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

This is a completely different scenario from elective dental sedation.

Both pregnancy and obesity are risk factors for difficult airway management and reflux / aspiration. Labour exacerbates this, especially long labours.

Being overweight is a risk factor for difficult vascular access.

Entonox is a very unreliable agent and not a true sedative.

Giving genuine sedation to a woman who is obese, pregnant, in obstructed labour with no monitoring or vascular access, outside of a hospital environment would be indefensible in court.

You cannot safely sedate a heavily pregnant woman to the point of being able to remove her from her house against her will or to the point where she is unaware of what is happening.

Yes, sedation is used at dental surgeries. Dental surgeries that use it have to be fully equipped clinical environments.

The point about sedating her and taking her to hosp was about the original report where she was to be taken before she went into labour.

How much more dangerous is it than using force to take a mentally ill woman who is nearing her due date out of her house while she resists and then presumably having to restrain her in some way. That sounds like a recipe for disaster to me.

Is that not a different one, the judges name is different.

@NiceGerbil

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?

Can you not see how the planned mild sedation of a fit and well, co-operative patient in the clinical environment of a dental surgery is ever so slightly different from an agitated 40 week pregnant woman in her own home?

One cannula is fine at the dentist. Not fine when you' re transporting a patient. They come out.

If you don't want to be patronised, don't make daft suggestions based on Dr Google.

Ah is it?

That makes more sense- the report in the OP talks about taking her to hosp nearing her due date.

So it doesn't add up to do it when she was 72 hours into labour unless something changed in the meantime.

On the sedation thing, my concern is around the implication that it is always very invasive.

'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?'

I never had all that when I was sedated. Dentists don't do all that.

Just in case the references to dental sedation are referring to my post in an attempt to help me (If so then I'm really sorry for the derail caused by my fears caused by the article and any subsequent confusion I've stupidly caused by posting here!) I cannot have sedation as I'm too ill. I also cannot have local anaesthetic as it doesn't work with my medical condition.

My last appointment where I allowed one near me was almost ten years ago and they dislocated my jaw yanking it open because of my condition. She claimed to be a "specialist in phobias" and "had seen it all" and then made gagging noises and said how disgusting I was for allowing this to happen. Then she told me I'd be dead from infections. She knew I've severe depression and chronically suicidal so saying I was going to die wasn't going to make me "snap out of it" and her telling me she would have treatment forced on me again made it worse. I couldn't get out of the chair. She delibrately put my sticks in another room to stop me leaving.

I was in agony for weeks and looked like I'd been beaten up for days. I can put my jaw back in (again due to medical condition) but honestly in my opinion all medics cannot be trusted anymore. I did trust my GP but then she blamed me for covid and accused me of wasting their time.

I really need to attempt sleep now.

I'm REALLY sorry for derailing this thread and causing confusion. It wasn't intentional I just wasn't brave enough to post my own.

I didn't think they intubated people without sedation /or after the GA has kicked in?

It can be really difficult to 'get the tube down' even when the patient is conked out.

You're suggesting that people are intubated as a matter of course beforehand?

The midwifery and obstetric team have a duty of care for mother and baby. High risk births are generally not considered suitable for a home birth. Some regions have suspended home birth services during Covid. I have sympathy for the mother, but I don't think this is the big patriarchy at play here.

Hi Becca no it wasn't you at all! I'm sorry you got that idea.

Based on the OP I said why couldn't they sedate her bung her in an ambulance do a CS get her home earliest opportunity etc.

There was a reply that I questioned. Not you at all. Don't apologise :) x

Becca I'm not surprised you have no faith in them.

That's s totally rational response.

The midwifery and obstetric team have a duty of care for mother and baby
[leaving aside the original case in question] Until the fœtus is born it has no rights, and therefore that duty of care cannot be equal. And if a woman not detained under the MHA or judged to lack capacity, for whatever reason decides on a course of non-intervention that might allow both the fœtus's death and her own, it is her right to do so. Isn't it?
If not, what other rights are up for grabs?

There was another case of a woman who was.. taken to hosp and it all sounded shitty.

I'll try and find it.

Re sedation: benzodiazepenes are safer than mahoosive catecholamine release I would have thought (and I know you can get disinhibition and excitation, and I know it wouldn't magically make for a perfectly compliant patient trotting to the ambulance, but still...the amnesic effects alone would be worth it).

