not going to mean more babies and women dying though.

I understand that consent in emergency situations can be tricky- but unlike most a&e emergencies women have nine months of preparing for different eventualities in order to actually look at what may go wrong and what their preferences would be in each scenario.

And these issues go beyond just ‘urgent emergency’ situations, pregnant women having drs dictate to them during pregnancy about what procedures they will have with no discussion, despite there being plenty of time to go over facts and options.

And re planned C-sections- they don’t necessarily carry more risks than attempting a vaginal birth. It comes down to so many factors- and one of those factors is what risks the woman is happier to take.

[ABingThing]

Would you rather women and babies die

Have you read this thread? Do you realise that so very many of the unconsented procedures weren't about life and death? Do you hear how many times women were ignored and the outcome became life and death?

People throw that would you rather phrase about in a bid to make women shut up, after all, only an unreasonable woman with an axe to grind would continue to argue in the face of life and death, right?

I cannot believe what I've just read

[JohnnyMcGrathSaysFuckOff]

That ELCS leaflet is awful.

It reminds me very much of the leaflet given to multiple mums at my local hospital. It says in block, bolded capitals that all births will be induced or a CS date booked for 37-8 weeks. There is no mention at all of expectant management if a mum wants to go over. It also says things like women are strongly advised to have an epidural and lists all the things that can go wrong with twin birth if you don't. It does not list any of the downsides of epidurals or even where to get further info. It also actually, unbelievably, says "during your labour, there will be between 8-10 people in room including paediatricians, obstetricians etc etc and students who wish to observe a multiple birth. Many women find this overwhelming and sometimes distressing."

Then why the fuck do it?????? Why can they not wait outside till needed? It is bloody hard enough giving birth vaginally to twins. It's like they deliberately make it as hard as possible and take away as much control as possible.

Like a PP, I had some serious fears around giving birth. I asked for my wishes to be recorded at every antenatal appt. They never were and then at the next appt, the consultant would generally "forget" what had been agreed verbally last time.

I remember right before I was induced, and refusing an epidural, one of them exclaiming "but we are passionate about women having epidurals!" Fuck off. Just fuck off. That is not a basis on which a patient makes a medical decision.

[neonglow]

@JohnnyMcgrath

That makes my blood boil.

Re the medical students. That very clearly goes against a woman’s legal rights. Women have to be asked, and give their permission, before any medical student is permitted to be in the room.

How on earth do they get away with that?? Has nobody questioned it?

[JohnnyMcGrathSaysFuckOff]

So the students came into my antenatal appt (scans). I have a history of sexual assault and found the scans very difficult. For twins, they involve lying flat on your back, with the consultant over you and often putting a lot of weight on, and knickers pulled down to mons pubis. It was a position I found really triggering and had to sustain for 30-40 mins.

What made it worse was having even more people in the room, so I got my midwife to write in block caps PLEASE NO STUDENTS on my notes. I also rang the day before one scan and also asked the receptionist when I arrived. When I got into the room, there were students observing. I started to have a panic attack and sort of froze up and couldn't speak. So I had to go along with it.

By the time I actually got to being induced I was so angry and panicky that I just got really blunt and ordered people out of the room. But the scan incident and many other little things like it had got me into a huge panic stricken state before the labour started and when I saw a big team of male docs plus students doing the rounds after my induction had started and heading for me, I completely freaked, slipped out and locked myself in a loo to have the panic attack in privacy. That's when DS was born.

To the PP who asked about women and babies dying, are you fucking serious? My case is a classic example of how a baby could die through women not being listened to. I had a high risk birth on my own in a toilet when people didn't even know I was in labour yet and delivered a non breathing baby with a snapped cord. That would not have happened if they had listened when I asked them not to do things that would trigger a panic attack and also when I said I thought I was in established labour. It is a classic example of a straightforward birth going tits up and becoming a life or death emergency. If I had been in a room with a MW or two and or a dr it would have been different.

Anyhow I shouldn't keep posting - I just get wound up again and it's not worth it.

[StrawberryGoo]

stucknoue

Where is the evidence more babies would die if women had planned sections?

There are so many cases of horrendous birth injuries or deaths to babies from vaginal births, such as in the Montgomery case above where the baby would have been uninjured if the mother had a section but was left with severe disability due to the vaginal birth going wrong.

I find your comment simplistic.

[Booboostwo]

stucknoue there are different types of risks, some options burdening the mother more than the baby and vice versa, but if you wanted to rank birth options from least to most risky it goes

Uncomplicated VB
ECLS
ECMS
Complicated VB

This is mainly because of the risk of brain damage and serious disabilities should things go very wrong with a VB.

An uncomplicated VB is the best option but no one can promise that, so, some women chose ECLS to avoid the risk of a VB going wrong. It is a complex decision and not everyone will assess the many different risks the same way but the main issue is that women are not making informed decisions. Information is kept from them, some risks are minimized while others are exaggerated and medical professionals are taking advantage of labor to make decisions of behalf of women who could make them themselves or to ignore decisions already made.

[Inebriati]

Your post had reminded me of the other big factor in all of this, which is the midwifery obsession with natural deliveries.

DS was a big baby. I was refused an elective C section.
DS was born 5 weeks prem and weighted 8.5lbs at birth. I was in labour for over 24 hours and had a third degree tear.

I dread to think what the outcome would have been had he gone full term. I didn't know the risks & had no choices at all. IME, the NHS is anti elective caesarean, to the detriment of mothers.

[Sagradafamiliar]

DS1 was a big baby, whopping. And I went 2 weeks overdue. He was also back to back. This was when I was refused pain relief. I was a young mum. One of the midwives chuckled and said 'well she won't be making this mistake again!' I thought they were trying to teach me a lesson but I found that things hadn't changed with later pregnancies.

