Good point N2L. Increasing rates of assisted conception are going to have that effect and hopefully doctors dont take advantage.
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Good point N2L. Increasing rates of assisted conception are going to have that effect and hopefully doctors dont take advantage.
I totally agree with you. Everything I have said here is based on my experience and feelings and mine alone. I didn't mind, but I totally agree that many (if not most) others would mind. I guess me and my ob are just lucky that I was one of the 'not mind' people.:
i havent read others replies but heres my opinion, mainly from my experience.
Do you think women should have to give informed consent for an episiotomy?yes
Do you think that it is ok for HCPs to assume consent (for an episiotomy) if consent has been given for vacc or forceps?no, in no shape or form
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? absoloutely not
Do you think it is ok for a woman to refuse a procedure? When/Why? When is it not ok?yes it is ok to refuse, when it is rountine, just waiting for the perineum to stretch etc etc. its not ok to refuse when it is a matter of getting your baby out alive or when there is going to serious tearing in the wrong place, then consent should still be obtained, if refused, explained why it was really essential to have it occur. most women in that position would not refuse one. if they did i dont know what action should be taken, it would be a hard place for the Drs and middies to be in.
from my experience it is absolutely not ok to assume consent in any situation. for me it was unnecessary (DS tho playing funny buggers, had ridiculasly good apgars and there was plenty of oportunity to explain what and why things were happening) and led to lots of tears and stress post natally, and continues to cause issues now, over 2 years later.
Episiotomies place control in the hands of the care provider it is a 'known' risk and often speeds up the birth. It is gain gain for the obstetrician. For the woman it can lead to delayed healing and trauma. Evidence points to tearing being overall the better way to go. Of course there are extremes of each which overturn this idea, but on the whole tearing seems to be less complicated than episiotomies.
As someone else stated, you can't take organs from a dead body without consent, but you can cut a woman's vagina without informed consent. Pretty disgusting!
I don't think anyone here would refuse any interventions that would result in the life of their baby being saved. Isn't that just a given? Most episiotomies are not given because a baby is about to die, just as many extractions are not performed for that reason. Unfortunately the two are often mutually exclusive. I would be devastated if somebody cut through my perineum without my permission. The rate at which they're done, it's pretty clear they are not all necessary, otherwise our bodies must be faulty beyond belief. I also don't think the situation (birth) is generally that dire as to fall straight into the whole life or death scenario. A large proportion of women are given episiotomies because it's easier for the person delivering, or quicker. Falling back onto the whole 'whatever has to happen to save me or my baby' just perpetuates the feeling that birth is unobtainable without medical intervention. While it is needed, it should never be routine.
I think n2l is referring to the news article on the other thread where the ob has suggested (right or wrong) that he was denied permission and has attributed it, amongst other factors, to the death of the poor baby.:
When I brought up about episiotomies with my ob #2 he said he only ever cuts if he can see damage is going to happen from tearing in a bad direction or way. When I was in labour it certainly wasn't necessary and it never happened. That being said (for me personally) if the ob had to make the call to cut me while I was pushing, and asked me, I would have panicked knowing. Not knowing would have been the more positive experience for me.
I think a pp comment about the relationship you have with your ob is true. To me some random ob coming in and asking to cut me would have envoked outrage, whereas a person I trust and know advising why is a different matter.
I do believe though a woman can say no, and routine episiotomies are ridiculous.
I didn't think it was clear whether not having an episiotomy resulted in the death of that baby, just as it wasn't clear whether the equipment failure contributed either.
One thing I forgot. It's fine if some women don't care what happens to their bodies in the course of childbirth. Just as it's a woman's right to demand bodily autonomy, so it is to put that autonomy in someone else's hands. I don't debate that. BUT there is one large problem with some women not complaining or minding about assumed consent, that being the fact that because doctors are used to consent being forthcoming, or assumed, by their patients, it becomes routine to assume that the patient will comply with their wishes. So women that do demand autonomy are the minority, and because the feeling of trusting implicitly your OB seems to be the overriding attitude, women who feel they should have the right to informed consent at all times (and the right to refuse treatment) have their feelings on the matter belittled and dismissed by the HCP (and sometimes, other women) To me, when the dead mother/baby card is drawn, it blows an otherwise (generally) non life threatening situation out of proportion, and it insinuates that women who demand more for their births and bodies are selfishly putting themselves for an ideal, not demanding a basic right. This is my beef with assumed consent.
