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?

I imagine it's extremely rare for a mother to decline care in a genuine emergency. We care about it babies.
I would say that because there are occasionally feminine emergencies where it is important to be able to trust the medics, they should be scrupulously careful about consent in non-emergency situations. Coercion and disrespectful care damage trust.

I’m so sorry.

Similar happened to me (second baby 4th degree tear). She wanted to check that there was no retained placenta. Almost no warning. I grabbed the gas and air. The pain was very different and worse than the birth. So many things are coming back to me.

When you lack capacity. Not a common situation.

Legally the baby has no rights until born. But practically, almost all women in labour want a living healthy baby (as they would've had an abortion for an unwanted pregnancy) and theres not a huge amount of time to discuss relative risks of different options.

Consent just can't be as good as for most of medicine where you would routinely get given information then have weeks to weigh it up and choose before a procedure was done.

Even more reason to be honest (even if necessarily brief) and listen to women when they stay no. They've probably got a good reason.

I think sometimes medical professionals just see a job that needs to be done rather than an actual human being that has a right to give or refuse consent. When I was heavily pregnant with my son a consultant performed a sweep on my without even telling me she was going to do it (she told me she was just seeing if I was dilated). She then blamed me for the sweep being unsuccessful because I was “too tense” (I was in pain and had no idea what was happening). During the procedure she pulled a curtain around me and made my husband stand on the other side so he couldn’t see what she was doing or give me any support. Neither of us had any idea she’d done a sweep until afterwards when she said it hadn’t worked and it was my fault. I left feeling confused on violated, I even asked my husband if at any point I’d consented to a sweep and he said I absolutely hadn’t.

It’s not tricky at all actually, the law is very clear.

If you have capacity, you have bodily autonomy. Even when the decisions you make are irrational or will cause your death.

I think people get confused or struggle ethically with childbirth because there is a related life - but that child doesn’t have any rights until it’s born.

I had a third degree tear stitched up without any pain relief because the doctor didn’t listen to me despite screaming and nearly knocking this young male doctor out

Halfway though he threw his needle down and shouted take her away

I ended up in theatre

That was 25 years ago and I still find the whole memory of it very traumatic

Medical staff need to listen

Why do we excuse midwives and obstetricians who violate women's bodies?

Well in some cases it’s because

• if they don’t the baby may be starved of oxygen have Brian damage and possibly die
• if they don’t the health of the mother could be at rick
• because when you go to a hospital to give birth the medical staff have been I trusted by you to deliver a baby safely for thr both of you

Yes they should listen to the mother but frankly a mum doesn't always know better than medical staff in that overwhelming experience and if they don’t intervene quickly the results can be disastrous.

Can you imagine - yeah we needed to get the baby out immediately due to being starved of oxygen and not enough time to perform a c section but the mun said no, so we did nothing and one or both of them died.

You are making a very grey scenario black and white.

In some cases it's a genuine emergency. It doesn't make it right, but it makes it now understandable. In the vast majority of cases it's not an emergency and there is no excuse.
My SIL had her waters broken and they didn't even tell her they were going to do it. She told them something was wrong and she needed ac-section - they refused to listen.
They forced my legs open so they could get a better CTG reading.
My friend was told she had to have an induction because she was over 40 weeks but she wasn't told about the rush of hyper-stimulation. She was left alone for hours, no one came to help, when they finally did the baby actually was in danger and she was rushed off for an emergency C-section.
Read the comments on this post - not one of the women saying her rights were violated is talking about an emergency situation.

I have read the comments thank you and have experienced child birth via the NHS more than once so completely know it isn’t perfect.

But there are two different points here and we agree. In an emergency maybe okay otherwise not (as I said in my post).

I’m so sorry to all the women who have been assaulted sharing their stories on this thread.

To those saying that sometimes medical professionals have no choice, no time, it’s an emergency etc - sometimes that may be true (that doesn’t necessarily make their actions okay but I can see it feels more of an ethical dilemma). But, look at the numerous stories in this thread - most of them are NOT that scenario. Most of the stories demonstrate absolute contempt for women and dismissal of their experience, preference and consent. As a PP has said - if you treat women this way when you have the time or space to do otherwise then you erode trust in the medical profession for when it really matters.

I’m in numerous homebirth groups and many of the women in them arrive there because of trauma in their first birth. Some are so traumatised they don’t want ANY medical care during their subsequent pregnancies. And sometimes that can have severe consequences.

My homebirth midwife was amazing - treated me like an adult, full discussion of risks and benefits of things like sweeps, respected my decisions but I absolutely knew that if there was an emergency and she said to me ‘there is problem X and I need to do Y - it’s going to be painful / it may not work / etc but if I don’t then ABC may happen’ that I would have trusted her judgment. Because we had a relationship and she had shown respect for me and my decisions in routine care. To me, that’s ideally what we should be aiming for.

I'm sorry, I didn't mean to imply you hadn't read the comments. I meant to emphasise the non-urgent nature of the consent violations mentioned in this thread but I didn't word it very well.

