How do you feel about 'assumed consent'?

[Astrid]

Maybe the moral of the story is don't choose a HCP that you cannot trust to respect your wishes?

That is assuming there is choice. Not everyone can afford private health care. Going public, there is little choice. Yes you can get a doula, yes, you can a private midwife etc, but once you are in that hospital, it is basically the combo of the ob and midwives on duty (even in a midwife continuity program). Large cities, there is some choice of hospital, but it does seem to more the hospital choosing you. Rural cities, no choice. Even those with private health insurance have a limited choice with ob's as there are so few.

[nothing2lose]

With regards to the US infant mortality rate, it is well documented that the main reason for this is prematurity of birth and lack of pre and neo-natal care amongst the black, hispanic and caucasion underclasses. Yes, it is a tragic indictment on the US health system, but it has more to do with lack of access to care than interventions at birth.

[bellany]

Maybe the moral of the story is don't choose a HCP that you cannot trust to respect your wishes?

There shouldn't be hcp that don't respect a woman's wishes. How hard is it for them to ask permission before taking to a woman's perinium with a sharp instrument? If you would rather not know your being cut tell them before hand that if a epi is needed your ok with it and don't wish to know, but otherwise they need to ASK.

[Ginger]

i agree N2L.
i was cut and have no problem with it. i was asked before she did it and i said that it was fine. i was also well stitched up and recovered nicely. i trust that it was the best thing to have happen at that time in the birth of that baby. by the time i was holding him in my arms, i really couldn't have cared either way. i trusted my care giver and i vaginally birthed a 10 and a half pounder.

[PumpkinZulu]

With regards to the US infant mortality rate, it is well documented that the main reason for this is prematurity of birth and lack of pre and neo-natal care amongst the black, hispanic and caucasion underclasses. Yes, it is a tragic indictment on the US health system, but it has more to do with lack of access to care than interventions at birth.

I'm not talking about premature birth or lack of prenatal care. I'm talking about mothers walking into the hospital and dying there, or their babies dying, or both.

[nothing2lose]

I'm not talking about premature birth or lack of prenatal care. I'm talking about mothers walking into the hospital and dying there, or their babies dying, or both.

But you cant say the US has one of the highest infant/maternal mortality rates in the world and just put it down to the fact that they have a high rate of birth intervention based on some sort of gut feeling. You need to actually look at the real reasons behind the mortality rate. It isnt interventions. Yes, they do contribute a percentage but overwhelmingly, it is due to the totally shyte US healthcare system wherein impoverished women cannot access adequate prenatal or obstetric care. They also have a much, much higher rate of SIDS and infanticide (which is taken into account in the numbers because it includes the first year of a child's life.)

[PumpkinZulu]

I'm aware of that. I'm sorry, I assumed we were on the same page. Since we're talking about childbirth and interventions, I assumed we were focussing on the large part of those deaths that *are* a direct result of the birth culture in that country. Like DH always says, never assume, it makes an ass out of u and me. Apt

[Jellyfish]

The scariest thing of either of my labours was when I noticed a table of instruments being wheeled over towards me whilst in the pushing stage of DD2. Before that and during my entire birth of DD1, I was calm and collected. The instruments were for after the birth, cutting the cord and such but I did not know; I freaked. Knowing others had had things done without consent being sought made me really worried, I'd been saying over and over to DP leading up to the birth that I wasn't to be cut, don't let them cut me so just SEEING scissors I was suddenly in tears, my focus was damaged. If I ever have a third I will be requesting scissors etc to be nowhere in sight during the birth. Even though I trusted my Ob (private) and had two drug free spontaneous vaginal births... just knowing that culture is out there was enough to have me concerned and why should anyone feel that way during labour? I'm glad I only had to experience that feeling and not actually being augmented without permission.

I think it is dismissive for people to say there are bigger things, that the healthy baby is their focus because honestly, who doesn't want a healthy baby? Why can't we also want for more?? Why does having other preferences seem to suggest a lower desire for a healthy baby? If you are happy to have assumed consent then great, demanding HCP consider the need for informed and explicit consent doesn't take that ability aware from you but continuing to encourage a culture of assumed consent belittles the rights of somebody else. To me it is a bit like well, I can get married because I'm not gay and so the system works for my preferences... everyone should have the same rights regardless of their preferences.

[Babyluv]

The Ob who delivered my DD told me there was no room left for babies head and that I needed to be cut. I said no, that I would prefer to tear naturally. I made an educated decision and I'm glad I did because I only required 2 stitches for a tiny tear. A friend of mine was not asked for consent and the Ob was about to cut her, she saw the scissors and told him not to cut her and she ended up with just a graze. It seems to have become fairly routine to cut and quite often unnecessary. I have belly belly to thank for empowering and educating me to be able to make birth choices for myself and my baby. I believe consent needs to be gained not just assumed.

