Agoraphobic mum-to-be forced to go to hospital for the birth

[UppityPuppity]

Judge states she doesn’t have the capacity to decide to have a home birth.

Not enough information to form a view about the supposed risks, except that I am so sad for her and wish her and the baby well.

www.bbc.co.uk/news/uk-57108649

I can't imagine many women get scans at home, tbh.

Likely to be a significant back story here.

I can only assume that there is a backstory to which we are not privy. Home births are pretty routine for a low-risk birth, after all so there must be complications which increase the risk.

This is so sad for the poor woman and her partner. However if it's true the evidence shows there was a risk there could be a catastrophe if she had a home birth then they've obviously made the right decision. If that evidence isn't there it's barbaric but I can't believe a judge would make this decision lightly.

Considering how ridiculously high the bar is set for sectioning someone, this seems something of an overreach by the court. If she doesn't have sufficient capacity to determine where and how she gives birth, then presumably she has no capacity to care for the baby either and it should be removed from her at birth in the interests of consistency for its own safety...

... being judged to lack capacity in one specific area and for courts to restrict agency on that basis is something of a slippery slope, surely?

I don't follow your argument at all, @theThreeofWeevils. People are not detained under the Mental Health Act because they lack capacity, but because they have a severe mental illness, requiring inpatient treatment (or treatment on a community order). Capacity has nothing to do with it. You can have full capacity and still be 'sectioned'. Most patients detained under the MHA do have the capacity to make decisions about most medical care.

This woman apparently lacks capacity with regards to leaving the house, but not about other issues. The court has therefore ruled that she is unable to make decisions about the one area in which she lacks capacity. It's the very opposite of a slippery slope - it has the effect of protecting her right to make all decisions for which she has capacity, just not for the one issue for which she hasn't.

... being judged to lack capacity in one specific area and for courts to restrict agency on that basis is something of a slippery slope, surely?

No. Capacity isn't a monolith. You don't have it or not. The question is whether someone has the capacity to make a specific decision at a specific point in time in specific circumstances.

This really bothers me.

We don't know if she has a high risk pregnancy. It's hinted at but not stated.

This part:

'He concluded that "proportionate" force could be used by specially-trained staff if she refused to leave home on a specified day near her due date.'

What level of force is proportionate on a woman who is at full term? The fact he said that means that they know she will refuse. That if they try to what. Carry her out? Push her? She will struggle. So what the hell does that mean? That bothers me.

Also it's a specified day near her due date. I went 42+2. If they come and use proportionate force to take her. She could be in hosp for weeks. She will be extremely distressed. Obviously. How will they keep her there? Guard the room? And isn't that going to push her mental health over the edge potentially?

Why on earth don't they say. We'll come round and sedate you. Your family will come with you. You will have a C-section and we will keep you sedated and have someone come and look after you at home. You won't even remember leaving. Was that on the table? And resource-wise that's less than having a room which has to be watched and possibly managing a woman who is heavily pregnant and probably terrified, having a massive mental health episode.

The woman is let's face it likely to have a massive breakdown of some sort and assuming she can keep the baby it's hardly a great start to motherhood. That will cause issues.

Judges make awful decisions especially when it comes to women all the time. I find it interesting there's so much faith in the system being shown on the thread.

Capacity is decision specific

I think we need to be clear about what 'mental capacity' means, as this is a specific legal term, related to the Mental Capacity Act.

Firstly, capacity refers to a specific decision at a specific time. In this case, the decision to go to hospital or stay home for the birth. When you do a formal capacity assessment, you assess a person's ability to take that specific decision. It's not a judgement about that person's ability or thinking as a whole.

For someone to have capacity to make a decision they need to show that they:

• understand and can remember information related to the decision
• weigh up the information to come to a decision
• communicate their decision

So if this woman had been able to say "Yes, I understand that a home birth is risky to me because of [medical reasons eg breach position] and it would be safer to give birth in hospital. However, I would be so distressed by going to hospital that I would prefer to take the risk of me/my baby dying," then there is no way that s judge would make the decision that she had to attend hospital. There must be more going on that we're no privy to - because it's private.

Also, capacity to take decisions can change over time. It's possible that this woman currently has another mental health condition that is impairing her ability to make decisions. So she may absolutely have had capacity to consent to having sex, but may now be more unwell and not able to make a reasoned decision about where to give birth.

Related to that, many women stop taking medication for mental health conditions during pregnancy and when breastfeeding because they are worried that it may harm their baby. That can safely occasionally have very tragic consequences, if that causes a major relapse in their mental health condition.

Having seen how courts in the uk condone abuse of women in family law, I don’t have faith in the system.

There must be a better way to deal with this and a home birth would surely be better, with a midwife she knows.

There must be a better way to deal with this and a home birth would surely be better, with a midwife she knows.

You cannot say this without knowing the circumstances of her health and pregnancy.

If (for example) she has placenta praevia, a home birth definitely wouldn’t be better because she and the baby will 99.9% both die.

