How do you feel about 'assumed consent'?

[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.