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?

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.

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.

:

---

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.

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.

:

---

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!!

assumed consent is an oxymoron.



sent via my vortex manipulator!

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.

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.

Thats disgusting. Extremely unprofessional.

:

---

assumed consent is an oxymoron.



sent via my vortex manipulator!

---

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.

:

---

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*

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.

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

:

---

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)?

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.

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.

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."

You know, you posted a similar question some time ago and I said that I was cut without consent, but it was ok because i'd consented to the forceps and just figured the episiotomy was necessary.

I've changed my mind completely. I honestly feel really ashamed to have been treated this way and to have tried to convince myself that it was ok.

How on earth anyone could think it's ok to cut someone's genitalia without explicit permission (and excepting in a life & death situation where the woman is incapable of giving consent) is completely beyond me.

Ultimately women should and must assume and retain autonomy over their bodies. Ideally, they will be cared for with dignity and respect by a carer who will work with them to ensure they have the best birth possible. For most mothers, this means they will feel trust and security in the advice offered by their carer. I kidded myself that I trusted my OB - but it was a sham to protect myself. He didn't think I deserved even an explanation, let alone the opportunity to decide for myself.

MadB, I could almost have written your post word for word, except I had a vacuum assisted delivery.
I'd had an epidural, so although I felt no pain I could feel the tug of the scalpel on my skin *shudder*.
I was never asked for consent, nor even told that I'd had an episiotomy until 3 days later when I asked the nurse who was cutting my stitches how everything was healing down there, and she said the 2nd degree tearing and the cut were healing well... It's not until right now that I realise how wrongly I had been treated, and how angry I am about it, and am determined not to let it happen ever again

So yes, informed consent is a must. NEVER assume consent in any situation.

:

---

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)?

---

I'd think it would be from other both experiences I had been raised hearing. From the research I had done prior to birth I had decided I should be able to avoid being cut, and despite my ob's explanation I had written in my birth plan I wanted to avoid an episiotomy if possible. I guess it happens so often and appears common that you forget to question it.

I would say I am fairly trusting, but I also like to be educated even if that means me doing my own research. There are some things I would refuse medically completely, and if they were violated I would be angry to say the least. I believe in trying to work in with the hcp so that everyone is comfortable in the end. In the end though every patient has the right to accept and refuse medical treatments without judgement or pressure.

My mum actually tells me she wishes there was the same education of women in birth as I have afforded myself.

Wow I am absolutely outraged at how many people this has happened too. That is awful! I had in my birth plan that I did not consent to episiotomy and I also told DH if he saw anyone coming at me with the scissors to stop them!

Luckily it was never mentioned but I am so sad and outraged for all you ladies who weren't so lucky :(

Here's a question in a round about way. Ds 2i had tearing as he was face up. Dd i had tearing cause i didn't stop pushing lol. But ds1i was cut, no question, 3times even though i screamed and begged her to stop. She cut up- not down and didn't stitch anything afterwards. It changed alot of things after, one being i get uti easy now.
Anyways, my question is, why would she cut up-not down? and why couldn't it be sewen back up? it bled for ages, like weeks.
She was busy, hospital team and 3of us were giving birth at the same time, met 1of the others in a class run at a birth centre. But still, there was no ripping other then the cuts up she did.

Sorry if it doesn't make sense, the barefoot princess is covering me with kisses

I think I must be an exception to the rule. I had an epi. I didn't realise at the time. I didn't feel it. DD was coming out very fast (I saw on my hospital notes recently when seeing my ob for #2 that it took just 13 mins). I knew I had stitches afterwards, I thought it was because I tore. It wasn't until I saw my hospital notes back in my room that I saw 'epi' written and realised what had happened. It healed very well.

I say that I'm an exception to the rule as I honestly don't mind it was done. I think if I knew they were doing it I would have been more nervous. TBH, my main wish for the whole birthing experience was to have DD in my arms safely and that happened. TBH, if I had the exact same birth with this bubs I wouldn't care, I just want my baby.

