Consent and birth – supporting you to make the right choices for you in your pregnancy, labour and birth.
Hello and welcome, Tricia Murray here from The Birth and Baby Academy.
Today we are talking all about birth and consent and why consent is so important.
This topic has come up as a result of a conversation that I had last week with someone who was watching me on Facebook Live. She asked whether she had the right to ask not to have a vaginal exam?
Could she say no? This began to bring up questions in terms of when can you say yes and when can you say no?
At the end of this session, I would like to you to download the Resources Bundle (which includes 101 Questions About Birth). This is a free tool for you to use to get you really thinking about all the different questions that you need to consider so that you can prepare positively for your birth experience.
Knowing That The Choices Are Yours to Make
I really want you to help understand what your choices are in pregnancy, labour and birth and to enable you to say no at times.
When Do You Need Consent?
During pregnancy, labour and birth there are so many times when you need to give your consent.
These include for;
- Going to the hospital for an appointment.
- Vaginal exams at any time, including a membrane sweep.
- Stretch and sweep.
- Any monitoring of Mum or baby’s heartbeat.
- Any tests throughout your pregnancy.
- Continuous foetal monitoring.
- Pain relief such as epidurals, morphine, gas and air.
- Managed delivery of the placenta.
- Newborn observations.
- Giving your baby vitamin K.
- Suggestions to feeding baby alternatives to breastmilk.
- Students undertaking interventions.
- People arriving in rooms.
- Touching of the patient (particularly on the breasts or down below).
- Speaking in front of others about a medical matter.
Turning Our Beliefs on Their Head About Who’s Needs To Ask Permission
I wanted to bring this up because I wanted to turn a lot of it around on its head. We often think that when we go and see the different healthcare professionals that you are asking permission to be allowed to do something.
It could be to ask permission to have a caesarian or to give birth vaginally, permission to use the birth centre or have a home birth. But actually, it’s the other way around. They need to ask you permission for you to go to the hospital to have a vaginal birth. They need to ask you permission for you to go in and have a caesarian. We need to start flipping it around on its head.
Obviously, there are times when it might be medically reasonable to do that. But equally, it’s always our right to have a choice.
What is Consent?
According to the Royal College of Obstetricians guide about obtaining consent and it said,“To obtain informed consent, the process of shared understanding and decision making between patient and clinician must be approached diligently and robustly”.
There are some keywords in there. Often what happens is that people will go and see their medical professionals, but there’s never really a shared understanding. It continues;
“Before seeking a woman’s consent for a test, intervention or operation, you should ensure that she fully understands the nature of the condition for what is being proposed, what the likely consequences and the risks are for receiving no treatment as well as any reasonable or acceptable alternative treatments. Uncertainties that the woman might have about the management of the condition should be discussed”.
I think that’s really vital because I think often with these meetings, things aren’t always discussed.
It’s very much that you are going to the consultant and they are telling you that they want to you to do X, Y and Z. And what they will and won’t allow you to do.
What I’ve touched on so far is that the vocabulary is very negative, and there’s a thing that we call coercion. That is when a woman is convinced into a decision through fear. Not really through information.
What Can We Do About It?
What we can do as women is say, “Well actually can you tell me what the risks are?”.
When you start to ask them for evidence of these risks, what you will probably generally find is that you will be given very little evidence. They will say to you that their guidelines say X, Y and Z.
Looking at the evidence behind those guidelines you will find that the evidence is actually quite sketchy. The consultants themselves aren’t really sure of the evidence behind the guidelines. They just know that that’s what the guidelines are and they are sticking to those because that’s their protocol and that’s what they want you to go because it fits in with their system and their insurance models, etc.
Consent and Vaginal Exams
Back to talking about language and coercion, other times it might happen with vaginal exams. I work with a lot of women around vaginal exams and know what the positives and negatives of them are.
Vaginal exams are used to assess the progress of labour. It’s something that they have used historically for a long time. But, the evidence around vaginal exams and their accuracy and it terms of them being an indicator of how far along in labour you actually are, are quite limited. So using that when we are in labour actually is not such a great indicator at all.
What happens often is that when you go into labour, you go into triage and they will ask you if they can do a vaginal exam to assess how far progressed you are. One of the things around that is that they don’t want you to use up the empty beds. It’s an understandable hospital policy where they are trying to manage their resources.
Rather than looking at the woman and going, “You know what I don’t even reckon, just by looking at her, that she is very far a long”. So they say, “We won’t admit you until we’ve done this vaginal exam”. Well, that is absolutely coercion. There are other times when they won’t even ask you for your consent. They will just tell you that you’re not allowed in until you’ve had a vaginal exam.
Sometimes when they do the vaginal exam they can do this thing called a stretch and sweep without mentioning it or even suggesting it to the patient prior to doing it. It is often quite a painful procedure.
Sometimes the intention might be to support the woman by using this technique to speed along the process, but often it’s best to ask the woman first before doing it.
With vaginal exams I will counsel clients before and explain to them what’s going to happen. And sometimes it’s the clients that ask for it, but that’s completely different.
Consent and Inductions
Another time consent can become an issue is around induction. What happens is that women get to their due date and they automatically get given a date ten days after their due date, which becomes their date for induction.
Again, we need to change the terminology around that, so they’re booked in for their induction, but they are not offered and induction. So really what they should be saying to these women is, “I am offering you an induction ten days after your due date”. But actually that doesn’t really happen and women don’t really question it.
Obviously there are women who are getting really fed up of being pregnant and ten days after their due date, they do want to go in and give birth because they have had enough of it.
The evidence that we have around post-term pregnancy is really sketchy and we don’t have enough evidence to know what to do. We do know that the risk of still birth does go up slightly. I’m not saying it doesn’t, but we don’t really know why that happens.
I also think that it’s up to women to make the individual choices that are right for them. They can always say no whenever they want to.
Whose Risk is it Anyway?
The vast majority of Mums will ensure the safety of their child, so I really don’t think that a woman making a decision on what’s right for her is likely to have a negative impact, provided she has the right information.
What I find is that the women who come and speak to me are often highly intelligent women and more often than not it is their second pregnancy. In their first pregnancy they’ve gone along with the system and they’ve either been induced or something else has happened to have given them a negative experience. They come and see my for their second pregnancy and birth because they want to make it 100 times better.
However, with the status quo as it is, even these highly intelligent women with PhD’s and amazing jobs can still get intimidated into going along with something that doesn’t feel right to them.
It is time that we turned things on their heads and made consent in pregnancy, labour and birth something that is standard.
I am not giving any medical advice here and I am not saying that you shouldn’t go forward with induction at 10 days beyond your due date, because for many women that might be the absolutely the most positive decision that they have made.
But when you have that induction pressure and you don’t necessity feel it is the right decision, and then you end up feeling really traumatised by the whole labour and birth process, then that is an issue and it disempowers you from your birthing experience.
What are you going to commit to today?
For more information on birth and how to prepare, download the Resources Bundle (which includes 101 Questions About Birth). This will give you a great foundation to start getting informed and planning towards a positive pregnancy and a joyful birth!
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It’s your turn to learn how to relax deeply, learn wisely and experience a much better birth.