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've a severe medical phobia, to the extent my life is at risk from no treatment, worsened by covid. I tried everything, but nothing worked, in fact things were made worse. Long story short, I was severely sexually assaulted by a consultant and nurse at an outpatient appointment and by another patient I was trapped with on a mental health ward, my last admission I was taken to hospital by a GP trapped in a wheelchair where I endured emotional abuse by the staff.

In the process of my "professional" treatment (for over a decade) I was laughed at and mocked. I got to a point of attending appointments, and only not sleeping for two days, numbing myself with drink/drugs, only to be told after I looked and acted fine so was being a bit silly and needed to grow up and go with my (abusive) family or "worker" (who turned out to be an ex abuser and was when I found out the third sector we are all supposed to now rely on for help employ people who have been charged with abuse but found innocent). I got my notes and the people the appointments were with noted I was "severely distressed".

To put it lightly phobia is now an understatement.

I was told under no circumstances would "just" a phobia mean treatment was forced on me, even if my life was at risk, and now I've read this I'm terrified. If a phobia means someone is unable to consent... I've read about this and been threatened with this before hence asking social worker and other medical professional about it and was told it was impossible.

I was actually going to make a thread it's frightened me so much.

I've already had a thread on MN about it and sarky comments about "big girl pants" and I just need to grow up are really rude and unhelpful.

@Becca19962014 I'm so so sorry to read what has happened to you. Nothing helpful to add but I'm so sorry for what you've been through. Sadly unsurprised that's you got comments about 'big girl pants' and the like.

I have bad agoraphobia. Not as bad as this woman's, I can leave the house with support and it took a lot to get me to this stage. So I feel a lot of empathy for her. I really wanted a home birth and planned for it, then had to go to hospital. I think she must be high risk or they wouldn't be discussing this now. If not then I think they should let her try at home and have a court order (if possible) that if she needs hospital she has to go. She must be feeling such dread and terror now, knowing that she must leave the house soon and there's nothing she can do about it. It's horrible to feel so powerless. I was relieved and grateful to go to hospital in the end, both my baby and I would have died without it. It was really difficult though and I hope it won't be too traumatic for her. I hope she gets support for her mental health and that her family will support her too

@StrawberryLipstickStateOfMind Thankyou for the understanding. I wanted the start a thread as so terrfied, but too scared to after last time. I've lost all my teeth now and can no longer eat as well as having a deterioating condition that can kill. I can't even walk past a GP surgery now without having a panic attack.

There is no treatment when it's really severe.

I really worry for this woman's mental health now. I'd rather end my life than go into hospital - my "silly little bit of anxiety everyone gets ha ha ha" is that bad.

@Becca19962014

I am sorry this happened to you. It would be inappropriate for me to speculate on your particular condition and what the implications might be. But I just want to reassure you that having a phobia absolutely does not mean that you lack capacity to make decisions about issues affected by the phobia.

Hundreds of thousands of people in the UK have phobias, and a phobia about medical/dental treatment is one of the commonest, yet it is incredibly rare to have a court judgement of this type about someone with a phobia. 99.99% of people with medical/dental phobias will never be in the position of the poor woman in the OP. We don't know her circumstances, but they must be exceptional

The full ruling is out.

Bullet point are-
She was 72 hours into labour when the ruling was made.

She was deemed to have capacity until a certain point during the labour.

She has an increased BMI and had little prenatal screening and they're really worried that there's something delaying birth.

She had planned to attend hospital for urgent care in her birth plan.

She understands the risks but believes death and serious harm will not happen at home such is her belief in it being a "safe space".

Her entire family strongly support the ruling.

Judge mentions that there is no reason to believe her and her partner can't give the baby good care and indeed they have another child who is well cared for.

www.bailii.org/ew/cases/EWCOP/2021/18.html

It happened a couple of months ago.

@MissLucyEyelesbarrow Thankyou for taking the time to try and reassure me, I really appreciate it.

You really do not understand the law at all

@MissLucyEyelesbarrow, obviously not so well as you do. Thank you.
However, I do feel that 'capacity' is a concept liable to abuse.
I was coming at it the other way, from the sectioning angle (and you'd be surprised, I think, at how casually the concept of capacity as defined can be applied in closed environments). No, it wasn't me then, but clearly only a matter of time.

I do not have much confidence in courts in the matter of women's rights and childbirth. Paranoia, probably, or dikastiophobia.

You are allowed to request a home birth for any reason. As I understand it, the NHS can't refuse although they can strongly advise you against it.

Which is presumably why they asked the court to rule.

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?

Unlikely, given that that was presumably a decision she took several months ago and he mental state may have changed since the.

@Becca19962014

I've a severe medical phobia, to the extent my life is at risk from no treatment, worsened by covid. I tried everything, but nothing worked, in fact things were made worse. Long story short, I was severely sexually assaulted by a consultant and nurse at an outpatient appointment and by another patient I was trapped with on a mental health ward, my last admission I was taken to hospital by a GP trapped in a wheelchair where I endured emotional abuse by the staff.

In the process of my "professional" treatment (for over a decade) I was laughed at and mocked. I got to a point of attending appointments, and only not sleeping for two days, numbing myself with drink/drugs, only to be told after I looked and acted fine so was being a bit silly and needed to grow up and go with my (abusive) family or "worker" (who turned out to be an ex abuser and was when I found out the third sector we are all supposed to now rely on for help employ people who have been charged with abuse but found innocent). I got my notes and the people the appointments were with noted I was "severely distressed".

