Curiosity Question!

So, currently considering my birth plan and VBAC intentions and a thought has popped in to my head. I am only asking this out of curiosity but was hoping some people know the answer.

If I go in to hospital and end up with a doctor who wants me to have a particular procedure done and I refuse, at what point do they wash their hands of me? I figure they would have to get me to sign something, but what happens if I don't? There are lots of variables to this question I know, such as is it a minor ar major procedure, is mine or baby's life or health at risk etc

I'd like to know the answers to all the scenarios, but to just to give a starting point here is an example which is kind of where this question has stemmed from.

My Ob is supporting my VBAC, but he went through a few conditions that are usually put in place such as labour must progress, continuous monitoring and a bung in my arm. They are fairly standard procedures for VBACs especially through the private system. I am ok (not thrilled) with the first two, but I really really don't want the bung in my arm. My Ob seems to be ok with this after a discussion, but he gave me the heads up that if he just happened to be off-duty when I go in to labour and I fall under the care of one of his colleagues then they will insist on it to the point where they will be quite rude about it.

So, if this happens and I end up with a different Ob and they do start to get rude and insistent about this procedure, I know what to expect. The way I see it is the bung is a "break glass in case of emergency" procedure, not one to have just because. So if I refuse, they can't stick it in my arm, but if they still insist and I still refuse what happens next? If I threaten to walk out of the hospital without signing any discharge papers can they stop me? Would they stop me? How would they stop me? Can I demand another Ob? I know I can demand another MW.....

See lots of questions and variables.... I am not expecting to do any of this, but am just wondering to what point can something like this escalate?

They are not going to hold you down if you say no.

Why don't you want the line in? Just curious...... If it's a comfort thing, they are actually not that bad. A small plastic tube which would just have a little cap on it and be taped to your arm/hand. The sharp bit is removed and it is a tiny plastic tube that is left, so assuming it is taped down well it shouldn't get in your way. You can do anything you want and wouldn't be restricted by it.

If you really don't want one, then that is your right. They can't make you. x

They make me feel physically sick!! I associate them I think with when I had my tonsils out and my vein collapsed so my hand swelled and puffed up to painful proportions and they wouldn't remove it because I hadn't finished the fluids!! :wall: Then when I was induced last time the same thing happened (although they did remove it when I complained because I was no longer needing it - DS had been born and I was back in my room). I know it is just a bung and they aren't putting anything in to it unless I need it, but just the thought of it makes my skin crawl and I feel sick.

Fair enough then, you don't need anything interfering with your positive state of mind. I'd just insist i didn't want it and they could put it in if it is needed. Surely they would be flexible enough to compromise?!

You could also say that you discussed it with your OB and she/he said it was ok.

Hmm a bit off thread but I was supposed to have one in in case of PPH with DD2 but I couldn't stay still enough to get it in ;) I am not sure how it works with a VBAC tho. All the best for your impending birth! xx

Just make sure your birth support partner is ready to back you up. xo

At what stage would you have a cannula? Fair enough you don't want one. Me I'd prefer it there as a just in case I needed it later. In the case of life and death or serious illness they can take up precious minutes putting one in especially if your compromised making it harder to get in (like your haemorraging or something) and you can't guarantee someone experienced in getting them in will be there all the time.

As a midwife I would respect your decision not wanting it in but to cover myself I would have to document it in the notes that the client was refusing and the reasons behind that. Of course I would let the person know I was doing this not that I didn't agree with them just to protect myself. I would imagine the Obstetrician would do the same if you said no and of course are of sound mind so can not be made to have it in. I would say most reasonable health professionals would except your decision after telling you why they would want it there and then would cover themself incase something happened and an inquest was looking into what could have been done differently to chance the outcome.

In the event you did walk out depending on the circumstance (say your in labour and didn't want one in and said you were off to have a free birth at home) then legally the department of community services would be called and a report would be made to say that the medical staff did not think you were protecting your unborn child and they believed they were at risk of serious harm (in the case of failing to provide medical care) I am going to all extremes here. No one can hold you against your will except in the event they believe your not of sound mind but if a mandatory reporter (such as nurse or Dr) thought you were putting your baby at risk they would most likely report it (and nothing would probably become of it). A report wouldn't mean you would have the police on your door step dragging you back against your will.

The hospital were I work with have policies that we have to stick to. For a VBAC our policy is that continuous monitoring, a cannula is in place and a few other stipulations. If this is not done and say something happened like your baby was distressed and an emergency c/s needed to occur and say bub had some sort of disability (again going to the extreme) then that would come back to bite us if an inquest happened into the cause. Now this is going to the extreme I know but just outlining why these policies are in place. Unfortunately most maternity hospitals are medically based and don't protect the natural phylosophy of labour and birth.

If a health professional was following policy and you refused and knew the pro's and con's and were of sound mind when you made your decision then if it all went to court over something happening to you or bub then if it was documented that would cover them against medical negligency so to speak.

Once again I am going to the extreme but just thought I would add what would happen if that happened where I worked. The chance of this happening would be very low. Much more likely to come in in labour refuse a cannula have a troublefree birth, no complications, no need for a cannula.

I know it is not the same but I had to sign a form declining medical treatment when I had a physiological 3rd stage. Maybe ask your ob if you can sign a form declining a cannula as a routine thing but consent in case of emergency? that form is then put in your file and any other ob has to follow it.

alioops that sounds like a good idea.

Emmy, surely a hospital would be protected if the woman signed something saying she didn't want a cannula during labour? It would only be problematic for the hospital if they'd forgotten?

