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

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

One of the safeguards of home birth is the option to be moved quickly to a hospital should circumstances require it. If this woman would be likely to refuse in such circumstances, that safeguard is no longer in place. Refusing emergency treatment at such a time could result in her death.

I can see how someone with a phobia that is likely to prevent them from accessing life-saving treatment could be judged to lack the capacity to make decisions about a situation when this is more likely than usual to be required.

It's awful but this decision could very well be the right thing for her.

Then 'capacity' is a weak and fairly meaningless concept. We do not like your particular decision or intention. In fact only someone mad would make it. You aren't mad [enough to be locked up for reasons of mad] but will be compelled [by force if necessary] in this regard.
Not a slippery slope at all.

The PTSD they cause by forcibly removing her from her home and forcing her to give birth in a frightening environment she won't have any right to leave will hardly help her.

I question the conclusion that her disagreeing with her partner about where to give birth proves she does not have capacity to make that decision.

Having capacity brings the right to make unwise decisions that others wouldn't. It is not permitted to use those free decisions as "proof" of incapacity. She should have the right to accept the risk of her life ending by refusing any and all medical care, even where the reason for her refusal is how traumatic the care would be to receive.

Lazy traumatising coercion is the NHS's default approach to psychological distress. Creating traumatised broken people who can't live their lives.

You have not saved a person's life if in the process you inflicted so much trauma they can never live that life.

I have little faith in this judgment. Judgments can be wrong.

@Loopylobes

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

One of the safeguards of home birth is the option to be moved quickly to a hospital should circumstances require it. If this woman would be likely to refuse in such circumstances, that safeguard is no longer in place. Refusing emergency treatment at such a time could result in her death.

I can see how someone with a phobia that is likely to prevent them from accessing life-saving treatment could be judged to lack the capacity to make decisions about a situation when this is more likely than usual to be required.

It's awful but this decision could very well be the right thing for her.

Exactly. If she refuses to leave the home for the birth, is she going to willingly go to hospital if there are complications? I’m guessing no.

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.

That is true
But those of us that deal specifically with the court of protection know that they in general uphold the rights of people to make unwise decisions and don’t make decisions lightly that deprive people of their liberty

@theThreeofWeevils

Then 'capacity' is a weak and fairly meaningless concept. We do not like your particular decision or intention. In fact only someone mad would make it. You aren't mad [enough to be locked up for reasons of mad] but will be compelled [by force if necessary] in this regard. Not a slippery slope at all.

There’s a realty specific way to assess capacity and this has to be evidenced. As someone upthread has said, if someone is deemed to lack capacity a professional has to evidence that they are either unable to understand information about the decision, retain it, weigh it up or communicate the decision. I imagine that sadly this woman’s agoraphobia may be preventing her from weighing up information about the risks and stopping her from making an informed decision.

The Act specifically says that someone must not be deemed to lack capacity just because they are making an unwise decision!

I think it depends on what risks they say can happen. a judge would not agree to this without their being evidence. Although if she’s been stuck at home for years then I imagine social services will place the baby into care as it’s neglect to keep a child inside constantly. What will she do when the child goes to nursery or school? Keep them at home. She needs a home birth with a midwife and doctor but she also needs a lot of help.

@NiceGerbil

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.

The full judgement will almost certainly be published (with identifying details redacted, obviously). Decisions of this type are rare, so potentially significant in terms of case law, and are almost always published. Contrary to what some posters seem to believe, the Uk courts are strong defenders of patients' rights. I would encourage people who believe otherwise to read a few judgements, as I think it will put your mind at rest. You do not need any legal training to follow them.

The 'force thing' is important because it allows the emergency services to remove the woman from the home, if she will not go willingly. It does not mean that they will use physical force in the normal sense, which I am sure they will avoid if humanly possible. Normally, though, a police officer or paramedic could not even gently take someone by the elbow and lead her out against her will (unless she were under arrest, in the case of the police). It's very difficult - rightly - to remove someone from their own home legally, which is why the Court needed to specify that is was allowable in this case.

I can see how someone with a phobia that is likely to prevent them from accessing life-saving treatment could be judged to lack the capacity to make decisions about a situation when this is more likely than usual to be required.

