Consent in maternity care

[Nimnuan]

I just read a post on MN from a woman who said no multiple times to ventouse/episiotomy, and the obstetrician did it anyway. Obviously she did not consent. That is assault.
Around 70% of the comments were variations of "it's not assault, the obstetrician wouldn't have done that unless your baby was in danger so you should be grateful".
I am horrified! In what world is it acceptable to cut a woman's genitals when she is telling you to stop?!
Also, do these commenters somehow think that everything done in maternity care is based on good evidence?? Are they not aware that obstetricians were doing routine episiotomies until the 2000's?
When I was in labour with my daughter the midwives forced me onto my back and pulled my legs open despite me physically resisting for about 25 minutes (according to the notes) and me verbally telling them to stop. They called an additional person into the room to help overpower me. They told me husband to help them do it. Because I eventually gave in, they claimed I consented. Later, when I told them I had not consented, they claimed I forgot that I consented.
If I was in a sexual situation with a man, and he kept trying to pull my legs apart while I physically resisted, and he didn't listen when I told him to stop, and I eventually gave in and let him do whatever he'd decided to do to me - nobody would say that I consented to having my legs pulled open or anything that followed.
Why do we excuse midwives and obstetricians who violate women's bodies?

It's extremely difficult because unfortunately if the staff don't act and then the baby is born brain damaged or worse, the likelihood is the parents will sue and say they didn't understand the consequences.

Then the maternity system needs to change. It is not acceptable that the midwives attending me were more concerned about getting a good read on the CTG (not evidence based, even though it's been studied, by the way!) than about not assaulting me when I was vulnerable.

I agree with you that it is a massive problem, but it's very very tricky.

I had an episiotomy and ventouse for my first and an extended episiotomy and ventouse for my second. The obs I saw beforehand wouldn't let me have a cesarian. I was also told I couldn't be in any other position than on my back with legs akimbo. Probably the worst position to be in.
Unsurprisingly I hate midwives, especially as two of them stood there chatting, ignoring the fact that the anaesthetic had worn off, so I was cut and sewn up with virtually no pain relief.
It doesn't surprise me at all that any woman is told she can't do this or that while giving birth.
I swear they just want us to go in a corner with a gag on so they can't hear us.

I'm so sorry. That is awful.

Totally agree. Women are infantilised and often lied to. Most women don’t know that internal exams are not medically necessary but they are presented as a fait accompli. Same goes for sweeps and the majority of planned inductions based purely on due dates. This is why I had mine at home where I could be more assertive and in control.

If someone chooses to have a baby a balance has to be reached woth what is best for mother and the baby they decided to have, as I am not medically trained i had to trust the experts to guide me on what is best for the both of ua

Informed consent in maternity is horrific in my experiences. Yes there are times they need to act but I still have the right to know what you are going to do and to give or refuse informed consent.

For what it is worth, a lot of the reason my friends have ended up in these situations is due to failure to act earlier by ignoring what the woman are saying or by forcing medically unnecessary inductions. Because guess what if there is no medical reason and both mother and baby are well, trying to force a womans body into labour when it isn't ready increases the chances of things going wrong and having 'emergancies'

This.

@PollyBell - unfortunately they don’t always know best. Even leaving aside the appalling shortage of midwives - many hospitals will offer different advice and individual doctors and midwives may disagree. Many of the routine procedures: internal exams, electronic feral heart monitoring, routine inductions, have been shown to lead to adverse outcomes. I know that the reason I got the natural births I wanted was because I educated myself and pushed back on unsubstantiated advice/suggestions. My third was 42 + 3 - I had a speedy home birth with no complications but only because I didn’t just blindly submit to one-size-fits-all scaremongering.

If you want to do whatever is recommended then that's a perfectly valid choice for you to make for yourself.
There are a lot of things that many women do not consent to our would not consent to if they had full information. Just because you would agree to something doesn't give a doctor or midwife the right to do it to another woman against her will.

First post nails it to be fair.

AFAIK the law is pretty clear that women have bodily autonomy (even when in labour) and if they refuse to give consent then doctors are not in a position to lawfully ‘do it anyway’. The only time this would come into play is if the woman had lost capacity, in which case they should act in her best interest.

When I studied medical law and ethics (admittedly 10 years ago) we looked at a couple of cases where women in labour refused “necessary” cannulation due to needle phobias. It was established that fear induced panic can destroy capacity and in those scenarios they can act in the woman’s best interests. However, an adult with capacity can refuse medical treatment, even where it is irrational to do so.

I most recently gave birth 13 weeks ago and my experience was that I was asked for my consent at every stage. In fact, at times I was asked for my consent from several professionals for the same bloody thing. When the emergency buzzer was pulled and loads of staff ran in, I was asked for my consent for: a VE which I gave; application of an FSE which I gave; and cannulation which I refused because my veins are very tricky, there was a lot going on, and I knew that I was literally about to push the baby out.