[maybebaby2012]

The scariest thing of either of my labours was when I noticed a table of instruments being wheeled over towards me whilst in the pushing stage of DD2. Before that and during my entire birth of DD1, I was calm and collected. The instruments were for after the birth, cutting the cord and such but I did not know; I freaked. Knowing others had had things done without consent being sought made me really worried, I'd been saying over and over to DP leading up to the birth that I wasn't to be cut, don't let them cut me so just SEEING scissors I was suddenly in tears, my focus was damaged. If I ever have a third I will be requesting scissors etc to be nowhere in sight during the birth. Even though I trusted my Ob (private) and had two drug free spontaneous vaginal births... just knowing that culture is out there was enough to have me concerned and why should anyone feel that way during labour? I'm glad I only had to experience that feeling and not actually being augmented without permission.

I think it is dismissive for people to say there are bigger things, that the healthy baby is their focus because honestly, who doesn't want a healthy baby? Why can't we also want for more?? Why does having other preferences seem to suggest a lower desire for a healthy baby? If you are happy to have assumed consent then great, demanding HCP consider the need for informed and explicit consent doesn't take that ability aware from you but continuing to encourage a culture of assumed consent belittles the rights of somebody else. To me it is a bit like well, I can get married because I'm not gay and so the system works for my preferences... everyone should have the same rights regardless of their preferences.

I agree. A healthy baby and respectful, dignified care should really be the minimum expectation in my opinion. I don't believe they need to be mutually exclusive.

[Maruschke]

I think it is dismissive for people to say there are bigger things, that the healthy baby is their focus because honestly, who doesn't want a healthy baby? Why can't we also want for more?? Why does having other preferences seem to suggest a lower desire for a healthy baby? If you are happy to have assumed consent then great, demanding HCP consider the need for informed and explicit consent doesn't take that ability aware from you but continuing to encourage a culture of assumed consent belittles the rights of somebody else. To me it is a bit like well, I can get married because I'm not gay and so the system works for my preferences... everyone should have the same rights regardless of their preferences.

This is not fair. I don't think anyone suggested those who do NOT give informed consent have a lower desire for a healthy baby. Nor should any blame be pinned on the people happy to give implied consent for encouraging a culture which "belittles the rights of somebody else". If it is valid for you to have your choices respected, it is valid for me to have mine respected. My own implied consent doesn't mean you can't choose not to give implied consent, in fact it doesn't imply anything about you at all. My choices are just that, mine, and don't (and shouldn't) impact on yours.

[BellyBelly]

Thats awesome babyluv.

I think women get siderailed into it too, no matter how much they feel the care provider is on their side or what wishes they put forth. And for many of us, we cant compare state/opinion right now to the state where they're putting it to you during an exhausting and stressful labour, not knowing whats going on or making a judgment when your mind is trying to do what its meant to do - birth and let go.

There are also very, very minimal Obs who will take on breech women or other births classed as high risk. Many have 'their rules' if you want a chance at a normal birth.

Public too, a client of mine had to be induced for a medical condition. Mind you they booked her in AFTER the long weekend, then once the waters were broken and it was taking time to establish, they played the 'we induced you so you dont end up with a dead baby' card, and commenced filling the room with hcp after hcp trying to get this woman to ramp it up on the drip with no signs of problems. AFTER the long weekend. Real life threatening, clearly.

What is said and what is done can end up being totally different.

[Butterfly Dawn]

When will they realise our bodys are made to have babys. Tearing is naturally going to heal better then a cut.
Personally i feel if there isnt an emergency, no need for cutting, and even in the event perhaps try 1st.
Muscle damage- that makes sense now. When i am rich i'll get it fixed.

What happens to us is not much better then the gentile mutilation done in africa. Its traumatic and unneccessary.

Sorry if it doesn't make sense, the barefoot princess is covering me with kisses

[Jellyfish]

This is not fair. I don't think anyone suggested those who do NOT give informed consent have a lower desire for a healthy baby. Nor should any blame be pinned on the people happy to give implied consent for encouraging a culture which "belittles the rights of somebody else". If it is valid for you to have your choices respected, it is valid for me to have mine respected. My own implied consent doesn't mean you can't choose not to give implied consent, in fact it doesn't imply anything about you at all. My choices are just that, mine, and don't (and shouldn't) impact on yours.

