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Thread: How do you feel about 'assumed consent'?

  1. #1

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    Question How do you feel about 'assumed consent'?

    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?

  2. #2

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    Do you think women should have to give informed consent for an episiotomy?
    Of course. Its a medical procedure that carries risks.

    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.

    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?
    Absolutley not!

    Do you think it is ok for a woman to refuse a procedure? When/Why? When is it not ok?
    Yes. Its her body. Each procedure carries risks and its up to her to evaluate the risk vs benefit and give or refuse consent.

  3. #3

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    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 an ideal situation I think they should explain what is involved for vac and forceps, including an episiotomy. I also think that a woman should inform herself on anything that MIGHT happen during her birth, so that she knows what's going to happen anyway and can give/refuse consent even if it hasn't been requested.

    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?
    Big no.

    Do you think it is ok for a woman to refuse a procedure? When/Why? When is it not ok?
    Yes, whenever, for whatever reason. I believe she should also state WHY she is refusing, just as she would expect the HCP to explain WHY they want to do something. Nobody is a mind reader, there needs to be conversation.

  4. #4

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    Quote Originally Posted by Keike View Post
    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 an ideal situation I think they should explain what is involved for vac and forceps, including an episiotomy. I also think that a woman should inform herself on anything that MIGHT happen during her birth, so that she knows what's going to happen anyway and can give/refuse consent even if it hasn't been requested.

    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?
    Big no.

    Do you think it is ok for a woman to refuse a procedure? When/Why? When is it not ok?
    Yes, whenever, for whatever reason. I believe she should also state WHY she is refusing, just as she would expect the HCP to explain WHY they want to do something. Nobody is a mind reader, there needs to be conversation.
    Keike has pretty much summed it up for me.

    Even if it is written in a birth plan that they do not consent or consent I think verbally they should still clarify/ask if that is still what the woman wants.

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    I haven't read the other replies but here is my humble opinion:

    Do you think women should have to give informed consent for an episiotomy? Yes for sure. It's a surgical procedure in my opinion and no different to any other surgery.

    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 it's not ok. Consent for one procedure does not carry over into another. Vacc and forceps are not surgical and they are different procedures with different risks.

    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? No it's never ok to assume consent, regardless of the circumstances. Having said that, I think that labouring women in hospitals are assumed to agree to a wide range of HCP decisions all the time.

    Do you think it is ok for a woman to refuse a procedure? When/Why? When is it not ok? It is always ok to refuse. As long as she's conscious and has the cognitive capacity to make her own decisions (by that I mean that she was not intellectually disabled etc prior to becoming pregnant). If there were a situation where the woman had become unconscious and could no longer participate in the decision making process AND her HCP believed strongly that to not perform an episiotomy (or any other procedure) would put her life or the baby's life in real danger then I think they can go ahead without consent, but they should still be getting consent of the birth support person if one is present. Other than that, I think it's up to the woman. She needs all the issues and risks/benefits explained calmly and without emotive language. Most (if not all) labouring women want what is best for their baby but it comes down to trusting the HCP that there is no other workable solution and the risks of not conducting the episiotomy outweigh the risks of doing it. Sometimes I think when HCP's take the time to fully discuss all the issues and gain true informed consent, (rather than just telling the woman what they need to do as I experienced), then it can open up discussion and other ideas can be considered. Even if the outcome remains the same, the fact of having gained true informed consent is MASSIVE imo.

  6. #6

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    Quote Originally Posted by HotI View Post
    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?
    Hmm this is interesting for me. As one of the ladies who didn't know about the required consent, I can say its a new thought for me.

    I would say I am a generally well educated female, and when it came to my birth I felt I was in control. That being said my first ob had a "no episiotomy" policy, which I had checked ( like I mentioned on the other thread, MASSIVE fear of being cut, more so than the birth lol). Ob #2 is an older "school" ob and he will cut if he thinks it necessary. This scared me but I figured I would cross that bridge later so to speak.

    Reflecting on it, I think it is such a commonly accepted practice that I hadn't thought to be able to say no. For me when I "employ" an ob I am in effect saying I trust you to make the right decisions and give the right advice when the time comes.
    I agree that as a woman I know my body best, but my body in child birth? I've never birthed before and whilst I did the process myself with dd, I know if something went wrong that I had my trust in someone who had seen and helped hundreds of times.

    I might add I do like the fact I could say no next time power to me against cutting lol!!

  7. #7

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    assumed consent is an oxymoron.



    sent via my vortex manipulator!

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    Great thread, I have just added this to the transfer section of my birth preferences about asking for my consent on all procedures and not assuming any consent.
    Kelly xx

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    Had at written on my patient card "Do not assume consent and all procedures must be explained". Pretty sad it had to get to that point.

    With my first birth, I refused an episiotomy and the ob then refused to treat me (basically had a tantie screaming "all her ventouse patients have it done" and threw her gloves on the ground). She was not for informed consent, but for forced consent.

  10. #10

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    Thats disgusting. Extremely unprofessional.
    Kelly xx

    Creator of BellyBelly.com.au, doula, writer and mother of three amazing children
    Author of Want To Be A Doula? Everything You Need To Know
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  11. #11

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    Quote Originally Posted by ~TT40~ View Post
    assumed consent is an oxymoron.



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    So true. In no other field would consent be assumed for a medical procedure. If a patient is unable to give consent someone must do so on their behalf. We don't even take organs from the dead without consent in this country.

  12. #12

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    Quote Originally Posted by Astrid View Post
    Had at written on my patient card "Do not assume consent and all procedures must be explained". Pretty sad it had to get to that point.