To put it lightly phobia is now an understatement.

I was told under no circumstances would "just" a phobia mean treatment was forced on me, even if my life was at risk, and now I've read this I'm terrified. If a phobia means someone is unable to consent... I've read about this and been threatened with this before hence asking social worker and other medical professional about it and was told it was impossible.

I was actually going to make a thread it's frightened me so much.

I've already had a thread on MN about it and sarky comments about "big girl pants" and I just need to grow up are really rude and unhelpful.

I'm so sorry about what you've had to go through and how bad you feel now. You're right that a phobia is not enough to consider someone not having mental capacity. Because we are only irrational when faced with our phobias. People that don't have phobias don't realise how terrible they can be. It's got to be even worse for you because to try and ask for help with it would mean you have to face your phobia by approaching a medical professional in the first place. If you're under no delusion about the consequences of not consenting to medical care then you shouldn't be forced to go through it imo. And/or, if possible, medical professionals should make every effort to make it possible for you in the least traumatic way if you do consent.

Before covid I was told it was impossible to have a phone consultation or appointment, it was impossible to wait outside and be called in when it's my turn. Apparently that's not the case when everyone else is scared of a germ too. Allowances and assistances can be made, they just don't like to make them. If you need them try to ask for them. But, it's so hard to battle about that whilst battling mental health problems. I've been able to access more medical help now that telephone appointments are allowed than I could when I had to find a carer to take me to the GP.

So basically, most of the reporting was pretty inaccurate - it was a second baby, she was 26 not 21, it was an emergency application matter 72 hours into labour, and she'd had zero scans.

And although the application was granted, she did actually give birth at home, and the order wasn't needed in the end.

After reading the judgment, i think the right decision was made.

[quote Becca19962014]@MissLucyEyelesbarrow Thankyou for taking the time to try and reassure me, I really appreciate it.[/quote]
Having had a quick read of the full report, it looks as if it wasn't the phobia itself that was the issue - it was the fact that she had a delusional belief about her home. It was the delusional belief that made the court decide that she lacked capacity.

As I say, I don't want to comment on your personal phobia, so I'm going to use a different example. I hope it doesn't sound trivialising - I'm just trying to stay away from commenting on your phobia in case it is triggering.

Say you had a terrible phobia of spiders. If you needed medical help but said that you didn't want to go to hospital because you might see a spider in the hospital grounds, that wouldn't be delusional, because it is clearly true that you might. Just because most people don't have the same phobia doesn't mean that you lack capacity because you do have it - same as with JWs: most people don't share their beliefs about blood products, but that doesn't mean that they lack capacity.

However, if you believed that you couldn't go to hospital because the nurses had all been replaced by spiders, that would be a delusion. But the number of people with phobias who also have delusions on the same theme must be tiny - probably only a handful in the whole country. The poor woman in the OP is very unlucky and not at all typical of people with a phobia.

I'm on my phone in bed but @Becca19962014 just to add more reassurance there has been at least one ruling I can think of were even with delusional beliefs the court ruled that the person could decline medical treatment. They thought declining treatment would lead to death in that case, it actually didn't in the end but the odds were he would have died.

It depends on a number of things. Another example is the lady who was detained under the mental mental health act (or sectioned in common parlence) and wanted a mid term abortion for a planned pregnancy. The court ruled she had capacity to make that decision because although some of her reasoning appeared to be based on disorderes thinking other aspects of her rationale were sound.

Oops finished to soon. I didn't mean to suggest you were delusional but only that even in the case of delusional beliefs it is not a forgone conclusion that you will be forced into treatment or found lacking capacity.

@Becca19962014 one more thing... The law is there to protect you and is generally reasonable... But... Not all professionals understand the law, if anybody ever wants to start care or treatment and you don't want them to and they try to coerce you by saying you lack capacity tell them they need to get a court order. Because they do.

Oh fuck really sorry!

You can get sedated by the dentist.

I've been sedated prior to surgery.

Are you an anaesthetist? Just wondering. My mum is one. I can ask her.

The dismissive comment about gas and air. Why?

I know of the woman in question. There is a lot you don’t know about her and her past history. Lets just say this decision is definitely in her best interests. Also, I think MN should delete this post - discussing this case won’t add any value to her situation and might lead her not to use MN for support which is something she will probably need.

The info we didn't have-72 hours in Labour- makes it a different situation.

Doesn't make sense why the judge said to take her to hosp before her due date though.

Not enough information.
I would assume there is more to it than a simple uncomplicated pregnancy, though.

Sure, you can use Entonox (50:50 nitrous oxide and air) for labour and old school dental sedation - but it’s mainly an analgesic not a sedative per se. (You can make people a bit giggly and suggestible with nitrous but not anaesthetise them unless you use it as a co-induction agent with something else - or really sedate them.

Also, a minority of people get very disinhibited with it and can become more agitated.

I mean maybe things have changed but they don't intubate at the dentist do they.

The idea that all methods of sedation involve cannula, intubation etc. That's not my experience.

I'd like to understand more but the bit of gas and air thing... Why so condescending?

I've been sedated loads and it did make me very woozy.

The dental sedation thing says the same.

It's just not correct that sedation involves intubation and 1 maybe 2 cannula etc. Is it?

Is this NHS page incorrect?

'If you're extremely nervous you may prefer sedation through an injection into your hand or arm (intravenously) during treatment. The drugs won't send you to sleep – you'll be awake and able to talk to the dentist – but they'll calm and relax you so deeply you probably won't remember much of what happened.'