I've been in that situation. Luckily the HCPs working with me recognised that simply making a different decision to them did not mean I lacked capacity, documented that capacity and supported me with a legally binding advance directive to protect me from anyone else coming along to try and do what has been done to this woman to me.

I bet the HCPs involved in this case when she's left severely traumatised, unable to trust anyone or feel safe anywhere will all wash their hands of her and leave her to suffer the hell they are responsible for inflicting.

Then 'capacity' is a weak and fairly meaningless concept. We do not like your particular decision or intention. In fact only someone mad would make it. You aren't mad [enough to be locked up for reasons of mad] but will be compelled [by force if necessary] in this regard.

That is not how it is supposed to operate legally but when it comes to mental health patients it gets abused.

Giving someone lifelong PTSD is not in their best interests.

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

Wouldn't that have been in the judgement though as it sounds much more reasonable.

But it just says take her near her due date.

I understand the desire to look for reasons. In the end the report is brief.

The talk is of force not sedation. That seems off.

Don't forget our treatment of female prisoners who are pregnant/ give birth.

www.newstatesman.com/politics/uk/2019/05/crumbling-britain-how-it-feels-give-birth-behind-bars

It would be comforting to think that she's getting some much needed support behind the scenes, regardless of the reasons behind this.

I had my first at 21, and in hindsight, I was little more than a child myself.

@theThreeofWeevils

Then 'capacity' is a weak and fairly meaningless concept. We do not like your particular decision or intention. In fact only someone mad would make it. You aren't mad [enough to be locked up for reasons of mad] but will be compelled [by force if necessary] in this regard. Not a slippery slope at all.

You really do not understand the law at all. Capacity means the ability to understand and communicate a decision. It has nothing to do with the wisdom or otherwise of the decision. I have already given the example of JWs. Most people who are not JWs would consider it barking mad to die, rather than have a blood transfusion, but the courts have rigorously defended the right of JWs to make that decision.

My mind went straight to placenta praevia too. The judge will be privy to medical information that can't be released to the papers due to confidentiality. I trust the right decision has been made.

'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.'

She wouldn't be in Labour. Planned sections take place before that.

It's also fucking dangerous to take a woman who has a mental health problem so severe she hasn't left the house for years, send people round who are able to use 'proportionate force' to get her out of the house when she's heavily pregnant... They obviously anticipate her getting very distressed/ struggling and so she'd presumably need to be physically restrained somehow. Taking her to the hosp 'near her due date' and then keeping her there for what could be weeks.

If she's that I'll she's going to be incredibly distressed. Her mental health will be fucked. Because not only has she left home, she's been removed from it forcibly/ against her will. In that state she might see her options to get out of that situation as to get rid of herself/ and or the baby. She's going to need to be watched.

Yeah but that's all fine. Way better than giving her a sedative and bunging her in the back of an ambulance. General anaesthetic. CS. Sedated and taken home with the baby and someone to keep an eye on her.

Don't get that. Don't get it at all.

@SunshineSuxx I agree, I really hope she is getting lots of support behind the scenes.

I just think this is a really sad case where it is near impossible to be comfortable with whatever the judge decided. I think the judge has genuinely tried to put her best interests first and not just that of the baby- as horrible as it may be for her to have to leave her home, imagine how horrific the impact would be if something were to happen to her baby if she didn't go to hospital. That surely is part of the reasoning- there should be support for her to try to recover after this, whereas if something happens to her baby, it would be so incredibly devastating there would be no way back from it for her.

I just really hope she is getting a huge amount of support and that they are doing all they can to help her.

SunshneSuxx: ...how on earth do you parent when you can't leave the house?
.......
I wondered the same.

The talk is of force not sedation

Have you got any idea how dangerous and difficult it is to sedate someone against their will? It is far more invasive and requires far more restraint than simply removing someone from their house.

To sedate someone to the point that would be needed to take them to hospital, you need IV access - at least two cannulae, in case one falls out. You need heart, BP and oxygen saturation monitoring. You need to protect their airway by putting - at the very least - an airway support device into their mouth, and you may need to place a tube into their throat. How do you think that's going to go, if the patient is resisting?

You then give them drugs with unpredictable effects, And you want all this to happen to a terrified woman in labour in a domestic setting?