Anyway, surely they'd be able to get one in when they realised you needed it - my last birth I had a cannula put in and they had a fair bit of trouble with it, but I'd had a fast birth at home and had lost quite a bit of blood by the time I got to hospital - nothing anyone could have done about that really, just one of those things that happened. But I imagine, after birth, if they realised 'ooh, we might just pop a cannula in', surely they'd have a bit of time up their sleeve before it got difficult?
I imagine it's just a convenience thing (which I guess I understand), but if the situation called for it I imagine someone good at cannula's could be called in? That happened a few times with me, once when they couldn't find a good vein, and another time when it tissued.

Anyway, that was rather a ramble, but I'm just thinking, surely if you're AT a hospital, it's not going to be that hard to put a cannula in after the birth if it's needed?

Or is the issue if you ask for drugs of some sort? Do you need an IV line for that?

Nelle your right the cannula is just for precautions.

Where I work most midwives do not put cannulas in (a few do, and out of them not many are experienced so put them under pressure in an emergency they are just as likely to miss as to get it in) to call a Dr they would come from home or from ED so it would be a 5min wait in an emergency at least to get the Dr to put it in (if a midwife couldn't do it) out of our 25midwives about 5 cannulate so not always is there a midwife on that will be able to even attempt. Some places have Dr's there all the time so this wouldn't be a problem but many places such as where I work do not have drs but one or two on call for emergencies.

Yes a hospital would be protected if the woman signed something to say she was happy to take responsibility for no cannula or leaving against medical advise for example.

Hi MT - there are so many variables aren't there? Its tough, and I can really relate to your thinking.

At the end of the day, if you don't consent they can't do ANYTHING to you. But at the same time you don't want to be using your precious energy in labour fighting it out with a random OB or midwife who won't listen to you. And no one really wants it to escalate to drastic measures either. Maybe you could prepare your lines IYKWIM....practice saying to yourself or your DH what you would say to an OB who was pressuring you into the bung in your arm i.e. "I am aware of the reasons why you wish for me to have a bung in my arm or [insert other intervention here!] however I am well informed of the risks associated and respectfully refuse." Or something like that. Sure they'll probably write it in your notes, but who cares.

One of the hospitals I talked to this week regarding my VBAC are happy for midwives to support me in their Birthing Centre. I simply sign a form saying I don't want a bung, or monitoring and they're happy with that.

If you are really butting heads with an OB or midwife, ask them to leave. If it gets to the point where you are being ignored or they simply won't listen, request different careproviders.

Are you planning on writing a birth plan? If so, I would make it detailed. Go into every possible scenario. And if they continue to ignore what you are saying to them in your refusal, get your DH to whip out a copy and politely point out to them that maybe they should have a read.

And as far as I knew you can discharge yourself from hospital at any point you wish. They can't restrain you last time I checked. If it is against their advice, then I'm sure they'll write that in your notes too. But if you're not comfortable in hospital then its your choice.

Good luck MT - I know that so much of this isn't really that black & white, but at the end of they day, its your body and your choice.

:hug:

I'm not planning on going to extremes, but was just wondering what happens in certain scenarios.

Thankyou Emmy, you answered my questions perfectly. What kind of hospital are you in? Major, minor, public, private, city, country etc?

And Alioops that is interesting about the notes in the file that the other Ob has to follow. That's pretty much where I am heading, but it was just that my Ob gave me the heads up on what would happen if I get another Ob - that they would be rude to me. I get the feeling he even gets exasperated with them, he's told me a few things that he doesn't like how they handle certain situations. So I guess I just wanted to know how rude I would have to be back, which of course led to all these other scenarios in my head and what I can and can't do.

I did know that I can demand another m/w - I wish I had last time!! But I know how I behave in labour now - and I get a bit submissive. My DH was going to request another m/w but I wouldn't let him.... I thought I would get over it, and I couldn't put her on to some other poor labouring woman (yes, she really was that awful. I think childbirth and labour and all the lovely details that go with it grosses her out!! All she cared about was the monitors!!) But I wasn't sure if I can demand another Ob.... and of course then they are in the 'club' so they'll just cover each others butts and treat me in the same manner.

Nelle - that was what i was thinking about getting a cannula in when needed rather than in case it is needed. I have no problem with having one if they deem it absolutely necessary, or think that I am heading in to dangerous territory and I might need one just in case. But I don't want it when all is well and there are no threats on the horizon.

Infinity - I had a detailed birth plan last time and no one read it. At all. They constantly asked me about or tried to do things that I didn't want that were explicitly in my birth plan. Of course I am mainly talking about my clueless m/w but as my Ob only popped in and out throughout the time I expect that it is the m/w who should be familiar with the plan, and ask any questions or clarify anything at admission so that I didn't constantly have to keep repeating myself. Even when she asked things or I told her she would still just start doing the opposite. :wall:

This is also probably half of my issues, that I don't want all that hassle again. I really felt that I wasn't allowed to just get on with it because I had to keep one eye on what she was doing. My DH was very supportive and was telling her stuff too, but she would listen to him even less than me.

I would just keep saying 'no thank you' and let them write in your notes that you declined bung. Simple really!
Infinity summed up what I was thinking.

I had a non medicalised twin birth (so similar to VBAC in that I was high risk). I wrote a detailed birth plan and discussed it with my obstetrician who agreed and signed it so I could show it to anyone who said I was breaking the rules. I also had a long discussion with my midwives who added lots to my birth plan and got me to sign it too (no routine cannula, no continuous monitoring, etc).

I think as long as you make it very clear you are willing to do whatever if you deviate from normal most caregivers will be ok, but having your birth plan signed by your obstetrician may help. I completely understand the cannula thing though, I hate them in too and during labour I believe you need to be comfortable and not constantly annoyed by a tube in your hand which is there "just in case".

ETA one of my birth preferences was that no doctor came anywhere near me unless there was a complication, so maybe that's why he was so happy to let me have my way as he was in another ward having a cup of tea!