How do you feel about 'assumed consent'?

[Maruschke]

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.

Where is this coming from? Who is saying that there is no problem / pretending there is no problem? Who said anything about destroying the current one?

If you are speaking about people like myself who didn't have a problem with their treatment, I'd plead that just because I am happy and got out without being violated, doesn't mean I have failed to see that others haven't been so "lucky". I am not blind. I am also not without empathy for those who have been violated. Surely we can discuss our own personal observations without anyone reading into it a more general conclusion.

If you aren't speaking about people like myself, who are you talking about? Who is holding the opposing opinion here? I'm just a bit baffled about who the opposition (for lack of a better word) is in this discussion.

[little_O]

Where is this coming from? Who is saying that there is no problem / pretending there is no problem? Who said anything about destroying the current one?

If you are speaking about people like myself who didn't have a problem with their treatment, I'd plead that just because I am happy and got out without being violated, doesn't mean I have failed to see that others haven't been so "lucky". I am not blind. I am also not without empathy for those who have been violated. Surely we can discuss our own personal observations without anyone reading into it a more general conclusion.

If you aren't speaking about people like myself, who are you talking about? Who is holding the opposing opinion here? I'm just a bit baffled about who the opposition (for lack of a better word) is in this discussion.

I was wondering the same. Thought I missed something.

[Arcadia]

This is a very emotive topic, and I think we should all assume people are giving their opinions based on a wide range of experiences and observations rather than just this thread.

I totally get what you're saying rouge, but marushke I also hear your point. I think this is one of those discussions where we need to see 'we' and 'you' as hypothetical rather than directed at anyone.

Let's keep the harmony and very envigorating discussion going.

[Maruschke]

This is a very emotive topic, and I think we should all assume people are giving their opinions based on a wide range of experiences and observations rather than just this thread.

I totally get what you're saying rouge, but marushke I also hear your point. I think this is one of those discussions where we need to see 'we' and 'you' as hypothetical rather than directed at anyone.

Let's keep the harmony and very envigorating discussion going.

I get that. I am reading the "you" and "we" as hypothetical, but I still don't see which hypothetical "you" is against change in the way HCP's presume consent?

Part of the issue is that the OP asked how we felt about consent, and some of us has responded with how we feel personally, and others have responded with a commentary on the current situation. I get the feeling some have mistaken the former for the latter.

[nothing2lose]

I get that. I am reading the "you" and "we" as hypothetical, but I still don't see which hypothetical "you" is against change in the way HCP's presume consent?

Part of the issue is that the OP asked how we felt about consent, and some of us has responded with how we feel personally, and others have responded with a commentary on the current situation. I get the feeling some have mistaken the former for the latter.

Yes, that. Reading back it seems no one is against informed consent as a concept but that some of us would not necessarily be angry or violated should we have an episiotomy without explicit consent.

[Rouge]

Sorry I didn't mean it as an attack on anyone here. Just an overall view of how I feel sometimes. Guess I was just going bluuuuurgh. I've seen so many discussions which have turned sour because it becomes personal. I'm also stressing a little because I'm about to be birth support so I have a lot of stuff playing on my mind. So pleaaaase don't think I was having a go. Just blurting.

[Maruschke]

I hope it goes well Rouge.

[chody47]

Yes, that. Reading back it seems no one is against informed consent as a concept but that some of us would not necessarily be angry or violated should we have an episiotomy without explicit consent.

I think you've summed it up very well

[Rouge]

Oh I totally get that too. And I don't thing that anyone SHOULD be, but I do think that those are should be heard.

[loulabelle]

I was cut with my first ds. I had no idea they did it until they said they had to stitch me up and I asked how badly I tore, only to be told that I was given an episiotomy. It was awful, it didn't heal and I was stitched again 6 weeks later. I would have liked to have be asked or even informed, even though as a first time uninformed mum I probably would have said yes anyway. It wasn't a needed episiotomy, I simply took too long to push him out.

