I Do Not Consent: A Sequel

I wrote a post almost a year ago now entitled “I Do Not Consent,” and I noticed it was getting a lot of traffic (for my blog, anyway!) the past few days. As I reread the post, I felt as though it needed to address some additional issues in order to give a complete picture of my views. Some comments I received also confirmed this need.  I feel that further exploration of the topic of non-consent is an important pursuit.

If you haven’t read the original post, you can go ahead and read it here first so that we’re on the same page before continuing. Okay, here we go…

1) Non-consent is a serious decision.

I did say this in my original blog, However, it appeared as though some readers missed it, so I quote: “I will say… that this phrase should probably not be taken lightly. Weigh your caregiver’s experience against your own intuition. Is your baby still ok? Are you still ok?  Find out whether the caregiver is recommending a procedure out of medical necessity, or because of convenience or a hospital policy.”

I am not– I repeat- I am not recommending anyone deny a procedure that is truly medically necessary for themselves or their baby. This is utter foolishness. I am also not recommending that you go into the hospital (or at your home) throwing this phrase around at the drop of a hat. This probably will not be helpful to your cause. This leads me to my next point…

2) Communication is key!

I am not much for fighting during a birth. I am not suggesting that you argue with your care provider. Keep an open line of communication with your doctor or midwife before and during the birth. Ask for things politely. Discuss your preferences first. If you come to a disagreement, then you can can implement my suggestion from my previous post:

“You can always say, ‘Wait. I do not consent yet.’ Go on to ask these four questions:

1) Is this an emergency? (If no, move on.)

2) What are the benefits of this procedure?

3) What are the risks of this procedure?

4) What happens if we do nothing?”

If you disagree with a procedure, talk through your options with the doctor or midwife (provided that #1 is answered with a no). Goodness, you could even compromise if you’re both comfortable with it! Even non-consent to an unnecessary procedure, however, doesn’t have to be rude.

3) Consider your relationship with your care provider early on.

Please do not go into a birthing situation planning on being “up-in-arms” about everything. If you think all OBs are surgical monsters who don’t know how to let a woman labor, then why did you sign up for their care? If you think your home birth midwife is full of fluff and incompetent, why are you paying her to attend your birth?

In most cases (with some well-acknowledged exceptions), you chose your care provider. Don’t plan on not trusting them from the start. If every appointment you are thinking how much your midwife makes you mad or uncomfortable, then you should switch providers.

As one reader commented, “You should never discount your providers education, training and experience. There are times during birth when a caregiver must make life and death decisions and may not have time to offer a 30 min. consult on the pro’s/con’s of their decisions. I am not saying that there will be an emergency in every situation, however, If you do not trust your provider and their judgement to do what is best for you and your baby, you should find a different one! Yes, be well informed. Ask lots of questions PRIOR to the birthing room when there is time to go over all the nuts and buts of why things are done a certain way – but waiting to be informed until you are in the middle of your birth is…well, negligent on your part.”

Ideally, you should choose a  provider who respects your preferences as much as is possible, AND whose  expertise and training you can respect in situations that you are unsure of. However, less-than ideal situations sometimes can come up in the company of an on-call doctor, or a nurse, or with the midwife’s assistant (or what have you!), no matter how well-prepared you are.  In this case, non-consent should still be considered a reasonable option.

4) Don’t leave the hospital in the middle of a c-section.

Yes, I know I’m being silly. When I wrote in my original post that it’s never too late to switch care providers or birth sites, I guess there was an actual limit to that. Pushing and surgery are probably cutting it pretty close. However, I have heard of many women who have requested new providers, left their home birth, or traveled to a different hospital in order to find the respect, courteousness, and medical sensibility they lacked in the first place.

4) Women need to have the option of non-consent.

Women still need to have the option of non-consent. Why?

  • Because sometimes there really are flat-out medically unnecessary procedures being performed out of habit, preference, liability, or policy. I’m not saying it’s happening all the time or that this is the primary motivation for most care providers. I’m just saying it happens sometimes, and it shouldn’t.
  • Because even for the most well-prepared mom, unpleasant surprises can arise during labor. Sometimes its from an on-call staff member that she just didn’t have time to talk to before the birth.
  • Because sometimes there are situations that are just plain assault. Like the mother whose doctor cut an episiotomy “just to teach her a lesson.” Or the two doctors who ripped a mothers perineum with their hands when she asked them not to cut her. Or the midwife who emotionally abuses her patient by scolding her for not handling pain. No woman should have to feel that she should sit through something like this for the sake of being a “good patient.” If we don’t allow women the right to stand up for themselves at this point, then when will we?

