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

[Nomintrude]

@Veganmedic That's interesting about use of forceps; I thought that they were actually banned or certainly not used in many other countries? How can that be, if they're often the safest option as you say? I'm just wondering what's done in other countries, and why, because as you say - no woman wants a forceps delivery and frankly I think they are barbaric and would love to know why they're still such an NHS favourite given they're out of favour in other places.

[Bearfrills]

When I had DC3 I had an ELCS. He was fully engaged (0/5) and they had to do quite a bit of maneuvering to bring him out of the incision/opening. At one point I asked did someone have their hand in there because I could feel so much rummaging and shoving, lots more than my previous section, and was told yes. My recovery was fine, I was very slowly pottering around the shops by day five, but I was so very bruised. From the bottom of my ribs down to the tops of my thighs I have livid purple and yellow splodges, the ward midwife commented that they must have been quite rough with me and wanted me to stay an extra night as she felt I needed the adjustable bed and pain relief on tap as the anaethetist had written me up for oramorph if I wanted it.

I'm guessing the bruising was due to him being so low down in my pelvis and the extra jiggling around to get him out?

Even so, it was a much faster recovery than the people I know who have had forceps and it was still possible to get him out via section despite him being so low.

[LHMB]

20:39FullMoony thank you, I'll take a look at those threads

[Veganmedic]

I cannot pretend to be an expert on forceps as I’m not an obstetrician, normally keep myself busy up the other end
However from what I have been told moving a baby back up the vagina when very low in order to facilitate a section is quite a high risk option. I believe many places, including some in this country, are now moving away from rotational forceps and only using the type which simply applies downwards traction to the baby rather than attempts to reposition. From my perspective as somebody fairly close to having my baby, I would consent to a forceps delivery if the head was low to avoid a fully dilated section. I would decline rotational forceps in favour of a section.
I agree we need to do more antenatally around consent-not just with expectant mums but also with their partners. I’ve more than once been nearly blocked from doing epidurals by birth partners (usually the men) who at best are trying to act as their partner indicated they wished to and avoid the epidural. At worst there are a few that seem to relish the control they have when women are in a particularly vulnerable state.

[Veganmedic]

My biggest pet peeve is the phrase ‘we don’t want an epidural’.
Well I’m not offering you one mate...

[neonglow]

Also I think mumsnet is a lot more open-minded and educated with regards to maternal request ELCS than average. When I see it mentioned on parenting groups on FB or social media news outlets etc, the overwhelming response is all the typical misinformed ‘but c-sections are wayyy more expensive/dangerous/terrifying/painful why on earth should women be allowed to choose them?!’ nonsense

[FullMoony]

neonglow you missed 'too posh to push' 😂

Hideous phrase.

[grisen]

I was told by a sonographer and a midwife that my baby was going to be big so I would not be allowed to go past 40 weeks. They would induce me on the due date at a different hospital and that was it. I asked if I could have a c section instead. No.
Long story short my perfectly average sized boy was born via EMCS because he wasn't engaged at all and the induction wasn't working.

[Pinkpanther473]

@Nat6999 I was shocked to read about the mw who did a sweep on you then said she didn’t ask you so you couldn’t say no.
This is assault, I would hate anyone to do that to me.
There’s not even 100% evidence that they are effective from the little bit I’ve read.
I would be so angry if anyone did that to me, we should be allowed to say yes or no to these things.
I’m nearing my delivery date and under the obstetrician. So far neither she nor the mw have been very receptive to discussing the decision that is recommended or exploring the risks with me.
It’s strange because I’m usually quite confident and have not had this experience when talking with a GP for example about another health issue.
I’ve actually asked for my husband to come with me to the next appointment so he can help me to discuss our concerns. Funny thing is he sometimes asks me to do this for him as English is not his first language. But he’s a HCP too so he’s coming to give me a hand.
It just feels so outdated to need to bring back up to have a discussion where you are listened to. Both obstetrician and mw are female too

[Nat6999]

I wish I had complained, but afterwards I was very ill with PND (probably due to the crap treatment in hospital) I still have flashbacks & nightmares 15 years later & have a pathological fear of NHS hospitals ever since.