Saying that though, if there was a some life threatening complication and I wasn't able to answer or they didn't have time, I would want them to do what they had to do get my baby safely to me. Obviously that would be a very rare thing to happen though.

[onthefly]

For me, it's not about the episiotomy, it's about the presumption that I didn't get a say in what happened to my body. I'm sure the OB thought it was all for the best. But that misses the point - it wasn't his decision to make.

Of course our perspectives are shaped by our own experiences - it is as it is with all things in life.

Maybe some women wouldn't mind handing themselves over to their carer or having them assume consent. That's their prerogative. I think what Rouge asks is would they be worse off if all health carers ensured all women gave informed consent? I'm not talking about episiotomies, I'm talking about everything from routine blood tests to post-natal care of your baby.

[Rouge]

Thank you that's what I'm trying to say.

[Ca Plane Pour Moi]

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

Sorry, only read up to here, but have to reply to you N2L (and I love you, but feel misunderstood by some of your comments).

THIS is why I am choosing a freebirth. Because there is no health "care" "professional" that I can trust to respect my wishes. Hell, there's no fricken HUSBAND I can trust to respect my wishes. I was cut not because Liebling was going to die, but because I had been bullied into things, my "no"s had not been heeded and the obs reg I had wanted (and had) to shove his hand up my vagina while I was pushing Liebs half-way down and I was "too muscular" and "too tense" for him. I, and most other women in the UK, do not get to choose providers. We can ask the NHS nicely but if they want us somewhere they either bully our DHs into it (as happened to me as I was trying to fight the world for a homebirth for a few months) or say we can have a birth centre IF they agree - but we still need a hospital we may detest because (a) it's closer and (b) the birth centre can decide they don't want you if you're more than a week away from their arbitarily decided and wrong due date (couldn't even get ONE person to listen to me that I didn't have a 4-week cycle, but irregular 5-8 weeks).

I do not feel violated because someone plonked a baby I do not recognise as my relation into my arms. I do not feel violated because a doctor decided surgery was best for me. I feel violated that I tried to discuss risks with the midwives and they ignored me. That they bullied me. That they laughed at me when I said I did not want drugs - then "told you so" when I had them. I feel violated because I said "no, I don't want this" and it was done anyway. I feel violated by a man's hand being shoved up my vagina while I was birthing then he complained about it and sliced me up, despite my wishes, because my husband agreed to it.

If it weren't a hospital, drugging and violating a woman's vagina would be rape. Why does a hospital that I never wanted to go to make it OK?

eta - the after-effects of my mutilation - 2 years before I felt comfortable during sex. Some positions made me scream in pain for 3 years. Even now, I can feel a scar. I hate it. I hate the mutilation that occured to me when I didn't want it. And I have a stupid pap smear tomorrow with someone I don't know and am freaking about it and just wish my period would arrive right now so I can cancel it. The after-effects of my mutilation is that I don't want a potentially life-saving check done on my body. And I know full well from discussing with the nurse who did my last one (who I did know pretty well) that this is not uncommon, but I am the unusual one who just gets on and does it, irrespective of the fear I feel.

[Chrispe]

In another thread, a few women said that they didn't know/think/believe that health care providers (HCPs) had to ask a woman for consent to perform an episiotomy (make a cut to her genitals).

Do you think women should have to give informed consent for an episiotomy?

Do you think that it is ok for HCPs to assume consent (for an episiotomy) if consent has been given for vacc or forceps?

Do you think that it is ok for HCPs to assume consent (for an episiotomy) because a woman is in labour and has entered a hospital?

Do you think it is ok for a woman to refuse a procedure? When/Why? When is it not ok?

I do believe informed consent should be needed, that it's not ok for HCP to just assume that a labouring women should just follow their lead.