[5zeds]

One of the midwives chuckled and said 'well she won't be making this mistake again!' . OUTRAGEOUS I’m so sorry that happened to you.

[ABingThing]

I was a young mum. One of the midwives chuckled and said 'well she won't be making this mistake again!'

The are no words

[SirVixofVixHall]

I was given a (very rough, painful and traumatic) sweep without consent, and although it was nearly 15 years ago I still feel angry and violated. I think conversations about consent and childbirth are really important.

[SirVixofVixHall]

JeezyPeepers
I agree, and feel furious on your behalf after reading your post. I know other women who have been through similar things. Including one who has needed a hysterectomy due to birth damage that would have been avoided with a prompt c-section.
Women in labour are not listened to.

[BojanaMumsnet]

Hello

to everyone sharing their experience - we've been horrified at MNHQ by some of the stories shared on this thread.

We thought some MNers posting on or reading this thread might be interested to know that we are running an online clinic with solicitors from Leigh Day on rights during pregnancy, labour and childbirth. They can answer questions on consent. Please do have a look here if you are interested.

Thank you
MNHQ

[BlooperReel]

Informed consent when utterly exhausted and in pain is so important a point to discuss openly. I signed for a c section after three days of labour with a transverse baby, no sleep, on and off syntocin (which just caused her to go into distress each time they ramped it up), to be told a c section was the only safe option. I really had no choice and there was no discussion to speak of, I dont even recall reading what was on the form, I ahve a vague memory of it being yellow paper, thats it! (That might even be incorrect).

[BlooperReel]

Oh and my first labor and birth was worse, I was fairly young and very scared, it was a very long labour, was failing to progress, was put on syntocin (not really asked, more told this would happen), I had multiple sweeps, very roughly for some of them, again, I was never asked, but told 'we are going to give you a sweep now'. The worst part was 'manual dilation' because I could not progress past 9cm and baby was back to back. I was too tired to take in what manual dilation meant when the words were said to me, when the midwife shoved her whole hand inside me, and tried to push the crivix over the babies head, I cannot describe the pain, I howled, absolutely howled in agony. Anyway, that failed, and baby was eventually delivered by ventouse. Horrific experience.

[Nat6999]

When I was taken up to the labour ward to have my waters broken, there was no mention of doing a sweep at the same time. The midwife handed me the gas & air, I began to feel very apprehensive as she started by giving me a very rough sweep, I screamed so loudly that my mother who was at the end of the corridor getting drinks heard me over all the labouring women in the other rooms & the midwife then broke my waters. When I got my breath back I asked why she hadn't told me she was going to do a sweep & was told that she didn't ask so I couldn't refuse.

[LHMB]

I had a very traumatic birth 17 years ago which left me with PTSD and health problems I still struggle with. I and my son nearly died, I lost a lot of blood and had a seizure. I am now pregnant again and due at Christmas. Terrified, getting panic attacks about the birth. I want a c section but been told I can't have one and that I must be exaggerating how bad my previous labour and birth were as I suffer from borderline personality disorder and people with this condition get confused! Needless to say this has increased my anxiety

[Sagradafamiliar]

L, I'm fuming on your behalf (and at so many of these stories), I'm sorry you're currently dealing with this. I thought that NICE states that you're entitled to a C-section if you want/require one? I'm sure you know more about this than me as you're living this, but I'd be staggered if they have a leg to stand on legally.
I'm disgusted at their justification...'exaggerating' and 'confused'...bloody hell!

[LHMB]

17:38Sagradafamiliar thank you and I'm disgusted by the way you and so many others on here were treated, it's appalling. I'm not sure how to go about getting an elective section, I feel undermined by the midwife they've given me and as though she's just dismissing my fear and not taking me seriously because of my mental health

[Weathergirl1]

@LHMB I would suggest you speak to Birthrights: birthrights.org.uk they have fact sheets about maternal request and I think you can get advice from them directly. Their first port of call is to contact the Head of Midwifery at your hospital (i.e. go over the top of the midwife you are currently seeing). I'd also be raising concerns about how you feel your mental health is being dismissed. Good luck 🤞

[LHMB]

17:59Weathergirl1 thank you

[MatildaTheCat]

It is worth pointing out that Montgomery was, indeed an obstetric incident but the ruling is equally valid and applicable to all medical consent. Mrs Montgomery was not offered the information which would have given her the opportunity to make a considered decision about the birth of her child.

Surely it’s also worth discussing the importance of all medical consent being obtained correctly? I’m not aware of any research but strongly suspect that women are frequently offered less choice and information when making decisions on medical care.

I have very good reason to be aware of this and the Montgomery ruling, for which I am very grateful. Essentially that ruling placed the patient at the heart of the process rather than the doctor.

[Nomintrude]

This whole issue is a huge one that affects probably the majority of women. We need to do so so much more around this, sub standard care and lack of respect and proper consent cause a huge amount of damage (and mistrust of the medical profession). I wish this whole thing had a higher public profile.

[FullMoony]

LHMB so sorry you are being treated this way. I started a thread on Ask Me Anything about my tokophobia (I had two ELCS)- I don't know if anything on there will help you.

Definitely agree you need to speak to Birthrights and look at the NICE guidelines. Would it be worth looking at the Leigh Day thread as well and speaking to them for advice?

I've been on and off MN for the past seven years and I don't know if it's ever been done, but given all the stories on this thread, and countless other threads, would MN consider some kind of campaign around these issues? I'm so disgusted that in 2019 women are still being treated like this during pregnancy, labour and postnatally. I would love to think there is something we could collectively do. I guess the more support Birthrights get, the better.