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?

She's not saying that women should be left alone for their babies to die. That's literally not at all what she said. The right of a mentally competent patient to refuse treatment is enshrined in the law - and women do not forfeit this right upon becoming pregnant. I want babies to be born healthy, but I don't think that women should be forced into painful or invasive procedures for the sake of the unborn. This is not the handmaids tale - not yet anyway. We've worked hard to win our reproductive rights and to not be treated as reproductive slaves. We should never let our rights be overturned - not even a little bit.

She's not saying that women should be left alone for their babies to die. That's literally not at all what she said. The right of a mentally competent patient to refuse treatment is enshrined in the law - and women do not forfeit this right upon becoming pregnant. I want babies to be born healthy, but I don't think that women should be forced into painful or invasive procedures for the sake of the unborn. This is not the handmaids tale - not yet anyway. We've worked hard to win our reproductive rights and to not be treated as reproductive slaves. We should never let our rights be overturned - not even a little bit.

Hi, lawyer here - you are patently incorrect.

Someone has decision-making capacity if they demonstrate the ability to understand information, weigh up the risks and make a decision. If a woman says "I refuse XYZ" and I understand that the fetus might die, then she has made a decision. The only legal defence that a medic has for violating autonomy of an adult is if they are in some kind of physical or psychological state that renders them decisionally-incapable.

A decision doesn't have to seem "rational" for it to be made with full capacity. Rationality is subjective anyway - two people might rationalise information in very different ways. Who is to say that doctors are the only people who can decide what is or is not rational? Are they Gods?

Seeming "overwhelmed" does not equal lack of capacity either. People are allowed to make decisions based on emotions. It doesn't necessarily invalidate the decision.

There's been multiple maternity scandals and a national birth trauma inquiry - and you think midwives are generally good on consent? Pull the other one.

Sorry, but if you can't handle the fact that women are going to make decisions about THEIR bodies that you disagree with, then don't work in healthcare.

I understand that it must be upsetting to see women make "unwise" choices that lead to poor outcomes, but it's also upsetting to think that women could so easily be stripped of their bodily autonomy and reproductive rights by the people paid to care for us. Rights that we have fought tooth and nail for.

Oh, and if you are really going to argue that pain strips a person of capacity (I would contest this, btw) then maybe midwives should stop being to bloody anti-epidural? Maybe give women actual analgesia instead of sterile water injections - a literal placebo for extreme pain.

Maternity wards have gained a reputation for denial of pain relief. You can't on one hand deny pain relief to women, and then argue that their untreated pain renders them mentally incompetent. That's a catch 22 and a losing game for women.

Midwives are foolish if they do anything other than position themselves as advocates for women and their legal rights. The profession is already under threat and they appear to have a death wish. I was astounded a few years back when the (male) elected head of the midwives association suggested that epidurals and other pain relief ought to be minimised or paid for by patients as reported on in the press. Made me even more thankful I had an obstetrician running my birth not a midwife.

Many people already distrust midwives due to the many reported medical scandals. Private healthcare is increasingly popular. Caesarean sections are increasingly common taking midwives somewhat out of the loop.

I hasten to add that I had excellent care from midwives in my births and they were all respectful of my choice of epidural etc providing nothing but professional friendly care. However there appear to be a cohort who are unable or unwilling to do that.

1 trillion percent agree with this.

They are digging themselves into a very deep grave. I won't have any sympathy for them as their profession becomes more and more disgraced. I feel sorry for the genuinely good ones, but this is a structural problem. There are more than a few bad apples.

Every single woman I know has been treated like crap by a midwife. My mum's neighbour is a midwife who comes over uninvited, casually breaches patient confidentiality and brags about how she routinely denies pain relief.

Completely agree that what that male midwife said was abhorrent. And now, on this very thread, we have midwives arguing that labour pain renders women lacking in capacity and unable to make decisions. So, on one hand midwives are denying pain relief, then on the other hand, they argue that pain left untreated in their care renders women incompetent.

They just twist the narrative to serve their agenda.

This is similar to the post I made upthread. Couple wanted a very natural childbirth, it was all going wrong and not happening. Midwife was practically begging them to transfer to hospital and clearly spelling out the risks, including death. Eventually the baby did die. I think the couple just didn't believe what the midwife was telling them. The woman is free to refuse whatever care she wanted though, even if that results in both her and the baby inside her deaths.
Contrast this with my experience. My baby was born but hadn't talked its first breath. After a few seconds the midwife just cut the cord (told me, didn't ask) and took my baby away to give oxygen. Had I tried to refuse oxygen for my baby I would imagine the midwife would (rightly imo) ignored me. Diffence being, the baby was now born and I (imo) don't have a right to refuse life saving treatment for my born child who is now a completely separate human being with their own rights separate to mine.

That's very sad about the couple with the deceased baby. But you are right - she had the right to make that decision.

I am glad that your baby is okay.

Couldn't agree more with this.

I will say this though - some women are coerced into "natural" births by midwives, and to a lesser extent, obstetricians sometimes.

This "normal birth ideology" persists in the NHS. There were even campaigns by midwifery institutions for normal birth which have since been rescinded because they lead to unsafe and unethical practices. I have absolutely no problem with a woman freely choosing to have a low-intervention birth. But it should be HER choice, and not something that is thrust upon her by midwives and obstetricians. Obstetricians and midwives are not necessarily always sensible. They can be highly biased and set out to serve their own agendas. Women need to think for themselves, no matter what, and question things that don't feel quite right. I'm not saying we should ignore the advice of professionals, but women do need to go into healthcare settings prepared to fight for their most basic rights. Very sad reality.

It's unacceptable to force a woman into an obstetric intervention. It is equally unacceptable to deny her interventions when they are wanted/needed. Would men be denied pain relief for testicular torsion on the grounds that it is "natural"?

Yes, it's very sad and heartbreaking for the parents, they must be tortured by guilt as baby would have almost certainly survived with early intervention. I think sadly they just didn't believe what the midwife was telling them. Even in extreme cases though, women have a right to refuse and intervention they want.
By baby's fine 🙂 she's now 17.