I felt that expansion and clarification of “I Do Not Consent” was necessary, especially if you are not a regular reader who understands my broader views on birth and providers. I hope that my list of “qualifiers” wasn’t too long, and I hope that it was clear. Please feel free to ask questions/give input in the comment section. I’ll summarize with a reply I wrote to a commenter on my original post. Thanks for reading, as always. 🙂

“Birth should ideally be a partnership between birthing mother and caregiver. Only when the mother is being coerced or attacked for non-medical reasons should refusal be resorted to. I am sorry this didn’t come across more clearly in [my original] article… I don’t want to encourage recklessness. But I do firmly stand behind the protection of a woman’s intelligence and dignity during birth, and that means that she has to still have her rights in the birthing room.”

*Not to be taken as medical advice.

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10 responses to this post.

  1. […] I Do Not Consent: A Sequel […]

    Reply

  2. I really appreciate your perspective, and that you took the time to write both articles. I understood your points from the first one, but the second was still good to read. I am 39 weeks pregnant with my first today, and had a huge scare with this yesterday when I went into the hospital thinking my water broke. I see the one CNM midwife at this hospital, and really like and trust her, but she was not on call and was also ill when I went in, and so I was stuck with the on call doctor, a woman I had seen once three weeks ago for a prenatal (hospital policy that their midwifery patients must see a regular OB once prior to birth), and she practically assaulted me during the cervical exam, leaving me in pain, bleeding, and terrified. I am a survivor of nine years of childhood sexual abuse and rape, and it says right in my chart that this is so, and that I am not to be touched without permission and am to be informed at all times of what is going on “down there” during exams, to avoid panic attacks. She told me to lay down on the table (at the exam a few weeks back) and then dove head first into my girly bits while my butt was still in the air! It was startling, excruciating, and violating, and when I cried out in shock and pain and fear, she scowled at me and told me to hold still. I was a wreck the rest of that day. So when my husband and I went into the hospital yesterday thinking my water had broken and with powerful contractions only minutes apart, only to find out that SHE was the on call doctor, we were both quite upset. We DID find out that our midwife had put a note in my chart telling the L&D nurses to call her if I came in, even if she wasn’t on call, but that she was out sick and couldn’t risk coming in since i recently had a massive respritory infection and can’t risk getting ill again. It was very good to know how much she cares about me, but of course at the time we were facing a crazy toolbox of an OB and were quite upset with no options. It got worse, too. The OB wasn’t at the hospital when the nurses called her (there was some question about whether my water had actually broken, and a test needed done that only the OB was allowed to do), and she told them that I had to remain on the fetal heart monitor until she arrived. Well, she didn’t arrive for an HOUR AND A HALF after the call. I was in agony!! Contractions every 2 minutes, strapped to the monitor, flat on my back (slightly elevated, but it didn’t matter). The nurses were extremely sympathetic and kept calling the OB, but she wouldn’t be rushed (wasn’t even doing anything, just not at the hospital), and wouldn’t let them take me off the monitor. When she finally arrived, I was so furious my husband was holding my hand and kinda pressing my shoulder into the bed at the same time (he told me later he was afraid I was going to kick her in the head, and he wasn’t far wrong – I was less than rational by this point). She came meandering in, puttered around the room, ignored my greeting (I was trying REALLY HARD to be nice), and didn’t even look at me or my husband once. She said something I didn’t quite catch about the fact that my husband and I had sex that morning (sperm can turn the strip blue, not just amniotic fluid, and that was the question the other test had to settle), but my hubby did and I felt his anger through his hands (he wouldn’t repeat whatever it was), and the nurse glanced over at us in obvious embarrassment, and later made several very strong comments telling us that it was a GOOD thing and RECOMMENDED that we have sex if we felt up to it since it softens the cervix and helps start labor. They had to repeat the cervical exam to get a new sample to see if it was really my waters that broke or something else going on, and the OB was going to dive head first into me again, but the nurse (GOD BLESS HER!!!) stopped her and pointed to the note in the chart and said that she (the OB) needed to tell me what she was going to do before doing it, and to be very gentle because of my background. The OB looked at us for the first time since entering the room, let out a HUGE sigh, rolled her eyes, and then proceded to tell me in minute detail everything she was doing, in such a way that it was abundantly clear that she thought I was stupid and dramatic.And she twisted the metal speculum while it was in use, which almost made me scream (and I have a VERY high pain tolerance), and the nurse patted my knee and it was clear to both of us that we were not the only ones who wanted to punch the OB at that moment. In the midst of all this, my contractions suddenly stopped cold turkey, and in the end I was sent home. Knowing that your bag of waters can reseal itself after a break, and that anxiety and fear can stop labor, I am not entirely convinced that I was not actually in labor when I entered the hospital. I am, however, extremely grateful that I did not have to have my baby attended by that THING. Anway, sorry for the novel *wink* Thought you’d be interested in my story, anyway. And the issue of consent has definitely been on my mind – both my husband and I woke repeatedly last night from nightmares about that woman attending our birth. Horrible.

