Me: “Technically, unless it’s a dire emergency, before performing any procedure, no matter how big or how small, your provider is supposed to obtain informed consent.”
Students: “Okay, good. So they can’t do anything before we give them permission?”
Me: “Not exactly. They’re not supposed to. Most providers wouldn’t. But a small percentage do perform interventions against their patients’ wishes. So you have to choose carefully when picking a provider, and be aware of what is happening at all times.”
Students: [shocked] “Wait, so even if they know you have refused, some will still do something against your wishes?!?!”
Me: “Yes. MOST won’t. MOS’T are honest, upright people. But some do, usually because they are convinced they are doing it for your own good.”
Students: “Give us an example.”
Me: “Okay. I have had more than one student talk to me about their birth, and even though it was discussed beforehand that they didn’t want AROM, the doctor broke their water during a vaginal exam and only told them as he/she was doing it. It was all done by the time they had a chance to protest, and there’s no un-breaking it.”
By this point their eyes are huge and a shocked hush has fallen over the class. I’m not sure if it’s due to this new information that a small minority of providers don’t bother to ask permission or respect their clients’ previously expressed wishes before performing an intervention, or because they are wondering what kind of a paranoid nutball they have signed up to take classes from.
I can tell you from the universal gratitude I get at the end of class and after the births that it is the former… but I can’t help but have that twinge of self-doubt sometimes. Am I a childbirth conspiracy-theorist?
I have decided this week that I am not.
Last week, one of my students told me, quite upset, that her midwife had stripped her membranes not only without her consent, but (get this!) after her telling the midwife “no!” What I gathered was an attitude of “Calm down, it won’t hurt that bad…” and then proceeding to do it anyway.
This prompted me to ask on my Facebook page:
“Have you had a care provider do something without your consent, or even after you expressly declined? What did they do? How did you react?”
I was horrified by some of the responses. Please keep in mind that this was from only SIX different people responding. SIX!
- One mom was told that she was being given saline, when in fact it was Pitocin.
- Several had their membranes stripped without their consent.
- One had an internal fetal monitor (scalp electrode) inserted without bothering to ask for consent. This was when the baby’s heart-rate had been fine the entire time on the external monitor.
- A few episiotomies without consent.
- A couple AROMs without consent.
This is just from the the six on that Facebook post! I can tell you that I’ve verbally heard of many more stripped membranes, AROMs and coerced inductions from my students. And keep in mind that my students are EXTREMELY well prepared! They have far lower intervention rates in every category because they are prepared to ask questions, and decline interventions if there is not a medical benefit. So you can imagine how much worse it would be for a first-time mom who has taken only a hospital “here are our policies” class.
So no, I am not a birth conspiracy-theorist… because even though I believe MOST providers would not directly defy their client’s refusal of a procedure, I know that some will. And you really never know for certain which category your provider truly falls under until game day. So you need to be knowledgeable, aware, and confident enough to ask a hell of a lot of questions.