I cannot understand the idea of her having to spend potentially weeks in hosp.

And the force thing.

Need more info. I am unwilling to say well a judge said it so it's fine without knowing more. Which I doubt we'll get.

@humanitariancisis yes. Good point.

@PanamaPattie

It's not about the mother - she is nothing but an vessel and incubator.

What a ridiculous comment.

It's reasonably likely that she will have a caesarean on that day, rather than waiting around in hospital for weeks?

If (for example) she has placenta praevia, a home birth definitely wouldn’t be better because she and the baby will 99.9% both die.

Actually, to be fair, if someone is a purist who believes in autonomy above all else this might be the “best” outcome for someone who has capacity and is intent on this.

but very few people really think that, either for themselves or for others

@BernadetteRostankowskiWolowitz

What a shame. I wish we knew a little more information, but there will be a reason for that.

I would question, though, that if the woman has been judged "lacking in the mental capacity to decide where to give birth" - could it be reasonably argued that she lacks the mental capacity to consent to unprotected sex and the consequences of that?

Is this more than "just" agoraphobia.

Not necessarily....you can have capacity in one area but not another. So if it is just to do with agoraphobia then any she will have capacity for any decisions which don’t involve leaving the house.

@NiceGerbil

This really bothers me.

We don't know if she has a high risk pregnancy. It's hinted at but not stated.

This part:

'He concluded that "proportionate" force could be used by specially-trained staff if she refused to leave home on a specified day near her due date.'

What level of force is proportionate on a woman who is at full term? The fact he said that means that they know she will refuse. That if they try to what. Carry her out? Push her? She will struggle. So what the hell does that mean? That bothers me.

Also it's a specified day near her due date. I went 42+2. If they come and use proportionate force to take her. She could be in hosp for weeks. She will be extremely distressed. Obviously. How will they keep her there? Guard the room? And isn't that going to push her mental health over the edge potentially?

Why on earth don't they say. We'll come round and sedate you. Your family will come with you. You will have a C-section and we will keep you sedated and have someone come and look after you at home. You won't even remember leaving. Was that on the table? And resource-wise that's less than having a room which has to be watched and possibly managing a woman who is heavily pregnant and probably terrified, having a massive mental health episode.

The woman is let's face it likely to have a massive breakdown of some sort and assuming she can keep the baby it's hardly a great start to motherhood. That will cause issues.

Judges make awful decisions especially when it comes to women all the time. I find it interesting there's so much faith in the system being shown on the thread.

I agree with a lot of what @NiceGerbil has posted. I do agree with others too that the judge is obviously going to be privy to medical information that we aren't aware of. But there's something about this that seems off- there surely must be a better way to help this poor woman, without the threat of force? I would be interested to know what other help and support she has received- if there are the resources for this to go to court and to use force if necessary, are there not also resources to attempt some kind of compromise or a kinder way of getting her into hospital? Some kind of sedation to get her there, a c-section etc. And how much support has she received for the agoraphobia?

It's a shame if there could be a better way to do this for her, that perhaps could be the turning point for her and that may even help her overcome her phobia. I'm really sad to think this is likely to make things even worse for her and perhaps leave her with other issues too.

I do agree that sometimes there are no easy options and it is in her best interests to make sure that both she and her baby are ok but I just wonder how this could be done differently.

@MissLucyEyelesbarrow

I don't follow your argument at all, *@theThreeofWeevils*. People are not detained under the Mental Health Act because they lack capacity, but because they have a severe mental illness, requiring inpatient treatment (or treatment on a community order). Capacity has nothing to do with it. You can have full capacity and still be 'sectioned'. Most patients detained under the MHA do have the capacity to make decisions about most medical care.

This woman apparently lacks capacity with regards to leaving the house, but not about other issues. The court has therefore ruled that she is unable to make decisions about the one area in which she lacks capacity. It's the very opposite of a slippery slope - it has the effect of protecting her right to make all decisions for which she has capacity, just not for the one issue for which she hasn't.

Exactly- sectioning has absolutely nothing to do with capacity.

Why on earth don't they say. We'll come round and sedate you

Er, because it's fucking dangerous to sedate anyone outside a clinical environment, let alone a woman in labour.

There’s a lot of reading between the lines here- if scans have been provided at home it does seem like she’s been given at least some tailored support with respect to her circumstances.

I hope it works out as best as possible for her- I’m not going to say that it’s poor reporting due to the lack of detail, as behind all this there’s obviously a very scared young woman and a concerned family who deserve privacy to work their way through this.

I also don't see why her mother or partner's opinion is of any relevance in the slightest confused it should be between her and her midwife and/or consultant.

It’s in the mental capacity act 2005
When determining what is in the best interests of someone who lacks capacity to make a particular decision, those close to the person have to be consulted and their views taken into account.

@humanitariancisis

but very few people really think that, either for themselves or for others

Isn't that the argument behind the mantra about abortion being available up to the very last minute? Surely if one supports that (I don't) one would support this woman in making a choice no matter how dangerous it would be for her baby?