I agree with you pz, I am certainly not suggesting the ob in the article is right, just what was suggested.:
I also agree that everyone deserves the treatment they desire, with no pressure or judgement. Tbh, as I mentioned before I had never even considered that I would get asked in birth as it is portrayed as a common thing.
I think it's disgusting when anyone's rights aren't respected in any medical situation (not saying birth is medical, just being in a hospital tends to make it fall in that category)
I guess we all have our own fights to fight. What is a priority to me may not be a priority to the person next to me, and vice versa. Ultimately though, I think it comes down to is educating yourself, working out what your priorities are and working out how to make sure those priorities are respected. That may mean freebirthing, homebirthing, birthing within the private system with an OB you know and trust or birthing within the public system at a hospital of your choice using the model of care you prefer.
Everyone wants to be respected. Everyone wants the best care they can get. Everyone wants a healthy baby at the end. Just some are not too worried about how that is. For instance, PZ says she would be devastated if someone cut her perineum. I simply dont feel the same way. I've been in an emergency situation wherein my child and I almost died. I am thankful I had developing world obstetric care at hand to save us. If I ever find myself in that situation again, I would be thankful if the OB cut me from ear to ear if s/he had to. To me, there are worse things in the world than an episiotomy. Just look at the rate of fistula in the developing world (not to mention infant/maternal death rates).
Obviously though, birth activism is not my thing. If people feel the need to fight for this particular practice to be stopped, more power to them. I have other issues in my sights :)
No one is saying it needs to be stopped just ask permission before doing it.
Yep I agree.:
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.
I would be devastated to have my perineum cut without my consent, to assume that I couldn't make that decision for myself, yes. If I or my baby were about to die and that was the split second deciding factor, I wouldn't care. I think the about-to-die scenario is a minority and vastly different from a HCP simply choosing to forgo consent. Nobody is talking about banning it, and I find it's attitudes like this and calling it birth activism that is exactly what I was meaning when I said that attitude invalidates people's rights. Informed consent is a right, it's not activism. Not every birthing situation is life or death, I think it's a bit redundant to base an attitude on assumed consent on a life or death basis, seeing as that's not really how the majority of birthing scenarios play out. Yes, I'd be devastated to be physically mutilated without a thought I whether that's what I wanted or not. Birth and dying are not mutually exclusive, I don't see every epi as saving a life. I'd be more devastated to lose my baby. Who wouldn't? That's not what we're talking about though. I feel blessed to live in a country where, if need be, I have highly trained professionals to care for myself and my baby if need be. Many die because they don't have access to obstetric care. Unfortunately, many are also damaged or die because they are exposed to this type of care without cause. Which is why these professionals should be asking all the not-about-to-die women whether they can cut through them first or not.
ETA As for bigger problems, the USA has the one of the highest rate of maternal/child death in the developed world...they also have some of the highest rates of *unnecessary* (read, not talking life or death) intervention. I don't feel this is at all a coincidence.
ETA 2: (Life or death once again aside) During sex, if a man assumes consent, it's rape. I've not ever experienced birth trauma and hope I never have to, but I can see how the term birth rape was coined.
Maybe the moral of the story is don't choose a HCP that you cannot trust to respect your wishes? :dunno:
I think it's exactly that.:
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.:
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.
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.:
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.
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.:
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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.)
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 :lol:
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.
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.
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.:
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.:
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.
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
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.:
You may not like them, but you have consented. You haven't given away your autonomy.:
These are decisions you have made, no one has forced you or done things to you without your permission.:
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.
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.:
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.
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.
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.:
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.
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.
I was wondering the same. Thought I missed something.:
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.
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.:
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.
I hope it goes well Rouge.
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I think you've summed it up very well :)