    With my first birth, I refused an episiotomy and the ob then refused to treat me (basically had a tantie screaming "all her ventouse patients have it done" and threw her gloves on the ground). She was not for informed consent, but for forced consent.
    WTH? A professional having a tantie like a 2 yo child who can't have a choccie freddo - *shaking head*

  13. #13

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    When taught about assumed consent at uni we are told it is along the lines of

    "Mrs Smith, may I take your blood pressure"
    Mrs Smith says nothing but rolls up her sleeve and presents her arm.

    It is not about introducing interventions or procedures without discussing them, it is about not necessarily waiting for the word yes, but instead waiting for body language which indicates the procedure may go ahead. Therefore in the throes of labour this is not appropriate, as if a woman has consented to a vaginal examination her body language already suggests she is ok for an episiotomy, for example, but we know in fact that is not the case and being a separate intervention, a separate consent is required.

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    I am a HCP and therefore would like to think I have some idea when it comes to consent etc. I was one of those women in the other thread that said I had an episiotomy with forceps delivery and was not directly asked if I consented to being cut. I did not know I had had an episiotomy until after the epidural wore off and I was in a huge amount of pain that one of the midwives .

    After labouring for 30 hrs I was exhausted and I just wanted my baby out. I was under midwife care throughout my pregnancy & labour until I was told I was 'failure to progress' in which case an OB was called in, I was told to shuffle down the bed, and 10minutes later my baby was born. She didn't even acknowledge me or tell me her name when she walked in. She just explained how she would work the forceps. No mention of episiotomy nada

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    Quote Originally Posted by little_O View Post
    Hmm this is interesting for me. As one of the ladies who didn't know about the required consent, I can say its a new thought for me.

    Reflecting on it, I think it is such a commonly accepted practice that I hadn't thought to be able to say no. For me when I "employ" an ob I am in effect saying I trust you to make the right decisions and give the right advice when the time comes.
    I agree that as a woman I know my body best, but my body in child birth? I've never birthed before and whilst I did the process myself with dd, I know if something went wrong that I had my trust in someone who had seen and helped hundreds of times.

    I might add I do like the fact I could say no next time power to me against cutting lol!!
    Thanks for sharing. Do you know why you feel this way? i know the messages i got from my mum were labour is scary, you don't have much say and that is the way it is ('leave your dignity at the door' kind of comments). I thought her view sucked and so i looked into it further, but i think some of her fears still rubbed off. DS' birth changed this for me, and for my Mum.

    Do you feel similarly about other professionals (health or otherwise)?

  16. #16

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    SeppyM - at my first birth, i was similarly cut without any discussion or consent being sought. the first i knew was when i felt the cut. I was immediately, and subsequently, outraged at the hcp thinking they could do this to me without any explanation or question. i guess this is why i asked the question because a few people seemed to be ok with it, but i really wasn't.

    ETA- I was probably even more pee-ed off because my birth plan stated, and i had stated multiple times to multiple people during my labour, that i did not consent to being cut. Probably why they didn't ask me, cos they were going to do it no matter what i said.

  17. #17

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    I do consider pregnancy and birth is to a huge extent a "leave your dignity at the door" experience. I don't enjoy getting my knickers off for anybody other than my DH, but I don't really see how that can be avoided, whatever extent of consent you give. I feel the same way about pap smears. The fact is though that at some point somebody needs to get in there so to speak and some conception journeys require a whole lot more "getting in there" than others.

    I do, however, think that nothing should be done without my consent. The only exception I would consider would be if I was not able to make decision as a result of my level of consciousness. In all honesty, I would rather the decision be made by my professional, skilled OB who I have trusted with my care than with my DH. As much as I love him, if he was faced with the situation where my life or that of our baby was perhaps in danger he would I think lose the ability to make an informed decision anyway and would faff around until he ended up going with the HCP's recommendation anyway.

    For me it comes back to the level of trust you have in your choice of HCP, and I had faith in my OB that he would do everything in his power to honour my wishes unless my health or my baby's health required otherwise.

  18. #18

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    I said no to an episiotomy. I said it was not to be done. I explained I knew the risks of tearing and what was being done to me and also the risks of tears with subsequent children. No, I didn't want it done. My (lost by the hospital) birth intentions said it was not to be done.

    My cowed and on-their-side husband OKed it so I was cut. They had permission. Not by me, who was distracted by a midwife while they obtained permission from someone who will not be present at the next birth (this being just one example of him siding with them not me - he even pushed the drugs when they weren't around too!).

    Personally, I think if a woman says no that should be enough. If she is intelligent enough to discuss and reason about it, there's no way the hospital can claim she's incapacitated enough to get permission from someone else (even if she's not that educated about birth and is still saying no, they should go with that, as she's capable of saying no based on the information she has, which is not usually given by "care" providers). I didn't employ an Ob, or rather I just had to go with what I was given (although I pay my health insurance, the system is not very good). So next time I am employing no-one because I trust no-one.

    My forced episiotomy is just one example of why I now need to freebirth. WRT other professions - if a hairdresser cut my hair when I went in for a wash and set and DO NOT CUT, then I'd be well within my rights to complain. And hair is something that doesn't hurt or scar when it is cut, unlike a perenium. So why is it OK to carve up my body without my consent but not cut my hair? No-one should even touch me without my consent (according to the letter of the law), which again birth "care" people don't seem to bother about. Going into a hairdressers may be "assumed consent" for my hair to be cut, fair enough, but when I went in then said "no cutting" my hair should not be cut.

    So standing around peering at a vagina (or abusing a vagina) with a baby coming out with a woman saying "no episiotomy" doesn't mean "go elsewhere for consent" or "just do it anyway as it's implied consent."

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