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

@ChattyLion

As others have said, faith placed in professionals without question in cases like this revolving around their skill or experience in determining capacity to consent will sometimes be misplaced.

HCPs to a ‘significant’ extent don’t always know much about assessing patients around capacity and therefore making determinations around the patient’s ability to consent. This is according to academic research pointed to by Birthrights blog:
www.birthrights.org.uk/2021/04/07/blog-agoraphobia-and-mental-capacity-a-new-obstetric-intervention-case/

See pubmed.ncbi.nlm.nih.gov/32647042/
‘Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do.’ Journal of Medical Ethics, July 2020.

Abstract:

Background: The Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors' compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors' experiences of and attitudes toward mental capacity assessment (MCAx).

Methods: This is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.

Results: Participants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001).

Conclusions: This study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.

In this case the judge talking about reasonable force to get her to hosp sounds all wrong. How much force is reasonable on a heavily pregnant woman who is terrified and struggling etc? That statement from the judge is awful.

Reasonable force is lawful to use against anyone being restrained/transferred somewhere due to their MH. Police often assist ambulance/MH teams in restraining and transporting people who are being sectioned or if they require care elsewhere, many of which it's very traumatic for. If people are so shocked in this case I'm curious what they think about the rest of the MH system..

Not sure why it quoted that post!

^Like I said at the very beginning. If she has a high risk pregnancy then sedating her, getting her to hosp for immediate CS, keeping her on morphine/ sedated until safe to go home (24 hours sometimes round here), and getting her home again would seem a good option.

In this case the judge talking about reasonable force to get her to hosp sounds all wrong. How much force is reasonable on a heavily pregnant woman who is terrified and struggling etc? That statement from the judge is awful.^

What makes you think that something like this wasn't suggested? A pregnancy-safe anti-anxiety medication or gas and air and a trip to the hospital? What if she said no? They she wants to stay at home.

The impossibility of safely sedating a pregnant woman for a trip to the hospital was described earlier in the thread.

You asked "How much force is reasonable on a heavily pregnant women who is terrified and struggling?"

The answer is a whole lot less than the amount of force that would be needed to forcibly restrain and medicate her. Sedating her against her will would involve pinning her down on the floor or a bed and injecting her. Which I don't imagine is the outcome you were imagining.

It's not an outcome the Judge wanted either. According to the Guardian article

Justice Holman said any restraint should not include “mechanical restraint”, the use of a “prone restraint position” or any techniques which would apply “pressure to the diaphragm or abdomen”.

The whole thing sounds grim to be perfectly honest. I don't envy anyone involved in this whole miserable situation who has to weigh up a selection of imperfect and unsatisfactory options. But the thing is that grim situations with no good options arise and someone had to make the decision hide too deal with them. It's nice to think that of only the judge was less misogynistic or the medical team understood capacity better that the situation could be resolved in a more pleasant way, but sometimes there really isn't. There's only bad and worse.

It's nice to think that of only the judge was less misogynistic or the medical team understood capacity better that the situation could be resolved in a more pleasant way, but sometimes there really isn't. There's only bad and worse.

Of all the bizarre comments I have read on MN in the past few days this is by far the most bizarre and least informed.

Please do feel free to share the good outcome which gives nobody any discomfort

I'd like to know, too!

Of all the bizarre comments I have read on MN in the past few days this is by far the most bizarre and least informed.

Can you explain what you mean by this? What is the problem with what I have said?

@Maggiesfarm

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

Well, there are probably plenty of parents who can't or don't leave the house too often due to physical disabilities, and nobody suggests their child should be removed from their care.

She obviously has family support and a partner so I doubt the child is going to be indoors permanently until adulthood.

I also would like to know what’s wrong with @InvisibleDragon comment. This is a classic rock and hard place situation. Judges don’t want to deprive adults of their liberty but sometimes it actually is necessary for their own well-being and safety. The alternative is to let her give birth at home (even though this isn’t an informed decision) and hope to god things turn out okay. After listening to evidence from medical professionals, the judge came down in favour of requiring the birth to be in a hospital but it’s clear that this wasn’t an easy decision.

We do not know that medical staff have made an appropriate risk assessment based on the facts as presented.

Given that they've had to satisfy a judge that they have done precisely that, and have had their decision carefully scrutinised and challenged by an independent public guardian and lawyers acting for the woman in question, I think we can assume that they have.

There is a lot not being said.

For some reason the medical staff believe the best outcome will be achieved in a London hospital. That 'best outcome' will be a baby and mother who are both alive.

I grew up with an acrophobic (also alcoholic) mother and it is more complicated than not leaving home / safe space.

I am thinking about my mother here, but is she was told, "you have to go to the hospital now", even for life saving treatment, her mind would lock on to 'leaving safe space' and she would do anything to stay safe.

On the other hand knowing you have to leave at a date in the future things can be planned, how to travel there, what things to take, what will happen when you get there etc.

I'm trying to think of an analogy, maybe this. You are at the top of a 20 storey building and you are told to jump and that someone will catch you, just trust that this will happen - who is going to do that?