I understand what you are saying and I apologize that you have taken what I've written to mean I put any blame on any woman and their birth preferences because I can see where you have got that implication from although it was not my intention. I am expressing a desire for the culture to not be encouraged but I do not consider following an implied consent model of care does so and I completely respect somebody choosing to do so, I did partially myself as I did not want to know all of the ins and outs of complications surrounding birth and I put trust in my Ob to advise me in a way that is beneficial to me and my child. I do think an attitude that implies anybody wanting to make their own informed choice implies a lowered desire or focus on the baby's health and outcome is dismissive so am glad to hear that is not what people are meaning by highlighting the fact they are concerned only or above all for their child's wellbeing; I guess I just see it as an unnecessary distinction because I feel there would only be a the tiniest of minorities that did not care as first priority about the welfare of the baby.

[HotI]

Maybe I feel differently because so much of my bodily autonomy flew out the window long ago once the spectre of infertility raised its head. I have undergone nine IVF cycles which are highly invasive and emotionally fraught.

You may not like them, but you have consented. You haven't given away your autonomy.

I dont have the luxury of saying I dont want doctors to do things which are uncomfortable, painful and/or will have lasting repercussions on my body or my emotional state, if I want to have a chance at even becoming pregnant. Doctors are not my enemy. They are my partners on this journey because, without them, I stand zero chance of being able to hold a newborn child in my arms.

These are decisions you have made, no one has forced you or done things to you without your permission.

And, I know it's not politically correct to say this, but after what I have been through so far on this journey, I can honestly say that I have less concern about how I might be treated during the birthing process, whether I am cut, treated like a piece of meat, a number....whatever by the most arrogant OB that ever walked the earth, because to me, the end goal is far more important.

While your post was emotive, I don't think it is related at all. Just because a woman has had IVF, or multiple partners, or accepted treatment before does not mean that their vagina or body is public property or that they give up their right to autonomy.

[onthefly]

We should be able to trust that our caregivers won't assault us, certainly. But is it really reasonable that we must pick and choose and defend ourselves to ensure this?

And it's not about the procedure itself and how painful/unpleasant it might be. It's about being treated with the respect due another human being and in a particularly vulnerable situation.
I've had 2 episiotomies now. I have had BOTH experiences. I'm not upset just because it hurt or i had to have stiches, or that it tore up to my arse. boo hoo, poor me.

Having a baby shouild never mean a woman must give up her right to her self, or her dignity. Her carers should safeguard it - they hold this woman in trust. Anything less is not good enough.

[HotI]

This is not fair. I don't think anyone suggested those who do NOT give informed consent have a lower desire for a healthy baby. Nor should any blame be pinned on the people happy to give implied consent for encouraging a culture which "belittles the rights of somebody else". If it is valid for you to have your choices respected, it is valid for me to have mine respected. My own implied consent doesn't mean you can't choose not to give implied consent, in fact it doesn't imply anything about you at all. My choices are just that, mine, and don't (and shouldn't) impact on yours.

It is the hcp's responsibility to seek informed consent. it forms part of the principles of medical ethics that they are sworn to follow. It is not a patient's position to decide whether they want to be informed or not before giving consent.

I think I gave consent to my midwives to do what they thought was best throughout the antenatal period when we had many long chats about birth. I began to trust them to do what was necessary, only if it were necessary, and to keep the best interest of myself and my child in mind. So that said, I gave them consent in general to treat me the best they could, and they didn't need to ask for it at the time, because we knew each other well enough.

I had TWO epi's with this most recent birth, both without anesthetic, and both were vital, and they told me they had to do it rather than ask consent.... which was how we had agreed it would be... just do what you have to do and I'll do what I have to do. I don't feel violated at all.

It was my MW's first epi, and she's been delivering babies 7 years.

This sounds like you have given consent (during pregnancy) and during the labour they let you know that they were going ahead with it, and then it occurred. Presumably, you also had a chance to say 'no' if you had changed your mind.

Most people in this situation (given consent, consent confirmed, believe the procedure is neccessary) would not feel violated.

[Rouge]

Pretending there isn't a problem doesn't make it go away. Just because there are some people who don't have problems with the HCS doesn't mean there isn't problems. If I had my last birth first I might feel there isn't a problem. I don't think those that are fighting for a better system are destroying it for those that approve of the current one. Whereas doing nothing about the problems that do exist isn't helping anyone. We are human. The product of evolution and change. Without changes we'd still be using mercury as a cure for headaches. Medicine is a science, one that is always improving. I don't see why it can't get better. Who exactly suffers if it does get better? I don't get it. And by saying needs to get better isn't saying that those who gave had good obs, or good hospital births are wrong. Not at all. I was one of those people but that doesn't mean I don't acknowledge those who haven't had the same. There is a misconception that there is zero tolerance for intervention, I don't believe that is the case. I believe there is a zero tolerance for unnecessary intervention. Or intervention that isn't necessary without choice. Thats how I see it. I have a friend who was happily snipped, requested it to fix damage to previous scar damage from previous births. I requested no episiotomy. I had my wishes respected.