How do you feel about 'assumed consent'?

[~TT40~]

in some cases an episiotomy is needed. But in those cases there is still time to explain what and why to the woman and get consent.

[nothing2lose]

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.

I have also had considerable gynaecological issues which I have needed treatment for along the way.

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.

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.

[bellany]

If some of you would always consent to an epi thats fine, the ob would just need to ask. The issue is there are ppl, me included, that would NOT consent so they can't just assume that cos most ppl would consent that they don't have to ask.

[BellyBelly]

Exactly, there is no excuse for no consent.

Still makes me mad that so many are done as a result of some other intervention, usually stemming from an induction/augmentation which probably resulted in pain relief and or a baby in distress, likely an epidural so mum cant feel pushing. Of course, not in all cases. Just see it and hear it alot.

Get a doula for bare starters I reckon. If doula care reduces c/s by 50% alone then something is seriously wrong with how women are cared for in hospitals.

[BellyBelly]

Good point N2L. Increasing rates of assisted conception are going to have that effect and hopefully doctors dont take advantage.

[chody47]

If some of you would always consent to an epi thats fine, the ob would just need to ask. The issue is there are ppl, me included, that would NOT consent so they can't just assume that cos most ppl would consent that they don't have to ask.

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.

[AngelPants]

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.

[Arcadia]

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!

[PumpkinZulu]

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.

[little_O]

I think there is a difference between having a relationhip with an OB (through the private system) that you have chosen and you trust to do the right thing when it is game time, versus having your child delivered by someone you have never met before within the public system.

I would also prefer to be cut, with or without my informed consent, if it meant having a healthy child born alive at the end.
I imagine most HCP would see that as their end goal and would assume, rightly or wrongly, that most women would too.

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.

[PumpkinZulu]

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.

[little_O]

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)

[nothing2lose]

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

[bellany]

No one is saying it needs to be stopped just ask permission before doing it.

[Maruschke]

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

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.

[PumpkinZulu]

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.

[nothing2lose]

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

[PumpkinZulu]

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

I think it's exactly that.