On the other hand if you are taken to the same rooftop and told, "in 2 months you will jump and someone will catch you", in that 2 months you go back to that roof and see that there is someone to catch you, that that person is an expert and is wearing a safety harness. You will get your own safety harness, there will be a cushion underneath both of you and another person can jump with you, it will still be a hard thing to do but would you jump?

Hopefully she will receive support towards this.

@justawoman

It’s also worth pointing out that the doctors’ determination of her lack of capacity to make this decision was upheld by a judge.

I thought the ‘natural birth is always best, let’s get all women out of those nasty medicalised hospitals’ thing had died a death since the Telford and Wrekin scandal. Apparently not.

You would think so, but no.

Agree that the unborn child has no rights and should not be considered as it’s own entity in the judgment . It gets more complicated though if the mother is expressing a desire for a healthy baby and also for a home birth. Even if she is found not to have capacity her views should be taken into account.

Consider for example that she wants more than anything else to have a healthy baby, however she has a delusional belief that to have a healthy baby she must not leave her house. If she is found not to have capacity because perhaps she does not understand the medical information that a home birth is dangerous due to her delusion then the court must decide based on her best interests. The court should then look at what her priorities are in order to decide her best interests. Her priority is for a healthy baby therefore the court should make a decision for her that will lead to a healthy baby.

However if her priority was to stay at home whatever due to her delusion and she did not mind if this would cause her baby to die and she Underatstood that this was likely consequence of her having a home birth then it would be a lot harder to find she did not have capacity or if that she did that her best interests would be served by going into hospital.

In addition there is lots of talk about healthy babies here, but not about mums health. A home birth gone wrong is just as easily fatal for mum as it is for baby.

As well as the above it is worth mentioning that as soon as baby is born it has rights so if it was born v unwell after a difficult home birth it would be packed off in an ambulance to hospital without mum - her understanding of the likelihood of that happening and her thoughts about this would also have to factor in.

Finally although it might not feature in the judgment I really feel for the medical staff. If she has a home birth against advice will a midwife have to attend knowing it’s likely to end very badly. Putting the midwife in the position of having to attend to a birth that is likely to go wrong is so very unfair to that midwife. She (or he) may well have to watch mum and baby die knowing she could have saved them. Forceps used to be done at home for instance, there not now as it’s considered unsafe, should if needed they be offered to this lady at home even though that’s considered an unsafe practice. If something then happens would mum or baby sue because of that unsafe practice. Is the midwife going to have to deliver an ill baby and then refuse to hand it to mum to whisk it into an ambulance. Are two ambulances going to have to be on standby for this - how many other women will be harmed if multiple resources are diverted to this case?

Of course an about to be born child has rights. The right not to be born with a severe disability that could be avoided with a few medical precautions. Im glad the judge came to this decision.

@Viviennemary

Of course an about to be born child has rights. The right not to be born with a severe disability that could be avoided with a few medical precautions. Im glad the judge came to this decision.

I think if I'm remembering correctly you are a poster who is very anti- abortion Viviennemary?

If so then although 1 support the existing UK law on abortion I'm very uncomfortable with the idea that a full term, about to be born baby's rights can be trumped by any decision of the mother, no matter how absurd, irrational or dangerous that might be.

This thread isnt about abortion.

@Viviennemary

Of course an about to be born child has rights. The right not to be born with a severe disability that could be avoided with a few medical precautions. Im glad the judge came to this decision.

Not according to the law, if I've read this thread correctly.

Not according to the law, if I've read this thread correctly

That's correct. I assume Vivienemary meant "rights" in a moral sense, not legal. I mentioned abortion because although I support the UK current rules I do not support abortion to term so I'm very uncomfortable at the idea that the right to insist on an absurd, irrational and dangerous birth "plan" might just as well be abortion to term.

I’m sorry gerbil but you’re an idiot. It’s been explained why you can’t just sedate someone in their home and then move them to hospital. If you don’t know enough about healthcare then do not speak on such matters.

Fishandchips the idea of using reasonable force on a woman who is due to give birth is slightly different than on people who aren't in that position.

As I'm sure your aware your ligaments in your hips loosen etc so risk of injury is higher.

There has been no comment on the concern around suicide/ trying to induce abortion. They must be concerns.

And the idea that need to get a tube down to sedate someone is arse about face. The statement was to sedate someone you need to intubate and get at least one cannula in. That's not true. Statements like that can scare people reading posts for all sorts of reasons.

I've been sedated plenty of times. In no instance did they put a tube down my airway first.

When people have an anaesthetic they conk them out before intubating. Intubating a person who was conscious and aware would be extraordinarily distressing.

Not to mention difficult.

Calling someone an idiot because you disagree with them is not on.

Missbarbary it is misogyny to suggest that women would be getting late term abortions left right and centre.

She'd have to go to hosp for an abortion anyway so it's irrelevant here.

And yes of course force is used on people with mental health issues by various services.

There's stuff in the papers not infrequently about mistreatment, injury, death even.

How much force is appropriate on a woman who is due to give birth. And everyone is oh yeah that sounds fine.

Does the woman know about all this? Her mental health will be spuralling

Downwards fast I would imagine. If she does.

There has been no comment on the concern around suicide/ trying to induce abortion. They must be concerns.

That's because sensible people are addressing the facts at hand and not flights of fantasy.