Are you a childbirth conspiracy-theorist?
Every so often as I’m teaching a childbirth class and covering informed consent, I’ll have this moment where I wonder if I just sound completely insane and paranoid. This is about how it goes down:
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.
NO! You are NOT a conspiracy theorist. This is happening all over the world. It is especially bad here in the USA. Over and over again, I hear of women whose wishes are ignored.
During the birth of ALL 5 of my children I was given an episiotomy even though I said I did not want one. (Granted, this was in the 60s and 70s and women were not as aware of their rights, nor were hospitals as careful of not offending women as some few are now)
Never the less, it taught me that once I was under their “care” my wishes were secondary to the doctor’s or the hospital policy.
If I could only do it again, I would stay home to have my babies.
I missed that question, and I may not have even remembered because I had to read the others, but I didn’t give consent for my episiotomy. In fact, I had no idea they had done it until after birth..
Is it conspiracy when you tell the truth? It is so difficult to teach childbirth, work on a nursing unit or anything that involves following the orders of another. How do you tell a mother that yes, her son feels exquisite pain during circ, when the doctor tells her he feels nothing. How do you tell a mother that hospital policies are there to protect the financial security of the institution, not protect her instincts and well-being.
Telling a mother the truth, and following through with that truth takes time and patience. Induction of labor might be quick and easy for the practitioner: a few quick lies and you’re done: breaking your water will shorten your labor (by 15 minutes); Your water has meconium, we need to induce right now (but the induction will cause stress on your baby and he will probably release more meconium due to stress); Your cervix should dilate 1cm per hour, and yours just doesn’t work because you’ve been in labor for 8 hours and you’re still at 1 (but the first 5 hours were relatively easy, and you’ve only really had to stop your conversation during the past 5 contractions).
I don’t think practitioners attend births (or other interventions) with ill-will, but with the reality of having to get “their work” done in a certain period of time. If all of the check marks aren’t done on the form, someone else has to complete the list, and they get pissy about having to finish your work. The doctor is in the room for an hour, the nurse is with you for a day, but they have to work with each other for years: who are you going to try to please?
This is a hard balance, and the balance is different with each class. Your blog is neat and nails what I go through as a Lamaze educator. And when I share how a practitioner might not listen to them, I also share times when I know they have listened to the mother even when I knew the docs wanted something else.
To Heather, above, I actually say straight out in just about all of my classes about how hospitals are institutions and they have policies in place to help as wide a variety of women give birth as possible. But what might work for one, doesn’t automatically work for others. And just because a hospital has a certain policy, doesn’t mean it won’t agree to changes if the mom and baby are fine. Also, institutions change slowly, and only in response to those who pay them, birthing mothers, and moms are often the financial deciders in the family and birth is often the first major time a woman works with a hospital, so they want to keep you happy. In taking my course you know a lot more about what is best to keep labor safe and healthy and how to work with the docs and nurses. I also talk about how just about all the tech now used on all moms was previously used only on high-risk situations, and the resultant higher number of false positives. So, the parents and partners in my classes actually do get a straight out brief talk, not accusing toward the hospital, but here are the constraints that hospitals and those that they employ work under, so that the parents can better understand the field they are working in. Some here it more than others. Those who have already had a major interaction with health care workers understand more and I ask in my getting to know you bingo if anyone has done this, then I encourage them to share their experience so it’s not me talking.
later on, I might share an example of what about when their child gets older and a teacher might think the kid needs medication to help him calm down, but you think he just needs more running around? I encourage them to get used to questioning authorities in their lives, there might be people off and on who think you would be better to do something else, but you and your partner are the best people for deciding what’s best for your family. Kind of like, “Get used to being a parent!”
Thanks again for a good blog — glad a friend shared it with me.
Well done.
Keeping your students alert is a great thing.
Twenty five years ago my newborn’s nursing was sabotaged by a “caring” nursing staff who, rather than helping me work THROUGH the challenges my baby and I faced (with nursing), popped a bottle in her mouth.
Thank goodness folks likeyou are helping change the birthing stories of today’s mothers!
(my second child was homebirthed, much because of the horrendous experience I had in the hospital with the first one)
SOME doctors believe that the fact that you’ve come to a hospital to give birth under their care, it IMPLIES you are consenting to everything they wish to do.
I found your blog through facebook. I’ve had one birth, and I have mixed feelings about it. My daughter came 4 weeks early, with a very fast birth–the first sign of impending birth was my water breaking, and she was born just over 5 hours later. My husband wasn’t able to be there; he was overseas and had planned to come closer to the anticipated arrival.
I had a (mostly) unmedicated/non-interventionist hospital birth with a midwife and a doula, who had just been certified as a midwife but who still did doula work while establishing her midwifery practice. Most of the birth went as I wanted it to (though not as I’d expected to want it to–when asked if I wanted to be vertical, for example, I said “Heck no! I want to lie down!”), but things got a little dicey toward the end. First the midwife started pressuring me to push longer and harder than my body wanted–my doula later told me there was some concern about the baby being in possible distress, but they hadn’t wanted to tell me that then. Then, after my daughter was born, the midwife instructed the nurse to give me pitocin, something she and the doula both knew I didn’t want. As I started to protest, my doula–who’d given every indication that she was as adamantly anti-pitocin as I was–placed a quelling hand on my arm, surprising me enough that the nurse gave me the shot while I was frozen in shock. That never was explained. I’m choosing to give them both the benefit of the doubt and believe that there was enough bleeding to be alarming, causing a real medical need for the pitocin, but there’s still a nagging voice inside my head that wonders.
Overall I had a good birth experience (other than the absence of my husband), and I’m glad that I was in the hospital, as my daughter spent a week in the NICU, and I would have ended up in the hospital anyway, with her early arrival. But those nagging questions have made me just as happy that the midwife is no longer in private practice, so I’ll be using a different birth attendant next time, and I’m really hoping that my first-choice doula is available next time (had to go with my second last time, as the first was booked).
Not conspiracy at all. I think a lot of people forget the medical-paternal model of health care is alive and well. I think women have been convinced to believe that we do not know how to give birth and must rely heavily on doctors and that this gets taken advantage of.
For the birth of my first son I was administered several medications without my consent. When I demanded to know what they were, I was brushed off.
For the birth of my second son, which was completely natural, I attempted to refuse the external monitors. I found them uncomfortable and even painful. I was told that I was not permitted to refuse them. They even argued with me about whether or not I was in labor up until my 8th centimeter where I nearly gave birth in the triage room.
People will always, always think they know better than the pregnant woman.
I wrote about some of my experience here: http://www.declassifiedadoptee.com/2011/09/becoming-mother-adoptee-and-feminist_16.html