I was not always listened to (a bit of a theme) - but I was always asked for my consent for things they wanted to do to me.

What if you would have said no, and this choice had put the baby's life in danger? Would you have accepted this was a decision you had made?

So it's okay for midwives to physically force my legs open and stick their fingers in my vagina after I've said no? A non-consenting vaginal exam is not the same as giving emergency assistance to an unconscious person.

You're right, its not. Not sure who youre replying to, to be fair, if its me then the original post mentioned ventouse and the post i quoted mentioned similar- both conducted if there are concerns for baby and/or mum.

Yes I would have accepted it. What I knew (which they didn’t) was that the baby had moved down and I was about to push it out. Their problem was that they were relying on what ‘normally’ happens and hadn’t bothered to listen to a word I’d said which is why I was in triage until minutes before my baby was born.

I didn’t need prepping for section. I didn’t need a cannula. I was talking to the midwives throughout about why the buzzer was called, what the concerns were etc. I was calm and informed. I had bodily autonomy and I used it!

No absolutely not.. however if people are turning down things suggested they also need to know the risks.

If for example baby's in distress and needs getting out asap, but someone refuses any intervention so baby isn't born in time and has serious brain damage. Is the hospital then negligent for causing that as it happened in their care? Or does the hospital have no responsibility in that situation?

If a woman:

• has capacity;
• is given an informed choice; and
• refuses to give consent (against medical advice)

Then the hospital is not negligent.

If the hospital do not inform the mother of the risks, and she refuses, they may be found to be negligent.

Sorry, yes I was replying to you, thought I hit the button.
To be honest I really don't think a ventouse is any different, except that the risks of damage to both baby and mother are much greater. The key thing is whether the woman has capacity. Labour does not diminish capacity.
I think there is a really dangerous situation in maternity care where women are not listened to, medical interventions are not based on good evidence, and there's a huge emphasis on the risks of not intervening, while the risks of intervening are widely ignored.

I had a similar experience, admittedly many years ago. I had an explicit instruction that I did not give consent to a certain procedure. It happened anyway, without my knowledge- I only found out about it from the hospital notes. I wrote a first stage complaint and was basically told it was my word against theirs that I had changed my mind and given consent.
There were many other shortcomings in the hugely medicalised and unnecessary interventions but this was the worst. I knew there was no point in taking my complaint any further.

No. The hospital is not negligent.

I agree with you OP and those pointing out the lack of informed consent, the coercion and the infantilisation of women in maternity care. My second baby is a few weeks old. I’ve had two unmedicated straightforward homebirths but had to educate and inform myself in order to challenge the default ‘you should be induced at 40 weeks because it’s too dangerous/ we won’t let you go longer’. My experience of maternity care, and that of many of my friends, is that there’s a default towards interventions and inductions and a severe lack of information for women that (a) they have a choice (b) induction and interventions carry their own risks, and what those are.

As a result, the common story seems to be that women are advised they need an induction for something e.g being overdue, suspected big baby, suspected small baby, they accept thinking their baby is in danger if they don’t, their body and baby are not ready and not in optimal position, they struggle in labour and the cascade of interventions begins, often ending in a c-section but said woman then believes hers/ her baby’s life was saved by the whole process and that it had to happen that way even if traumatic for her. When actually, had the initial induction been explained properly she may have made a different choice and avoided all of that,

Before I get jumped on I’m not saying that’s the case for all women/ all inductions, or that there are never genuine emergencies or life-saving interventions.

But I do think we have a problem in this country with over-intervening in birth and inducing far too readily to the detriment of women and their babies. Just look at the big baby trial - almost 60% of women in the trial who were told their baby was going to be big ended up not having a big baby. But women aren’t properly told about the huge margin of error on growth scans, just that their baby is going to be big and they should be induced.

Totally agree with this. I went to my 40 week midwife appointment and she said “right shall we book you in for induction at 40+5?” I asked why. Pregnancy had no complications at all, had a growth scan at 37 weeks with no concerns. She said it’s just what they do. I refused and went into labour later that day spontaneously.

When I attended the hospital in labour I was offered a sweep with my VE. Why? I’m already in labour? An hour before my baby was born I was offered induction. I asked, induction of what? I’m already in labour.

Blank faces all round. Utterly ridiculous.

When I was in labour with my first I made it clear on my birth plan that I wasn’t comfortable with having internal/vaginal examinations unless absolutely medically necessary, because of sexual abuse as a child. During my labour a midwife completely ignored this and told me I had to have an examination (I later found out it was just to see how far along I was, not for any other reason). I felt like I couldn’t say no so gave in but ended up having a panic attack. Instead of showing any sympathy she actually shouted at me in frustration that giving birth was going to hurt so I needed to let her get on with it.

I felt completely traumatised by it and it really affected the rest of my labour and birth. With my second I was able to advocate for myself much better but I was so anxious throughout my pregnancy in case I had a similar bad experience again.