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?

Bullying comes up a lot. Both to each other and to patients. I can see why someone might consider it “stupid and psychotic”. Colloquial use, for sure, but not “ridiculous” if you’ve been on the wrong end of it.

I am not saying either is an illness but there is good reason why maternal mortality, for example, has fallen from 1% to practically nothing in countries like the UK. Primarily, it is the recognition of the potential life threatening medical dangers than can be a complication of both pregnancy and giving birth and taking appropriate, swift actions to maximise the likelihood of current and potential lives to exist.

I completely agree that for non life threatening aspects of pregnancy and birth such as the example you gave, the mother should be given sufficient time and information to make decisions about herself and the fetus she is carrying/baby she has delivered.

Sounds like we're pretty much agreed. I definitely would not dispute that safe cesareans/blood transfusions/forceps for example are a huge benefit to mums and babies.
I just take issue with people acting like it's an extremely dangerous thing to do and you'd be crazy not to be in hospital. Not saying that's your position but I told my godmother I'm planning a home birth and she started taking about having an ambulance on standby, and not entirely tongue in cheek! Despite the fact that I'm healthy pregnancies, hospital birth compared to home birth with registered midwives and the ability to transfer if required is no safer for babies and demonstrably less safe for mothers.

Again - look at the maternity care reviews carried out by the Care Quality Commission (2023 - 67per cent required improvement and scoring low on safety!!) and the reviews into various high adverse incident rate hospitals carried out by ms Ockenden and other venerable obstetricians and midwife leads that have consistently found evidence of substandard or abusive ‘care’. I’d suggest that any expectant mother who doesn’t do her research, ask questions and enlist support is negligent.

Actually that's a point about ambulances. We've had 10+ hour delays recently in ambulance arrivals. Mother and baby would both be dead before an ambulance got there if an emergency situation arose.

Actually, that reminds me, talk of cord clamping. I remember when my third baby was born they were put straight on my stomach, cord attached. After a few moments the midwife just picked them up, cut the cord herself and took baby away to give them some oxygen as they hadn't started breathing. Baby started breathing and all was fine. Scary though. I remember I kept saying that they weren't crying. Midwife saved the day but I don't remember her asking us to concent to anything like cutting the cord, or can I give them oxygen, she just did it.

It is so sad that this is still happening. Twenty years ago we knew that the cascade of interventions was a conveyor belt to worse outcomes - but it seems that nothing has changed.

Gosh how awful - when was this (hoping it's far back in time....)? Was it for you to give birth or for an examination?

I'll post this once and then I'll hide the thread because the "what did you expect with your vagina" comments have raked up hurt from 14 years ago and made me cry, but I shall continue to tell what happened to me because it was absolutely appalling.

It concerns the period of time that is being investigated by Ockenden - so I finally felt some vindication that Shit Was Actually Wrong when that review was launched as for years I blamed myself and assumed I'd deserved it.

I went into premature labour with DD1 at late 33 weeks. I had pelvic girdle pain problems so bad I'd been on crutches and virtually housebound, so obviously I'd researched the importance of trying to protect my springy pelvic bits during delivery and that you needed to note the gap you could move your legs apart without pain before spinals etc. I was fucking terrified of being left in that pain long term as it was absolutely horrific.

Long story short - I have funny labours I now know - I get the pain but not the dilation (therefore no fucking pain relief) and then (to quote the midwife who delivered DD2 "blimey you just go bang") go 0cm to baby in stupid time (sub 10mins with DD2). At the time - I knew none of this of course (and no one would have listened to me anyway).

So DD1 had decided in her usual style of doing things as dramatically as she can do, that she was going to attempt to make an early entrance, back to back, executing a nice spin as she did so - and her aspirations exceeded the ability to execute this - so backup was called for, forceps were discussed and I was TOLD I was having a spinal.