I thought first time mothers were seen as high risk, and giving birth in hospital was the doctors preferred outcome. I may be wrong but forcing her doesnt sit well with me. Surely, alternatives like hypnosis etc would be better for her. And how is her bonding with the baby going to go after being forced and distressed. Her partner and family etc can take baby out and about or to school, clubs etc. So its irrelevant whether she can leave the house or not. This ruling is more about convenience for others, not about her needs, which needed to be addressed.

Midwives are extremely supportive of home births, the fact that this hasn’t been an option means the case is extremely complex, her mental capacity has been mentioned.
You don’t often hear of cases like this.

The woman hasn’t left the house for 4 years for goodness sake, how can anyone expect her to raise a baby?

She wouldn't be in Labour. Planned sections take place before that

It's even more dangerous if she is near term but not actually in labour, because the baby is more affected by the drugs.

Any sedation powerful enough to make her compliant cannot be given without full IV access, monitoring and airway adjuncts.

Posters who think that's a question of a whiff of gas and air and all will be easy have been watching too much Call The Midwife. Deep sedation is far more dangerous than a proper general anaesthetic.

Surely, alternatives like hypnosis etc would be better for her

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

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

@MissLucyEyelesbarrow whether feasible for other reasons or not, was the suggestion of sedation not made with the idea that this could be offered to her, and that it might be an acceptable option to her, therefore she wouldn't be resisting?

Whether technically possible or not for other reasons, it wouldn't be sedating someone who was resisting. The idea surely was that it would be a way to help her leave the house without being forced- she may be accepting of leaving the house if she were sedated so wouldn't even realise it were happening.

There is so much background missing I don’t think any of us can make a reasonable judgement on this article alone.

She’s 21, barely left the house in 4 years, it dosnt state if it’s her parents home or her own. I don’t know many 17 year old who could afford decent accommodation to give birth to a child. For all we know she could be living in a tiny bed sit. It also states she’s a long way from London where they want her to have the baby. I’m assuming the fact that if there are complications that this means it won’t be a quick trip to the hospital and given her issues she’s not going to make that easy if there are problems, therefore creating even more problems for her and the baby.

Any medical history will not be reported on so we don’t know if there is anything else other than her agoraphobia.

As for the mum and partner, I’m assuming their opinions have been taken into account because they are the closest people to her who care about her welfare and safety and also have a vested interest in both her and the babies welfare. Also if she is still living with her parents then they should be entitled to an opinion about a baby being born in their home, especially if they have concerns. What if there are other children or vulnerable people in the house that may be effected by the trauma of her giving birth at home, especially if there are complications.

There really isn’t enough information to know the full story. Then there is how on earth this woman if going to be able to raise a child and give them a full healthy life if she can’t leave the house. I think it’s wholeheartedly irresponsible of both her and her partner to bring a child into that. As someone else mentioned they should be focussed on getting her help rather than getting pregnant.

[quote StrawberryLipstickStateOfMind]@MissLucyEyelesbarrow whether feasible for other reasons or not, was the suggestion of sedation not made with the idea that this could be offered to her, and that it might be an acceptable option to her, therefore she wouldn't be resisting?

Whether technically possible or not for other reasons, it wouldn't be sedating someone who was resisting. The idea surely was that it would be a way to help her leave the house without being forced- she may be accepting of leaving the house if she were sedated so wouldn't even realise it were happening. [/quote]
That would be less traumatic for her, but still very dangerous. Lay people tend to think that sedation is safer than an GA, but that isn't true at all. A GA is a controlled way of reducing someone's level of awareness. Most of the drugs are given as gradual infusions, meaning that you can constantly adjust the dose up and down, depending on the patient's response. Sedation is much less predictable and less easy to control.

There really isn’t enough information to know the full story. Then there is how on earth this woman if going to be able to raise a child and give them a full healthy life if she can’t leave the house. I think it’s wholeheartedly irresponsible of both her and her partner to bring a child into that. As someone else mentioned they should be focussed on getting her help rather than getting pregnant.

Funny how you've said there isn't enough information to know the full story but you want to judge her and her partner as being 'wholeheartedly irresponsible' without having any idea of what has happened- you seem to have imagined the pregnancy was planned and you have no way of knowing this. Of course she needs help but no need to be so judgemental.