All good and thank you. Sometimes in a post it’s hard to convey things.

Strongly recommend the book How to give birth like a feminist' it was eye opening for me for my first baby.

Many people here are using the fallacy of extreme examples which has the effect of shutting down legitimate concerns. Yes there are very, very, very rare situations where certain extreme actions may be deemed necessary but that isn't the case for examples we are seeing on this thread.

There is not a woman who has gone through 9months plus of pregnancy and who is in her right mind who will turn down necessary intervention because she doesn't fancy it, that's just not happening. I had strong preferences for my births but of course if the baby had been in danger it would all have gone out the window.

While modern maternity care has undoubtedly saved countless lives its also true its become a conveyer belt. I was pushed very hard to have an induction with both babies despite all signs looking good and a family history of going over. After one appointment the consultant said, 'while youre here we will book you in for your sweep' presented as fait accompli despite the fact it had never been discussed.

In my first birth I had the most incredible midwife. My baby was back to back and the pushing stage was going on a bit long and some flags went up. She knew if baby wasn't out soon I would have to come out of the pool and intervention may be necessary. There was no scaremongering, no telling me what was going to happen to me. Gently, quietly she explained that if baby wasnt out soon her recommendation would be x because of y. She gave me what choices she could so I had agency. The conversation was less than a minute but ensured i still felt in control.

Ridiculous answer. If a patient says no,that's it, they can't do it. It's the medical staffs job to offer, not insist.

But you could have done your research. Even a small amount would have shown you what was necessary or not.

Your experience sounds awful OP. I can only hope these stories are from the past because It feels appalling that it would happen now. If someone says no and the Doctor does it anyway, they should sue and raise hell.

It's the medical staffs job to offer, and that's it! If you say no, they write in their notes 'declined' later on. It's as simple as that. All of you saying otherwise have been groomed into thinking women should be treated as infants.

I have birth in Australia last year. Birth trauma is still very prominent here, as are interventions, but my midwives followed my birth plan and when I said no to something they just left it. Not even vaginal examinations. If a doctor or midwife doesn't know it's her job to offer, not insist, then they shouldn't be practising.

That is also why expectant parents need to do antenatal courses and brush up on things. Your partner needs to be there to say 'she said no. Don't ask her again' There is so much blind faith in the medical profession here. Most of women's medicine is not based on evidence. So that means there is zero evidence that something produces better outcomes, but they do it anyway.

No you are making excuses. They should still ask consent in an emergency. The baby has no rights until it is born. That is an important law because women should still be in charge of their own bodies. If it was an emergency it can still be explained and consent given.

No I’m not making excuses, I am giving real life examples of what can happen . You may agree with the law that that baby doesn’t have rights until it is born but saving the mother’s life in an emergency is still warranted.

Women can't trust maternity services to act in their best interests because quite frankly they do what the fuck they want half the time including ignoring information the mother has provided throughout her pregnancy. It's not ok just because it's tricky. There are a million other things that can be done rather than ignore explicit instructions related to consent. Maybe for a start it could be made clearer in some areas that a birthing partner is actually supposed to be an advocate for the labouring woman and not just a figure of fun.

Are you advocating for medical personnel to be able to override consent? Do you have any lines?

“Saving the mother’s life in an emergency is still warranted”.

What do you mean by this? If a woman with capacity refuses life saving treatment, that is her right. It doesn’t have to make sense, it doesn’t have to be rational. Doctors cannot intervene without consent unless capacity has been impaired.

I don't think that's actually true though, there's no balance, the women is the patient and can refuse any intervention she wants.
I know of a couple who wanted a very natural, no intervention, home birth. They had a midwife in attendance and things were going wrong, midwife wanted to call an ambulance and transfere to hospital. This was refused and became increasingly urgent, but kept on being refused, midwife even got the patient to sign the notes saying they refused transfere. Midwife was really spelling out how much danger the baby was in. Eventually the couple agreed to go to hospital but it was too late and the baby died. Even with such a tragic result, you can't force the women into hospital and into medical treatment they don't want.

@Kendodd This is where I think this becomes ridiculous!
I’m all for having the type of birth you want and opting for at home and as natural as possible if that’s your choice but I feel like so many women are now so caught up in the idea that birth should have as little intervention as possible that it must be fucking infuriating to be a midwife or a doctor!!

Refusing that transfer was ridiculous quite clearly. And that poor midwife having to stand and watch that happen, likely completely unnecessary.

A friend of mine was so off her face on pain relief that she was refusing episiotomy and ventous when her baby was physically stuck. She was bleeding very heavily, and she kept passing out. The doctor carried out the procedure and saved both of their lives and she still complains to this day about how she didn’t give consent and should sue. It’s ridiculous!

I also know another mother who refused induction because it “wasn’t necessary” as it was only based on her dates. She went to 42+2 still refusing induction as “baby would come when he was ready”. She then had to go in for reduced movement and baby was stillborn.