Showing posts with label consent. Show all posts
Showing posts with label consent. Show all posts

25 October 2010

Informed Consent

Every day for the last two years I have encountered either directly or recounted through someone else, at least one woman who genuinely believes that because she is pregnant she has sacrificed her most fundamental human rights. The vast majority of women become submissive to the will of their care providers and the NHS does nothing to correct this misconception, in fact, it perpetuates it. Women are regularly told by their midwives and doctors that they are "not allowed x", or they "must have y". I myself, while in labour, was told by a midwife that I had to have an internal examination every 4 hours. No consent was sought, it was presented to me as non-negotiable and this happens routinely, probably with the most regularity in relation to induction.

Women are told that their baby is due on a specific date, the Estimated Due Date (EDD), with the emphasis on "due" rather than "estimated". Women fall for this almost every time, if they go just one day past their EDD then their baby is "late". Midwives seem to not point out the fact that babies can and do arrive whenever they are ready and that the World Health Organisation (WHO) defines normal pregnancy as lasting anywhere from 37 to 42 weeks. Once a woman passes 40 weeks, which about 50% of women do, they are told that they are now on a clock and must go into labour quickly otherwise they will "have to be induced".

The exact date at which hospitals routinely induce women with no clinical need, varies from one area to another, but what doesn't seem to vary is the lack of informed consent. Women and their families are not given the facts that enable them to make a decision for themselves, they are routinely led to believe that they have no decision to make, they will be induced, this is non-negotiable. They are not told the risks of the induction process, they are however given exaggerated and out of date "advice" about the risks of remaining pregnant for longer than 41 weeks.

If a woman's waters break she is put on a clock and if labour does not start spontaneously within 24 hours she is told that she must be induced. I've known women be told this and given no reason, at best they are told that it is because of the risk of infection. What they are not told is that the risk of infection only increases significantly after 96 hours and that it is a significantly higher risk in hospital than at home. Premature rupture of membranes (PROM) occurs in about 6-19% of pregnancies, 86% of women will go into spontaneous labour within 24 hours and 94% within 95 hours. Statistically, a baby born in hospital is 4 times more likely to acquire an infection than a baby born at home and around 9% of women birthing in hospital will acquire an infection, the highest risks being those who have a catheter and especially those undergoing a caesarian section, both of which are higher risks for those undergoing an induction.

It saddens me to hear women talking about their births as though they have no choices, no input to how and where it happens and what makes it worse is when people like myself try to inform them we are accused of being bullies! It is my sincere hope that the tide begins to turn soon and that women are given full, accurate information and are empowered to make their own choices for their births. It is one of Airedale Mums' primary goals, though it is not clear yet how we go about achieving it.

11 January 2010

Maternity Matters

I've been involved in the NCT 'Location, Location, Location' campaign to hold NHS Trusts accountable for meeting the deadlines for birth choice in the government Maternity Matters document. My MP has actually been very helpful and I have had replies from the Undersecretary for the Department of Health as well as the Chief Executive of my local Trust. The former was not very promising, she basically fobbed me off saying that they had recruited more staff and therefore met the deadline (end of 2009), despite the fact that only 4% of women actually have a free choice of where to give birth - the target was 100%. My local CE however, was very positive, there are two new midwife-led units in development in the area and the Maternity Services Liaison Committee has been relaunched. I promptly replied saying I would like to join the MSLC! I am very driven to see changes in the maternity services offered and this is a great way for me to help do that.

All of this has fuelled my desire to help inform and empower women. Unfortunately, I am always finding people who do not welcome information. They would rather be afraid, surrender to the doctors in white coats because I suppose that is easier than finding strength from within.

I recently had a conflict with someone on an internet forum who said that she was "not allowed" to go past her estimated due date due to history of placental abruption. She lost her baby at 20 weeks because of this, so I understand why she is afraid. However, when I pointed out that no doctor can "allow" or "disallow" anything she became very upset and hostile towards me. She turned her story around, saying that she had asked for intervention if she did not go into spontaneous labour before 40 weeks as she felt that the stress and worry of another problem would cause her to have a traumatic birth. I tired to point out that there is nothing magical about her estimated due date and that her using the word "overdue" to any day beyond that is factually inaccurate and not helpful to her own state of mind. She really didn't like that!

I have been stewing over this for a few days and need to get this off my chest. Whenever women talk about doctors "not allowing" them to do something they are perpetuating the myth that doctors have power over our bodies during labour. It is this myth that keeps victims of birth trauma from realising that something wrong was done to them. Birth trauma is physical or psychological abuse, it includes intimidation ("Your baby will die if you don't let us do this") and sometimes even rape (vaginal examinations without consent). So when I encounter someone who is saying that she is "not allowed" to go past her EDD and that this isn't even the truth as she perceives it it actually makes me quite angry.