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?

Those are obviously tragic situations and I agree that medical professionals may find it very distressing to see things unfold that way when they consider it could have been avoided. However it is a womans choice to decline a treatment if she wants to, and if the risks have been explained properly then the medical professionals can’t be successfully sued even with the worst outcomes.

The only way in which medical professionals can override a lack of consent is when someone lacks capacity. That’s why you see cases before the court of protection where they’re trying to get permission to force feed anorexics for example, and often, permission is refused; because if you have capacity it doesn’t matter if the lack of treatment will kill you, they can’t force you to do it. See also refusing a blood transfusion due to religious purposes.

@EnchantedToMeetYou2 I find your comments about a mother who went through still birth a bit pointed. You clearly deem it is her fault. The risk of still birth at 40 weeks is around 0.1%, rising to 0.2-0.3% at 42 weeks. That’s a jump from 1-1.5 deaths in every 1000 to 2-3 deaths in every 1000.

Tell me, if you went into hospital and the doctors told you that you had a 0.2-0.3% risk of death if you didn’t submit to a quadruple limb amputation, would you think it ‘ridiculous’ to refuse? FWIW, I think you should have the right to decline even if refusing will 100% result in your death and the law supports this so long as you have capacity.

Having the power to decline medical treatment is something that should be reserved for everyone with capacity. Not only men, or only men & women (who are not in childbirth). You might think it ‘ridiculous’ - but the alternative is that people have no choice at all.

Absolutely this. 👏🏻

Maybe for some, but that wasn't the case for number 2, I nearly gave birth in the car..the contractions got even more intense on the way there. Each pregnancy & labour is different. I was glad that things sped up with the sweep on my third. But yes it should be about choice and nobody should be railroaded into it. Apart from life or death situations, sorry saving a life is more important than a women's right or opinion.

What do you think they should do? Handcuff them to a hospital bed and start sticking needles in?
If paramedics were allowed to drag women into hospital transfer against their will there would probably be a lot more free-birthing. Not safer.
The stillbirth risk increases from 0.02% at 37 weeks to 0.1% at 42. Should she should have been forced to have an induction? Brought in by the police? Restrained and drugged at her last hospital appointment? Threatened with social services? Fined?
Whether a mother is making the right decision or not, it's her decision to make. You don't get better outcomes by allowing others to decide for her.
Emergencies are rare but are used to justify violations of consent in completely different circumstances. Sweeps, VEs, ARMs, checking stitches, grabbing breasts to "help" with breastfeeding, immediate cord clamping. Without consent, it's assault.
There's also a problem of women seeking intervention but being ignored. Being refused pain relief, told they're not in labour, don't need/can't have a c-section, waters haven't broken its just wee. Is it okay for the medics to ignore women in those cases?

That was a very tragic wake up call for that woman. I wonder how she feels about it now? Guilt for not listening to the professionals? Or is she still as self righteous as ever? I doubt she has ever admitted being in the wrong..

Pethidine and entenox. They made me feel incredibly drunk and out of control. My DH told me that I was pleading for the staff to give me some scissors so I could cut the baby out, I was screaming at them to F off repeatedly even when they were nowhere near me, pulling my hair out and at one point I tried to run out of the room to go home. I had been in Labour for 24 hours by this point and honestly fully beyond any reasonable control. It turned out that my baby was stuck and needed to be got out rapidly due to her falling heartbeats. Staff and DH tried to be reasonable and explain to me why this was happening and why baby needed to come out immediately. Finally they got me in stirrups, performed an episiotomy and baby was born safely. It was absolutely the most traumatic thing I’ve ever experienced and it took 10 years before I’d even consider another child. But my point is, my trauma wasn’t as a result of being made to have a procedure without my consent, it was the reason why that procedure became necessary combined with the effect the drugs had on me.
For context, I can drink only very small quantities of alcohol before becoming really drunk and any strong opiates I’ve been given (morphine was administered after knee surgery once) have knocked me out completely and made me very sick for a couple of days.

I'm so sorry you went through that. Thank you for sharing your experience.
I had no idea pethidine and entonox could have that kind of effect.

This is horrible. Bad things can happen even when the decision leading to them was not ‘wrong’. All the indications can be that things are okay and then suddenly they aren’t. Some women choose intervention and babies are harmed as a result - does that make their decision wrong? Or did they just make the decision they felt was right at the time and got very unlucky? You might need to have an operation and one of the risks of that operation is death. The risk might be tiny, say 0.5%. Is it wrong to have that operation if you happen to be the unlucky one who dies on the table? We can’t eliminate all risk all the time. Obviously it’s awful when people have terrible outcomes, but to describe a woman trying to make the right decisions as self righteous or criticising her for not accepting she’s ‘wrong’ is disgraceful. I can’t imagine such criticisms being levied at a man who refused a medical procedure.

I think one problem underlying this is that women have been sold a complete lie about childbirth. They are told its natural is best, they are in control of the process and just need to breath right, listen to their bodies (not the medical professionals) get into the right mindset and deliver naturally and easily. Intervention is painted as some sort of failure on their part and that they did something wrong along the way and let it get out of control. Women end up blaming themselves and feeling guilty about stupid stuff like having pain medicine or a C-section.

Childbirth takes on a life of its own and goes in unexpected directions all the time and modern medical Intervention must have saved the lives of millions of women and children by now. The idea that ordinary women know better than highly skilled medical professionals is right up there with anti vaxxers. Theres an undercurrent of this thinking on this thread, as there always is on these threads. The story I posted upthread about the baby dying is a victim of this. The poor parents swallowed this lie and their baby died as a result. Birth is a brutal and dangerous process for both mother and baby and there are no medals for a 'natural' childbirth, it's not better in some way than having every medical Intervention going. And I say all this after having three 'natural' births. I was just lucky, that's all and the women whose babies get stuck or whatever, are just unlucky, that's all, they didn't fail in any way.

