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?

This is appalling, I’m so sorry you experienced that.

No. This is wrong in law. The ‘baby’ has no rights until born. The mother does. Her welfare physical and mental and her consent are paramount unless there is a genuine lack of mental capacity on her part. Medical staff do not have a free pass to ignore the law and should not commit assault. If you’re having to restrain and fight a patient, there has been a massive failure in care and a breach of all trust.

Very few women would I suggest have a baby voluntarily at all if they were told that by doing so they would lose all rights to decide what happens to their own body and would be physically restrained and tortured if they resist.

It’s also a profoundly naive view to assume that all medical actions are undertaken in the best interests of that particular mother and baby Much is done for hospital and staff convenience or based on generalities rather than the particular circumstances of a patient. I find it inconceivable that people can repose such complete uncritical trust in UK maternity services in light of the independent scrutineers rating of so many as inadequate or failing.

The vast majority of medical staff are well intentioned and benign but it’s a fallacy to assume that the medical professions do not attract undesirables as do other professions where the desire to exercise power over others and to have one’s will prevail outweigh more benign motivations.

I agree, OP. To me, it is a general attitude of disregard for the female body, at best; and, at worst, it's contempt and hatred. Also known as misogyny. The word is loosely used and misused, sometimes, but it applies perfectly to the situations you are describing.

Labour absolutely can diminish capacity. Especially if the mother had been given strong drugs.
I absolutely lost capacity to make an informed choice whilst in Labour with DD1.
If the doctor had waited until I agreed to an episiotomy, my baby would have likely suffered tremendous harm or possible death.
Im glad they ignored my pleas to leave me alone.

Agree OP. I hope women in this situation would report to the police and take civil action separately against the medic.

One reason that I preferred epidurals over other pain relief was to avoid any diminution in my mental capacity. I’d also lived in other European countries where epidurals are commonplace and the concerns expressed about them in the U.K. are regarded as nonsense.

May I ask what drugs they gave you? Obviously you're not going to capable of filing taxes in the middle of labour but I didn't think they'd give you anything so strong it would stop you understanding that your baby was in danger.

“Labour does not diminish capacity” has to be the default position IMO.

That doesn’t mean that capacity cannot be diminished during labour as a result of certain drugs (e.g certain opioids/sedatives), fear induced panic, passing out etc.

It is the role of the medical professionals to assess capacity. It’s important to remember that capacity is assumed, unless shown otherwise. A woman doesn’t even need to be able to vocalise - gestures are enough.

Sweeps didn't work for me with my first two dc but with no 3 I was in labour and the contractions started to taper off once I got to hospital. I was very disappointed as I thought id be sent home again but the nurse did a sweep and it hurried everything along immediately. So sometimes they can speed things along. Maybe you weren't in any rush but impatient people like me are 😁

It's pretty normal for things to slow down when you travel to the hospital just because it's disruptive and stressful to be travelling. Labour generally progresses better in a calm and safe environment. Wish they would offer a comfortable room to settle into instead of sweeps/ARMs/drugs.

I have just written my dissertation on this, it was alarming research. That doctors and paramedics have as poor an understanding of consent and autonomy as some of the posters on this thread.

Doesn't surprise me. I listened to an episode of the feminist law project podcast with a medical ethics scholar who used to be an obstetrician. Her main takeaway from her research was that we need better antenatal education so that women don't decline interventions in the first place. It's not consent unless you have the option to say "no"!
She actually talked about women in debriefs post-birth being upset and not understanding why they "weren't allowed" more time.

Out of interest how are you hoping to give birth with your legs clamped shut?

Are you serious?

Are you stupid or snide?

This is an appalling comment. Why are you being so dismissive of a woman's distress at being sexually assaulted by medical staff?

What a stupid comment 🙄

So how long do you think the doctors should take explaining everything and gaining consent?

I posted on the original thread. My DS was being monitored during the birth, there were signs he was becoming distressed and then his heartbeat disappeared. I was informed they needed to get the baby out now and were going to do an episiotomy and ventouse. There was no time to fuck around gaining consent, it was all just matter of fact.

