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Obstetric violence - What happened to consent?

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Birth (105)      Obstetric violence (3)      Violence against women (1)     
This is a blog piece that has been in the works for, literally, months. Ever since I saw an awesome independent midwife talk about the issue of consent at a conference.

And over those months the ideas surrounding this piece have evolved.

But through my conversations here is one thing that I have found: Assault and battery of birthing women, by their care providers, is ridiculously normal. And normalised. It’s fully accepted by society that women will be routinely abused during pregnancy, labour and birth.

Here’s just how normalised it has become:

I was in a meeting with a client recently. The OB was talking with her about some risks associated with her birth plan. The language was pretty atrocious, but nothing worse than either of us expected. Until…I turned to my client and said “But it’s still your decision” in regards to something. The OB said “Well it can be hard to make a decision when in the pain of labour. Sometimes I have to be the bully, make the decision and then sort it out later. It’s not possible to get informed consent during labour”.

Yep – assaulting women is so normal that this OB admitted in front of a pregnant woman, midwife and doula that she does it as a matter of routine. Because getting consent is “too hard”.

I would bet real money that she’s not the only one doing this. Because she’s made it to a very senior position – obviously other OBs and midwives are not reporting her. And if they are nothing is being done. Or worse…they are convincing women that this sort of behaviour isn’t worth a complaint because “That’s just how birth goes”.

And then people wonder why women feel unable to lodge complaints against perpetrators of obstetric violence.



CTG Machine
Want to run a trace on bub? You need consent! Image courtesy of Wikimedia Commons.


Let’s move on to another consent issue that is bugging me. It’s a separate issue that I’m including here because it happened in the same appointment.

Implied consent.

A midwife walks in and tells the client: “Oh that’s right. I need to take some blood for xyz.” And then walks out to get equipment. I’m sitting there wondering: Is she going to obtain consent? Er…nope!

Implied consent is not valid consent. When the risks and benefits are not explained and no opportunity is given to decline, consent has not been obtained. Have you ever heard any of these statements? Or, if you are a care provider, have you ever said any of these statements?

• Time for your blood pressure check.
• Here’s your referral for that ultrasound / test / procedure.
• Just hop up here so I can feel bub.
• At your 38/39/40/41 week appointment we will do a stretch and sweep.
• Hop up on the bed, it’s time for your VE.
• You have [insert medical condition here], we will have to induce at [insert random gestation here].
• We just need to test bub’s blood sugar levels.



Blood test
Blood tests also require full consent! Image courtesy of Wikimedia Commons.


Now, most women will comply with these orders from their care provider for a few reasons. The important issue here is to remember that simple compliance does not equal valid consent. Women need to be informed of the benefits, risks and alternatives and be afforded the opportunity to decline in order to be said to have given full consent. Over the course of my own 2 births and the births that I have supported as a doula I have only seen 2 midwives ensure that they had full, valid consent before performing any procedure or test.

I know that there are some people out there who will tell me that it is all the woman’s fault. Just be strong, use your voice, don’t let them do it, get better support. It’s so simple – just say no.

But there are actually some really valid reasons why women end up complying with these things.

Firstly – look at the language used.

It’s time to…”. Most of us live our lives to a sort of timetable. When it’s time for work – we go to work. When it’s time for lunch we sit down and eat lunch. Time for bed and off we go. We have been conditioned throughout our lives to do things at the assigned time. So when a care provider says that it’s time to have a VE our brain tells that we need to do it because it’s the assigned time.



CTG Machine
We're not "just going to measure bub" - we're going to talk about what the procedure is, what information we hope to gather, how that will affect our recommendations, check if you have any questions and then ask if you would like to consent to the procedure. Image courtesy of Wikimedia Commons.


I’m just going to…”. Often when using this way of speaking the care provider will throw in the word “little” as well. “I’m just going to have a little listen to bub’s heart”. “I’m just going to put a little bit of medicine in your drip”. Women comply with this because “just” and “little” suggest that the care provider isn’t performing an “intervention” it’s just a little something of no consequence. Of so little consequence that it doesn’t even have any risks, because they aren’t explained. Of so little consequence that it doesn’t actually require consent.

In my opinion the overall reason that women comply with these “orders” is this: Women need to feel safe in order to labour effectively. If a care provider says something and we could interpret it a few different ways we are going to interpret it in the way that makes us feel safest. So, unless the care provider is very overtly bullying a woman, the mind will just assume that the care provider is being supportive.

I also believe that this trust issue is how we have ended up with so many women who believe their care providers are allowed to allow or not allow things. In order to feel safe in the presence of our care providers our mind interprets “I’ll let you vbac as long as you go into labour by 41 weeks” as “I support you to have a vbac”. When you look at it rationally there is nothing supportive about that statement. But when you are pregnant and realise that this person is going to be a part of your birth your mind will interpret this in a way that makes you feel safe.

Sadly in the current state of our maternity care system anything other than “I’m going to tie you down and force you to have a caesarean” is seen as supportive, because for many women it’s so much more than they had hoped for. We have stopped demanding supportive care, because we don’t feel that it is achievable. Instead we consider it great if we are just not cut as we yell no.

The absence of valid consent in our maternity care system is a HUGE issue. The fact that everyone is so okay with it, is also a huge issue. So let’s reframe it:

If you are not obtaining full, valid consent you are abusing the pregnant or labouring woman.



CTG Machine
Says it all really. Image courtesy of Wikimedia Commons.


A procedure performed on a woman without valid consent is obstetric violence and abuse. It should not be happening to ANY women, let alone happening as routinely as it is. It is time that we all stand up and say:

It is NOT okay to abuse pregnant and birthing women.

#Birth
#Obstetric Violence
#Violence against women

Further reading:

Trust us - We're the experts

Trust - A crisis in maternity care

Birthing revolution - The fight against cultural conditioning

Evidence based care - No thanks!

To the Australian Medical Association - Please remove your opinion from my vagina

Stop telling me that I'm strong enough

My midwife betrayed me, giving me a beautiful gift

Obstetric violence - Victim blaming, victim shaming
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The very reason that labouring women are in pain is hospitals messing with them, making them lie down in labour and breaking their waters and other rubbish like that. I hope you reported that Ob for what she said. You can always gain consent and our docs do it all the time or they would have us (midwives) to answer to. If a woman holds out her arm for bloods then that is consent, if she did not consent then she would keep her arm to herself. www.painfreelabour.blogspot.co.uk
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