[BestZebbie]

I had the opposite problem with c-section consent - I had a breech baby and for some bizarre reason* they really really wanted to see if I could push him out naturally and so at one point tried to tell me it was too late for me to sign a consent form for a c-section - fortunately I had already been booked in for a planned section for him the next day and so already had my consent recorded on the system.
*I presume either cost/hospital stats or fetishisation of 'natural' birth.

[Shutupseaguls]

I haven't had as bad an experience as some here but with my first I was in labour not far off giving birth when a man walked into the room shoved his hand between my legs and said "give her an hour". I asked the midwife who on earth that was and she said "oh that's the Dr" like what he had done was perfectly normal. I was so upset by it as I'm very shy (spent all 3 births trying to stay as covered as possible). For all I knew he could have been the cleaner as he didn't even say who he was.

I also had a mw with my second refuse to let me hold him until I had a bath and she had got him dressed. I begged to hold him as I didn't want a bath and he had been born blue so I wanted to check he was ok but she refused. It still upsets me to this day.

[Loopytiles]

I had negative experiences of consent during labour, and during early pregnancy and gynae vaginal scans. Good to see this discussed and action being taken.

[Booboostwo]

The situation is even worse in other countries. In France I went to three hospitals to discuss an ELCS, I had not made my mind up at that point, just wanted to discuss options. Doctors at the first two hospitals refused to even discuss the matter, the third told me that a CS was her choice not mine! She said the decision was her responsibility and when I asked her if she would then be responsible for caring for my child if it had a brain injury she refused to talk to me further (I was not rude, I did not shout, or behave in an inappropriate manner - I just asked her questions).

[ChilledBee]

The argument against routinely warning women about vaginal births is that is the physiological way for babies to be born. People see it like gaining consent for drinking water because there are risks involved with that but it is the way that humans take on fluid. A caesarean is an alternative, non-physiological method of birth which is safer in some situations. Nevertheless, it is an alternative.

[Weathergirl1]

@ChlledBee right, but you can't just take the risks of a caesarean in isolation - if you are to be able to make proper informed consent, you need to know what the risks of the alternatives are and they still don't do this (in the UK).

[Booboostwo]

ChilledBee that argument only makes sense in situations where one type of VB is the only option available, so if one were giving birth in the middle of a wild area with no time to make it to a hospital and no doctor or MW present then there is no point in gaining consent for a VB, it's going to happen anyway. However, this is not the case for most births. Most women, even if considering VB, should be informed about different alternatives for VB, e.g. forceps vs vendeuse, episiotomy vs natural tearing, etc. Add to this that ELCS and EMCS are also options for many women and you can see that unless fully informed on all options, choice is meaningless.

[ChilledBee]

But I'm assuming we are talking about prenatal consent and information sharing here.

Firstly, you can't elect to have a forceps birth like you can a cesarean so we are already in a different field. I learned at my doula class that many women mistakenly think a forceps birth is always more traumatic than a section and will write birth plans which forbid forceps (or all instruments) to assist birth. However, a low forceps delivery is often less dangerous and distressing then prepping for an emergency section and forceps might have to be used at section,especially with a baby close to being born vaginally. They'd have to be pushed back up into the uterus.

Based on this, I don't see how teaching forceps and ventouse can be presented as an option like a caesarean or trying for a VBAC. It is an emergency procedure and the likelihood of success is definitely in the moment. The obstetrician (sometimes midwife)does an examination which gives the information there and then. The best theyd be able to tell you is that they think it feels like an easy one or that it doesn't and they might have their 2 or 3 goes as per protocol but still need to section anyway. That's the moment you get to say "just do the section". But you can't make that decision without that contemporaneous information.

Apparently, according to research, most women having elective sections reported they were not aware of their individualised risks and risks specific to having a section without labouring. They were given generic stats.