All I wanted was for them to document and stick to a relatively safe pain free gap so I didn't end up long-term damaged. Didn't refuse the forceps, didn't refuse the spinal - just wanted them to note that before they numbed me up. A room which felt full of doctors shouting at me that they were GOING to do this and I was not going to stop them, and me trying to convey that I just wanted to try to make sure that I didn't end up with a permanently fucked pelvis - and they shouted at me more and more and more. Then one woman rolled her eyes - waved a tape measure in the air, said "see, done" and they proceeded to whip me up for a spinal and get the forceps out. I remember the realisation that the fleshy things right up near my ears were my knees. I also reacted to the spinal and couldn't stop shaking - was ignored completely, and I asked why something in theatre was beeping alarmingly - and was told "you don't need to know".

I'd also asked them to tell me if they were going to need to make a cut - not to ask, just to tell me out of courtesy to know what was going on down there. I was fully conscious throughout and they actually said to me "we can't cut without your consent - that will NOT happen"... then I found out they did so anyway - and I was perfectly able to give them any consents required.

DD1 was born - they didn't even tell me whether she was a boy or girl - then, to hammer it home, they rang social services on me as a "resistant patient" so I had to deal with the safeguarding being investigated while I was on the post natal ward from hell and DD was in NICU (my community midwife went mildly thermonuclear when she heard what had gone on).

I have a massively fucked up pelvis, permanent pelvic and hip pain to the point I cry with how much it hurts sometimes. I have such massive trauma about it that even seeing the hospital curtains can trigger flashbacks, it's completely destroyed my sex life and there's no chance at all I'd get a smear or anything because no medic is going down there. DD2 was one of the few shags I had post-DD1, and it was only when I saw how staff reacted when I said what had happened with DD1 and how absolutely shocked they were - that I realised that what had gone on was completely fucked up. With DD2 my consent was checked throughout, and when I needed a spinal to retrieve a stuck placenta - they handled my wrecked pelvis like it was made of glass - such care and trying not to move more than required - I even remember a conversation with the theatre staff while he was furtling about up there while we were all discussing Holby City!

I did not deserve to be treated how I was. I was not trying to restrict medical intervention or chase some idea of an idealised birth - but I was nothing more than an inconvenient slab of meat in the way of the baby. 14 years on and the trauma is still raw - and that's despite counselling in the interim. It doesn't leave you.

My hod you poor poor woman. Sorry to hear this

I'm so sorry that was done to you and that you're still in pain because of it. That should never have happened.
Thank you for sharing your story.

For the other poster I'm not sure but I think it was in the last five years or so because she was asking about what action she could take.
For me it was 2022 and it was in the hour before my daughter was born, around the transition phase. They did it so they could get a better CTG, which I find particularly galling as there's no evidence to support using CTG on the first place.

What a depressing thread - I’m shocked at how many posters are defending medical staff’s right to force procedures on women. I’m sure there are grey areas, but posters are talking about experiences like finding out after the fact that treatment was unnecessary or not fully described or they were restrained when resisting. Dreadful.

When women themselves think it’s ok for medical staff to force treatment on us, what hope do we have?

I’m a midwife and I think we are generally quite good on consent. Sometimes a bit over the top, as previous posters have mentioned.

In labour - particularly with no epidural so women are very much in a primal
headspace - things can get extremely fraught and it’s one of the reasons I stepped back from intrapartum care. It’s way too stressful. I’ve been at a home birth, on my own with the second midwife not arrived yet, with a totally shit fetal heart rate, on the phone to 999 while simultaneously having an argument with a woman about the fact that she needs to push her baby out NOW, and she won’t do it. This mum was in such a place of fear and overwhelm that I’m not sure she technically had capacity at the moment to even realise what was going on. And if the outcome had been poor, you can bet it would have been on me as the midwife. (That situation turned out fine and the mum was giddy and straight back to herself as soon as baby was out!)

But this is the real life context that is lacking. Labour and birth puts midwives and doctors in a very vulnerable position.