Having said all that, people are completely free to ignore all medical advice, even if it costs the life of their baby.

The normalisation of overriding women's autonomy is pretty bloody frightening. Even more so when some of these comments are coming from women with a dismissive "as long as baby's safe that's all that matters" attitude.

Women do not lose the ability to consent during normal labour and usually intuitively know what they need to deliver their babies (which positions to get into, a calm stress-free space where they feel safe) but unfortunately most midwives in a hospital setting will push for a one size fits all delivery with a woman lying on her back under bright lights in order to facilitate constant foetal monitoring. When this inevitably doesn't work, instruments, episiotomies, or c sections are brought in. All of which cause risks to mother and/or baby but we are conditioned to accept without questioning.

Ladies please remember it is ALWAYS your choice and no one has the right to override your consent, regardless of their medical training.

@Kendodd
"people are completely free to ignore all medical advice, even if it costs the life of their baby"
Exactly my point.

I think the opposite. Women have been led to believe birth is dangerous and high risk, that medical intervention is necessary to ‘save their life’ even when it actually isn’t (and in fact may have created the ‘emergency’ to begin with).

There are so many benefits of physiological birth free from unnecessary intervention - quicker recovery, less risk of tearing or more serious tears, avoiding major surgery (c- section) and all the risks that carries, both for current and future pregnancies, better breastfeeding rates, better maternal mental health and bonding with baby, less risk of fetal distress caused by induction.

Conversely there are risks associated with induction which are rarely discussed in full. Babies are more likely to get stuck if you try and artificially force them out before they’re in an optimal position.

Making out that women who plan or hope for physiological childbirth are like anti-vaxxers is very offensive. I actually strongly believe that when women are empowered and informed they make the best choices for them and their babies. The evidence shows that birth in this country is fundamentally very safe, and homebirth is as safe as hospital birth. Of course, things can go wrong or unexpected things can happen so that plans may need to be adjusted but birth is not fundamentally dangerous and blindly following the push for intervention regardless of personal circumstances is not always best.

This isn't my experience of midwifes. Three deliveries, three different hospitals all in UK. Midwives all encouraged me to get into any position I wanted. The only things they discouraged me from doing was having a spinal block saying the baby was coming any minute. The antithesis was standing there needles in hand and baby was born about sixty seconds later so midwifewas right and I'm glad I didn't have it. Another encouraged me out of the loo. I was saying I needed a poo, she was saying that it was my baby coming. I then did a tiny poo followed immediately by a baby so I suppose we were both right but I'm glad the midwife encouraged/helped me out of the loo and baby wasn't born there.

I agree that "natural is best" is a harmful message. There can and will be medical emergencies and there should be no shame in accepting medical help in those scenarios.

However, you're ignoring that birth IS a natural process and that many of these Emergencies are triggered by unnecessary intervention. How many induced women are fully aware of the risks of induction? Most are sold on the fear that, if they do nothing, their baby will die. And the risks of induction are ignored or skirted over.

Believing that women should be listened to in labour, and allowed to birth in the way they feel most comfortable with full understanding of any risks, is not in any way similar to anti vaxxers who are actively ignoring medical evidence. What a ridiculous comparison

That's great you had a good experience. This thread is about respecting women's right to consent and it sounds as if you had that experience. It doesn't somehow mean that other experiences don't happen though.

My first baby was born in hospital and I was ignored at every stage. This also happens and isn't unique based on so many previous comments

Well that lady would have been well warned that the risk of a stillborn baby greatly increases after 42 weeks. Sometimes you need to put hopes aside and realise that it's not worth the risk. Believe me I had a terrible experience with induction with one of mine. I would say that it was quite traumatic, I was refused any form of pain relief and only offered gas & air. My contractions were horrific- every minute for 5 hours. But as soon as I saw my healthy baby I forgot about it. If there was any risk to me or my baby I would always go with what the professionals said. There is no excuse for going against them when the risk is high.

Your baby, your body, your choice.
I'm not telling any woman what to do or not do. I'm angry because I said "no" and midwives forced my legs open and stuck their fingers in my vagina without my consent. They should not have done that.

The risk of stillbirth isn’t high. It roughly doubles every additional week past 41-42 weeks, but doubling a very low figure still gives you a very low figure. According to the NHS the risk past 42 weeks is 6 in every 3,000 babies which is 0.2%. Even at 44 weeks AI suggests it’s still only 0.4% - 0.7% and I’ve never known a woman get anywhere near that!

By anyone’s standards, that is not a high risk.

You obviously have some form of trauma around your birth so I won’t be commenting on whether or not we should just leave women to their own devices and let their babies die. I suggest you get some counselling / a birth debrief / sue the midwife you obviously have massive issues with. I wish you luck in your healing journey

Or maybe giving birth naturally just isn't for you? It's ridiculous imo to not expect to be poked and prodded, it's part of the process.

There's a 64% increased risk of stillbirth at 41 weeks than at 40 weeks..even more so beyond 41 weeks..I just can't understand why you would take that risk. You say that the risk is still small but that's still a big risk to take just because your birth plan isn't going the way you want it to.

Very rare for a woman to want to be left to her own devices while her baby dies.
Very common for women to be coerced or even physically forced into accepting non-urgent intervention because of guidelines and policies. Also very common for women to be denied care and intervention because of guidelines and policies.

Pretty sure my baby was on her way out before they started poking and prodding tbh!

I can't imagine any woman refusing treatment knowing their baby would die as a result. The problem imo is that they don't believe what the medical professionals are telling them.