[Weathergirl1]

@ChilledBee they can't... what can be done though is presenting the risks of them being necessary if one chooses to go down the physiological birth route, and what the risks are to both mother and baby if those occur (risks of tearing/needing to be cut for example would be one of those). For me, because I am tokophobic, interventions like that would have a huge psychological impact on me which I was keen to avoid. It meant that I had a discussion with the Consultant Midwife about this and was going to plan along the route that I wanted to opt to go to CS sooner rather than later if it looked like there was an issue with physiological birth. I haven't had to do that as I'm now booked in for an ELCS this afternoon at 37+2 due to PPROM and breech presentation (I'm growing an awkward little sod - or maybe it's not awkward but looking out for my best interests!).

Agree that generic stats are rubbish - just like the caesarean stats that combine ALL 4 types of caesarean together!

[StrawberryGoo]

But chilledbee when told about the risks of forceps and the lasting damage they can do, many women would quite reasonably choose not to risk their birth ending up that way and elect a section.

I wasn’t told that I could end up like this after giving birth vaginally. I was told it would be better for me. I feel totally betrayed to be honest.

[RolytheRhino]

what can be done though is presenting the risks of them being necessary if one chooses to go down the physiological birth route, and what the risks are to both mother and baby if those occur (risks of tearing/needing to be cut for example would be one of those).

I imagine it ultimately comes down to caeserians being more expensive and not wanting to encourage people down that route by pointing out all the things that can go wrong with a vaginal birth. I'd guess (though I don't know) that if paying privately for all treatment the risks of both would be more fully explained.

Also, though, a bit of knowledge can be a dangerous thing if you suffer with anxiety and knowing, and being terrified about, all that can go wrong in childbirth while heading into it may well increase the likelihood of things going wrong, given the importance of oxytocin to the process.

[Spanneroo]

My current twin pregnancy has really opened my eyes to this. I had precipitate labours with my DDs (2hrs 20, and 45 minutes start to finish). The midwife for DD1 was useless and didn't listen to me when I said I was about to push, but it worked in my favour to be honest. I like to be left alone in labour and my body did a good job of pushing her out unassisted, even though she was back to back.

My second was a home birth, where the midwife only just got there in time. Again, I had a great experience because I was left alone and like to birth that way.

Now that I'm expecting twins, I've been told time and again what will happen to me, offered no choice, and not had risks explained - except when I have challenged their plan for me, at which point all the risks of the alternatives pop up and none of the risks of their plan do...

I have had to resort to pouring over medical journals and guidelines to make my own decisions about which risks I am more comfortable to take. Just 3 weeks from my due date now, not having been listened to throughout, I am preparing to tell them, as they have told me, what I plan for my birth of the twins. It goes against their expectations and will not go down well, but I am clear on their legal obligations to me as a labouring mother. I am very anxious about not being supported during the birth. If I had the money, I would without doubt be hiring private midwives. It is appalling that my only chance to attempt a normal vaginal delivery with twins with a fully supportive team is by paying THOUSANDS of pounds to private HCPs. This choice should be offered on the NHS, and I shouldn't be treated like I believe in unicorns and fairies when I ask to attempt this, when all evidence suggests there will likely be a good outcome for us all.

Women's choices need to be respected in pregnancy and birth, whatever they may be. But for that to happen, women need to be given choices and information about risk in the first place, so that they are well equipped to make these decisions. It's disgusting this is still happening in this day and age.

[Booboostwo]

ChilledBee look at this huge variation in delivery methods across European countries. If the decision was a clear cut medical emergency one, you'd expect to see very similar figures.

obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.13284

RolytheRhino while the argument that CS are more expensive is made quite often, in fact, the opposite is true. If you look at long terms costs of all delivery options, so costs that include future treatment, rehabilitation and support for both mothers and babies, everyone should be having ELCS as the cheapest option. This is because of the huge costs associated with serious brain injuries to babies during problematic VBs.

[5zeds]

@Spanneroo it should be possible to have a natural childbirth with twins on the NHS I did and like you have very quick labours (and also prefer to be left in peace!)