This is why it's so important to be clear on women's rights during pregnancy and birth/postpartum. I don't blame the midwife who assaulted me, I blame the hospital policies and culture that made her think it was more important to get a good CTG reading than it was to not assault me when I was in a vulnerable state.

So you’re saying that labour without adequate pain relief can remove a woman’s mental faculties and capacity - and yet most UK midwives I came across were very anti epidural which is one of the few available anaesthetics that doesn’t reduce mental acuity. I didn’t want gas and air or anything that would do that so I opted for epidural to ensure that I remained in control.

I can’t help but think that more women would opt out of mind altering anaesthesia if they realised their judgement would be so impaired and that this would be used as an excuse to disregard their wishes or need for consent.

It’s also odd to me that in countries where epidurals and pain free births are very common, that there don’t seem to be the same ‘risk factors’ in the statistics or discouragement of women from seeking such pain relief.

@TorturedParentsDepartment I'm so sorry for what was done to you, it was horrendously abusive 💐

From what I have read it a lot of it seems to be ideological, and influence from the NCT. I haven't rtft so this may have already been mentioned but the ockeden report talks about the influence of the NCT in creating a culture of 'normal birth at almost any cost'. https://www.theguardian.com/lifeandstyle/article/2024/aug/27/women-feel-like-failures-if-they-havent-had-a-normal-birth-how-the-nct-has-shaped-childbirth-in-the-uk#:~:text=When%20ideology%20enters%20healthcare%2C%20things,contributing%20factor%20in%20maternity%20scandals.
https://www.theguardian.com/commentisfree/2022/apr/16/relentlessly-pushing-natural-childbirth-abuse-pregant-women#:~:text=It%20has%20been%20reported%2C%20for,would%20leave%20them%20more%20%E2%80%9Csatisfied%E2%80%9D

35 years ago the consultant in charge of my first birth completely violated me.

he scheduled an induction for no other reason than he had a golf holiday booked and he thought I’d need a c-section because I was young and slight.

he examined me internally at every opportunity. And he wasn’t gentle.

because I was a disgrace you see. Young and unmarried in rural ireland. With no father to the baby on the scene.

im sorry things haven’t changed.

we need to do better.

Human Women are the the only species that give birth on their back. I wonder if that was womens choice and if it actually easier for women to birth like that 🤔

Of course it's not easier! Except very rarely if the baby is in a funny position maybe.

No, it's not is it. I agree with you. Women need to have more control in what happens to them in the maternity ward. It's their body and they're the ones having the baby. Unless they aren't capable of deciding, then yes women need more say over things and there to be more hospital accountability if things do go wrong

Yes I've heard giving birth standing up used to be encouraged in previous centuries w birthing stools etc

I think the trouble with the giving birth on your back thing is that it’s become the way we all imagine it to go too, because it’s what we see in any dramatisations or depictions of birth. In the west we grow up not seeing real birth. It’s hard to listen to your body when everything you’ve seen about birth is on your back. And on your back suits healthcare professionals because it’s easier for them to see what’s going on. I gave birth to both of mine on all fours as that’s what felt right and I was adamant I wouldn’t be on my back, but I was at home out of a medical setting so none of the wires/ equipment etc that might make the midwives want you on your back.

I gave birth in hospital three times. Two were on all fours, one on by back but born in the operating theatre with oven tongs after 36 hour labour. I was 'allowed' to be in any position I wanted with all three apart from the last bit with the one that suddenly became an emergency.

I did a straw poll of friends, none were forced/encouraged to give birth on their back apart from tongs or (obviously) c sections. I'm shocked midwifes in the UK are forcing women to be on their back, I even remember a midwife telling me it can be the worst position as you have to give birth 'uphill'. It seems very dated.

I don't know if anyone remembers it but there was a thread on here about a year ago about a women who lived in Japan and was terrified of giving birth as she'd learnt she had no choice but to be strapped down on her back while the baby delivered. I don't know what happened to her in the end.