:

---

I think I must be an exception to the rule. I had an epi. I didn't realise at the time. I didn't feel it. DD was coming out very fast (I saw on my hospital notes recently when seeing my ob for #2 that it took just 13 mins). I knew I had stitches afterwards, I thought it was because I tore. It wasn't until I saw my hospital notes back in my room that I saw 'epi' written and realised what had happened. It healed very well.

I say that I'm an exception to the rule as I honestly don't mind it was done. I think if I knew they were doing it I would have been more nervous. TBH, my main wish for the whole birthing experience was to have DD in my arms safely and that happened. TBH, if I had the exact same birth with this bubs I wouldn't care, I just want my baby.

---

This is what I have been trying to say, always thought it was a necessary evil. I just have a massive fear of being cut....and needles lol. Although new research says tearing is actually better (which also had me freaked out), either way that area may get mutilated!

:

---

This is what I have been trying to say, always thought it was a necessary evil. I just have a massive fear of being cut....and needles lol. Although new research says tearing is actually better (which also had me freaked out), either way that area may get mutilated!

---

I had a massive fear too, which is actually part of the reason I'm glad I wasn't told. I didn't need to worry about it about to happen.

Wouldn't you have rathered you'd not been cut at all though?

:

---

Wouldn't you have rathered you'd not been cut at all though?

---

Yes, if I wasn't going to tear then I do wish that, but if I was going to tear (and I guess i trust my ob in that they wouldn't have cut me unless I was going to) who is to say it wouldn't have been worse than the cut? Yes, it could have been less and I guess we will never know either way. Either way, I guess I'm happy with how my body has healed and feel that I had a pretty positive birth experience over all. I guess I've got a pretty simple way of looking at it.

His thread has mad me so angry. And horrified for all women. And disgusted. Did I mentioned that.

:

---

His thread has mad me so angry. And horrified for all women. And disgusted. Did I mentioned that.

---

Why are you horrified an disgusted?

:

---

Why are you horrified an disgusted?

---

I would say because women are being treated like slabs of meat, having their genitals cut without any warning or even being asked.
Tearing is almost ALWAYS less painful, quicker to heal, carries less risks, less infections etc so I know I would be livid if I was cut instead of being 'allowed' to tear naturally.
I have birthed 9lb babies with only a graze and a 7lb baby with a small tear so its impossible for an ob to predict you will tear and how badly imo.

Because women are having their genitals cut (often without true medical need, just in the name of routine) without their permission, and the only reason it's not seen as assault is because the person doing it went to university for a few years more than most people.

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 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.

---

Same here. And I agree with Chody too, I dont mind that I was cut. I went public, but I still trusted that the ob who was there with me had my sons best interests at the top of his priority list. When I saw him grab the scissors and asked what they were for and he told me, I was fine with it. Maybe I feel so 'meh' about it because I had zero healing issues with it and it wasnt painful. Idk. I definitely was not treated like a slab of meat, or feel like I was assaulted or anything like that.

Even though I have seen and heard this for years Rouge its fired me up about it too. Ive actually been at a breech birth where episiotomy was discussed before the birth, she said she didnt want it. At the birth (that was going beautifully) he announced he was going to do an episiotomy, so she turned to her husband and said something, cant remember but either a 'what do you think/I dont want this' and the Ob defiantly said back that he was telling her she's having one. I was so angry.

The thing is too, episiotomy also cuts through layer of muscle and as an expert once pointed out to me, Obs are specialists in obstetrics, not muscles. They do a quick stitch up job often without consideration to the muscles. So you hear of women who have bad recovery jobs. And Obs allowed to practice saying things like this to the husband: 'Would you like me to put in a couple of extra stitches for you?' (make her tighter. Grrrr so angry right now.

You only have to speak to independent midwives - many have done NO episiotomies or some remember one or two they had to do in their career. Rates in hospitals are way too high, private much worse and interventions facilitate many of these happening in the first place. Sure you can trust your Ob but sometimes you dont know what to ask because you have no idea what you're going to come up against.

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.

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.

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.

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.