My own story with DS2 reflects this. I went into hospital at 33+2 weeks because I had a blood show, they decided to keep me overnight for observation and to go for an ultrasound in the morning (this all with my consent, as a worried mum) I went into labour the next morning at 5:30am- didn't realise or confirm it and until I had contractions for an hour the doc did a ve & found I was 8-9cm dilated. Rushed up to labour ward & found bubs heartrate had dropped was asked about a scalp monitor to be put on baby said yup go for it, then it seemed like only a few moments later the big Ob comes in & tells me they are going to do an episotomy. I'm laying there baffled as to why & said no you are not. He looks at me & says yes we 'need' to, poor registrar is looking at both of us not knowing what to do. He nods at her says get the local ready & I started screaming at him that he had better not cut me. What they didn't realise but I did was that DS2 was already in the birth canal, not stuck, and moving rather quickly to crown. Poor registrar is trying to get local ready when I informed her he was coming & was ready to push him out. She then has to leap back over to the bed to catch him (there was another midwife there too, but they had been too busy following Obs orders) pushed DS2 out with one push- only 30 min after being wheeled into labour ward. He beat the neonatal cart to the room.
Found out later some hospitals have the policy to 'cut' with every prem birth.

Needless to say it is in my birth wishes this time about not wanting to be cut & my reasons why.


Also to cover the medical and legal factors- all HCP are taught in university that they are required to ask for consent unless either the patient is unable to communicate (ie semi or unconscious) or in extreme 'life or death' case where waiting would result in death. As a training HCP it really saddens and sickens me that so many are not following the code of ethics and law.

[Butterfly Dawn]

Sometimes there is no choice for person. For ds1 I had to go with the hospital team for a few reasons. Ds2 there was 1 place I could go to so again had no real choice then with dd its was the same. You just get who us on on the day. No lovely room with music and oils burning. No water option. Again multiple births happening at the same time so care Is split.
I don't dwell on being cut or my less then ideal births. -except when I have problems due to first cut. And we all know who ranks close when things aren't done as nicely as the should have so answers can be hard to get.
In a perfect world, we should always be asked anytime something us done to us

------------------------
unless someone like you cares a whole awful lot, nothing is going to get better. its not.
Dr Seuss

[HotI]

I know this thread was from a little while ago, but a few things have been playing on my mind from it.

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.

This para in particular has been going around my head. Not because it is not PC, it's that it doen't make sense. None of those things are going to increase your chances of having a healthy baby at the end, so i don't understand why you would accept for them yourself, or for any woman.

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.

This is the 2nd bit i have been thinking about, and i think the mistake is thinking that assumed consent and implied consent are the same thing. Assumed consent is where the hcp chooses to believes that consent has been or would be given, whereas implied consent can be the 'patient' implying consent without directly stating it e.g. by holding out their arm for a blood test. A 'patient' can state their consent or imply their consent but can't assume their consent- it the other person who assumes.

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 agree, why shouldn't we strive for better for all women. We should make all hcp accountable for their actions. One of the most concerning things for me when i was going through the hospital complaint process was that the hospital was not outraged that their staff were assaulting their patients. If i was told that my staff were not adhering to the principles of their profession and were assaulting clients, i would want to investigate whether this was true and wth had happened to get to that point. SImilarly, if i was one of the 'good' hcp s, i would want to help get rid of the dodgy ones, or pull them in to line so my profession is not hurt by their actions.

For me, it's not about the episiotomy, it's about the presumption that I didn't get a say in what happened to my body. I'm sure the OB thought it was all for the best. But that misses the point - it wasn't his decision to make.

Exactly.

[Arcadia]

The assumed/implied point has got me thinking...I will come back in the morning.

[Julie Doula]

If you announce, "I'm just going to snip a little pizzy" to a woman who is strapped into stirrups and lying in the stranded beetle position, vulnerable and disempowered, and then you start cutting before she even has time to draw breath let alone say anything, you can't then write in the notes, "episiotomy given with consent". It is common assault.

But this is what happened to this mother. Imagine how she felt, reading the notes later.