I really hope she is doing OK. I had an agoraphobic client once, who had finally braced himself to get in a taxi and take his beloved cat to the vet when she was quite ill. Poor chap it was obvious how much it had taken for him to do this, he was in a cold sweat and just about managed to keep his voice reasonably steady with a few pauses, a glass of water and a ton of effort. Before I met him I didn't really know what agoraphobia meant.

I hope she can get this overturned. It’s not illegal to have a home birth nor to have mental health problems. She deserves professional support and access to health care not punishment. She has mental health reasons for avoiding hospital. She must be aware of the risks she faces from giving birth at either home or hospital with her agoraphobia. I was really horrified to read about this ruling. I can only imagine how distressed she must be feeling. Where is the massive public and professional outcry over her rights?

So the whole cannula / intubation thing then is incorrect. You don't need to do that to sedate someone.

I worry that people will read that sort of thing and then avoid treatment etc.

In what situations do you intubate people who are fully conscious, no sedation or anything? When it's not been some terrible incident and so it needs done immediately?

I didn't know that happened. When I was young I was sedated before GA, and definitely intubated afterwards.

I know it can be hard to get the tube down even when the patient is unconscious.

I'm surprised to hear that in your line of work it would be done prior to sedation even and that sounds really extreme.

Being Agoraphobic does not mean you lack mental capacity, if that's the case why is she pregnant if considered vulnerable?

@ChattyLion

I hope she can get this overturned. It’s not illegal to have a home birth nor to have mental health problems. She deserves professional support and access to health care not punishment. She has mental health reasons for avoiding hospital. She must be aware of the risks she faces from giving birth at either home or hospital with her agoraphobia. I was really horrified to read about this ruling. I can only imagine how distressed she must be feeling. Where is the massive public and professional outcry over her rights?

No it's not.

What we don't have is any other information about her medical background. For some women a home birth could be very dangerous. Should her life or that of her baby be put at risk?

I've said before, I suspect the bigger issue is how she'd react to an emergency situation and whether it would be safe to transfer her if that happened.

We don't know how far along she is. My hope is that her midwives and doctors are working with her to feel comfortable to go into hospital at the appointment times. Spend some time there before the birth so she gets used to the environment. I think they'd only want to resort to this legal ruling if they have to

I expect that increased numbers of people with agoraphobia may be one consequence of the pandemic. So the mum in this situation may not be unique.

So the whole cannula / intubation thing then is incorrect. You don't need to do that to sedate someone.

For the sake of clarity, in a general sense, you do not need a cannula or intubation to give “sedation”. In the same way that you do not need to go onto cardiopulmonary bypass to have an “operation”.

Sedation is a spectrum of altered consciousness and the drugs, monitoring and interventions required to make it safe depend on a combination of the patient’s own risk factors, the level of sedation required and the reason for the sedation (including the likely duration, how easy it would be to stop halfway through or convert to GA etc).

This scenario is very different to elective dental surgery in a cooperative patient without risk factors.

If you need to have a procedure, and sedation is being considered, whether you are pregnant or not, you should discuss this directly with the person who would be giving the sedation so that you can give informed consent to it.

And if a woman not detained under the MHA or judged to lack capacity, for whatever reason decides on a course of non-intervention that might allow both the fœtus's death and her own, it is her right to do so. Isn't it?

Yes - the example of JW was given above, where it’s legal for people to bleed to death rather than accept transfusion.

But capacity is important, as people say all sorts of things in the heat of the moment / without full information etc etc and if everyone who ever used the phrase “I’d rather die than x or y” was taken at their word without any exploration that would seem a little remiss.

Does she have a high risk pregnancy? Is it a multiple birth? Does the child have a health condition diagnosed in utero that needs immediate treatment?

The are a whole host of medical reasons that a hospital birth could be the best option that this mother is ignoring because of crippling agoraphobia. I doubt a judge made this ruling lightly and in a situation where there was little risk. It would be exceptional to do so.

That article simply doesn't give details, and nor should it.

@SakuraEdenSwan1

Being Agoraphobic does not mean you lack mental capacity, if that's the case why is she pregnant if considered vulnerable?

No one is deemed to lack capacity because of a particular condition, and assessments of capacity are always decision specific and time specific. There’s really a whole legal framework about this (the Mental Capacity Act). Lots more info on the thread.

I was suffering from agoraphobia through my pregnancy and birth. I opted to try for a home birth but still ended up with a hospita

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

That's the case.