It wasn’t until I read the notes afterwards that I realised how tenuous the situation had become. We have to trust that the professionals are doing the right thing and let them do their job. I also would vehemently suggest that arguing in a delivery suite to gain authorisation would likely cause a birthing mother distress and be even more detrimental.

Argue about body autonomy all you want but it’s not just about you. If I had fallen somewhere and crushed another human being beneath me, the immediate task would be to move me. It would be absolutely crazy for me to argue that I did not want to be touched because it’s not just about me - there is another life at risk. It’s the same when giving birth. What you want and what the baby needs might not always be the same thing, who matters the most then?

Thanks for starting this thread OP. I was subjected to an agonising internal exam 6 hours after I'd given birth without my consent. I'd had no pain relief and had had a very deep episiotomy that had gone through the muscle and left me unable to walk properly. The doctor shoved her whole fist up there and kept it there for ages, moving it around and putting unbelievable pressure on my stitches. I kept screaming for the doctor to stop. There was a room full of about half a dozen medical students all watching (which I also hadn't been asked if I consented to). The doctor said there was no reason for me to be in pain after pain relief had been given, then the nurse/midwife had to point out that the doctor hadn't read my chart which clearly said that I'd had no pain relief, and that we were LITERALLY only seeing the doctor because I'm allergic to NSAIDs and needed something else prescribing. There was no reason at all for this internal exam. She backpedalled very quickly and prescribed something.

As I was shuffling back to my hospital bed, sobbing, completely unable to talk, the other nurse or midwife (who was quite a few marbles short) said to me, "well at least it wasn't a MAN." If I could have actually spoken at that point in time I would have told her to piss off. I'd already heard enough of her shitty comments to the woman in the bed next to me who was formula feeding.

There is no "oooh well they have to act in the best interests of the baybeeee..." sort of waffle to excuse what happened in my case. The baby had been a separate entity for about 6 hours at this point.

@Walker1178 In emergency situations a clinician can bypass consent to a) save YOUR life or b) prevent serious deterioration to YOUR health. They cannot do anything to you without consent to prevent harm or death to your baby. It has ZERO right to life until out.

I have adult and teen dcs and I'm still angry at the lack of consent/ helplessness I felt when I was giving birth. And extremely angry at the two idiot student drs giggling away while they were trying to get the sanitary pad to stay in place* (1 male and 1 female). So humiliating.

There is no consent in maternity care (in other words, if you get pregnant, it's taken as read that you consent to everything)

ETA - post emergency/ urgent cesarian - I had a spinal block and no use of my body. My waters had broken and that saw complications that meant I couldn't have a vaginal birth, but I was awake and able to consent if asked

So if the baby is born with brain damage or stillborn because they spend 10 minutes explaining and the mother deliberating over whether to consent, the parents don’t then sue the hospital??? A balance needs to be struck but if time is critical which is often the case in these situations, even 2 minutes can make a difference, medical professionals cannot be arguing with patients about treatment options. I gave birth in the USA and had to fill in all the consent forms weeks before my due date, no sign no hospital takes you (apart from via er)

The amount of time or detail depends on the situation but the assumption should be that the mother has capacity to make a decision until demonstrated otherwise, and get decision should be respected. The vast majority of mothers are much more interested in their babies' wellbeing then the healthcare professional. You're not going to improve outcomes by allowing the mother's right to be violated.
It's also really important to be honest about the risks. One of the tactics used to coerce me into lithotomy was to tell me that my baby was struggling and I needed to get into that position so she would be born more quickly. It worked. Turns out it was a lie, but I didn't know that until the birth debrief after the fact. Guess who is much less likely to trust the professionals another time if they tell me my baby is in danger?
It sounds like the doctors told you your baby was in danger, you trusted them, you consented to intervention, and in retrospect you're glad you did. That's not the kind of situation I'm taking about.
Last thing is, the baby does not have rights independent for the mother, and for very good reasons.

That is absolutely horrifying. I'm so sorry. There really is no excuse.

It's such a tricky one , when does medical need over ride your consent?