This is NOT informed consent.

This is not informed consent, its a chart. Based on some recent experiences I have been left feeling somewhat unhappy with the way I watch birthing and pregnant women treated.

The headline picture, that is not either informed consent or individualised care, it is a chart. Sometimes I take more care in explaining to my 3 year old why he can’t have a chocolate bar, than I see grown women being given in the important matter of their birth and the health of their baby.

They are not children, women and their partners deserve the opportunity to make informed decisions relating to themselves and their babies.

No-one wants a healthy baby more than the mother.

“Oooooooooooohhhhhh”, accompanied by pursed lips, sucking in breathing, “your baby is at significantly increased risk of x, y or z or indeed of dying, and you wouldn’t want a dead baby would you”, or “oh you wouldn’t want anything to happen would you?” “could you please provide the stats for that risk”, “no that is not my role it wouldn’t be appropriate, you need a consultant for that”.

Really?? So it is your role to tell a woman her baby might die, but it isn’t your role to help her by providing the information she needs to understand what you are saying.

And what are the statistics that say the intervention you are suggesting will actually lessen those risks?

And what are the risks of that intervention? As a doula I rarely (in fact I would say almost never), hear these risks being discussed.

How do those stats apply to you as an individual?

A Cochrane Report is not informed consent either. This links the Cochrane Report on Induction.

It is a collection and summation of other reports, it is not a report on the quality for example of continuous monitoring although the 2 are often lumped together in discussion.

These are the authors conclusions

“A policy of labour induction compared with expectant management is associated with fewer perinatal deaths and fewer caesarean sections. Some infant morbidities such as meconium aspiration syndrome were also reduced with a policy of post-term labour induction although no significant differences in the rate of NICU admission were seen.

However, the absolute risk of perinatal death is small. Women should be appropriately counselled in order to make an informed choice between scheduled induction for a post-term pregnancy or monitoring without induction (or delayed induction)”.

I personally do not see this counselling happening, I see women being given a single sentence – often along the lines of “you don’t want your baby to die”, and led down a single path. Often this is not happening post term but well in advance, in my experience.

This blogpost by my colleague Maddie MacMahon, “Coercing with Kindness” sums up how using soft language does not make something appropriate or lead to informed consent.

I have recently attended a presentation by Johanna Rhys Davies, of Birthrights, suggesting that while current medical practice is aimed at preventing negligence claims against the NHS, and I have heard that issue raised by Healthcare professionals to women, Human Rights claims for lack of individualised care and coerced consent are around the corner and potentially are a bigger concern.

I do not care how women give birth – even hanging like a bat from the ceiling. I do not ever tell birthing women what to do.

I care that she is given the information she needs, to make informed choices for herself, her body and her baby and that the plans and processes she puts in place, in advance of her birth, to achieve those choices are not declined at the last moments, when she is in the process of birthing and has arrived at the maternity unit door (which I have also seen happen).

If you have a life, birth or other story you will like to share, please contact me HERE. 

There is now case law requiring health care professionals to inform women of all the potential risks and benefits of each process in birth – is it being followed? I would say not. (Montgomery v Lanakshire Health Board). Nor would I say, in my view, the current way of working is how the amazing women centred midwives I know want to work.

Health care is understaffed, the NHS is over worked – we are seeing unprecedented cut backs – or “efficiency savings” but that does not make what is happening ok. Coerced consent is not informed consent. Not in health care, not in maternity, not in sex.

In fact if some of the language I hear around childbirth was transcribed to a sexual act, then it would be clearly seen as abuse.

This maybe a hard hitting blog post. But I am tired – tired of saying the same thing over and over again – it is your choice, there is a risk, that risk is small. ALL childbirth sadly carried risks – if we caesarean sectioned 100% of birthing women at 37 weeks, we would see other complications arise.

All of life carries risk, staying home, going out – we do not live our lives in a bubble wrapped cocoon, we make informed choices continuously.

Women know this and what they deserve, above all else – is CHOICE and information so that they can make those choices. How do these stats, these risks, these benefits, apply to their individual circumstances.

Click HERE for more information on National and Local Birth Pool and Tens hire.

The slide show below is of photos taken at the recent All Wales Student Midwifery Conference from a presentation by Kate Evans, author of Bump and the Food of Love creator of Mu-Thor and Mum-Ra (all slides are referenced in Bump).

Midwives do Maternity Care best, there is beginning to be a body of evidence that “high risk” (how I hate that term – I am beginning to wonder who is “low risk”) women do better under midwifery led care and have better outcomes and improved experiences. I have no doubt whatsoever that that is the case.

Midwife-led care also leads to an increase in natural birth.

Medical intervention saves lives, let there be no doubt about that – but informed consent is essential in all situations.

Thank you for reading my latest post – my final act before going on holiday is to get the thoughts that swirl in an amorphous mass around my head down.

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Feel free to join the South Wales Birth Circle, Home Birth Support Group UK or the South Wales Home Birth Group.

Samantha Gadsden walks with women on their life’s journeys. She is an experienced Doula, based close to Cardiff in South Wales, mother to 4 children and wife to Eddie, more information can be found on her facebook page, Samantha Gadsden Doula and her website, Caerphilly Doula.

If you are interested in writing a guest blog or sharing a life or birth story please feel free to contact her HERE.

“Your Journey, Your Body, Your Baby, Your Birth

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