    Reply

    • Ugh, I am SO SORRY you had to go through all of that. It’s stories like yours that made me want to write this article in the first place. Thank you for being so open in sharing it. (Thank you for understanding my points the first time! I would have preferred not to have had to written the second article as well, but it’s just the nature of internet that “anything you say can and will be used against you” so I felt the need to clarify) The fact of the matter is that these terrible situations DO happen and they NEVER should. Women need to have their dignity protected always, and especially during birth.
      I am glad too that you got to go home, and I’m hoping that you get the CNM you really like when you end up going back. No one should have to put up with being treated like that. I hope you have a beautiful and calm birth! Blessings. 🙂

      Reply

      • Posted by Rachel on May 6, 2012 at 10:48 pm

        Alena, your story genuinely brought me to tears and I could feel my anger building, I’m so sorry you had this experience. I am quietly happy that your fight or flight instinct kicked in though so you could birth in peace and safefy. What I will never understand is why any doctor practices in this field when they have no obvious passion or compassion for the women they are serving. It is such a privelige to be in a woman’s presence during this time and I don’t understand why there is so much negativity in the delivery suite.
        I’m 19 weeks pregnant myself and whilst I can’t afford a private midwife I have hired a doula that has been a godsend so far. I hate having to go to the government midwife clinic here in Australia where the midwifes are ex-Nazi’s that look at me like i’m from Mars because I don’t want to conform to their ways and be a sheep in the system. I am just hoping that between my supportive partner and my doula i can block out all negative influences when I go to deliver my baby.
        I hope you got the birth you deserved in the end.
        Rachel

    • Posted by Abby on April 24, 2012 at 6:47 pm

      From a potential future mom who wants to know what she’s going into, thanks for sharing your painful story. You’re strong for all of us. God bless you and your family!!!!

      Reply

  3. Thank you 🙂 I hope so, too!

    Reply

  4. Posted by Melody on April 23, 2012 at 7:16 pm

    it is harder when you live in a big city center that only has one hospital for delivery and seeing as it is a university hospital the care is poor and very unprivate so you are forced to go to a small town hospital with only two doctors and one is listed on the net as realy bad No options now what ? oh and midwive only acsept you if you live in the city limmits and you call in the first month after concieving .What do you do ?

    Reply

    • In this situation, I see it as having two options: One, travel to give birth. While not ideal, many women have done it in order to get the care they hoped for. Or two, really prepare prenatally. Talk to your doctor about your birth plan. Find out specific answers to the “what if” questions, and make sure you understand where the doctor stands. If he/she is in a group practice, make a plan for if you get a different doctor. (Maybe they can all sign off on your birth plan birth plan beforehand?) Find out what hospital policies are. Think through which ones you’re willing to live with and which ones you’d rather decline. Be well informed about both sides of each issue before you make a decision. Be willing to compromise on things that aren’t that important, but stand your ground on things that are. Communication is key! The more you talk things through with staff beforehand the smoother things will usually go. Good luck!

      Reply

  5. Thank you for this. I will give birth for the first time in a hospital in October and, as a woman prone to anxiety, I have been wondering–what if all my plans fall through? Just knowing that, if worse comes to worst, I can use these powerful words. Thank you.

    Reply

  6. Posted by Rachel on May 6, 2012 at 10:52 pm

    Anne-Marie, I would urge you to look into hiring a doula. I promise you the small investment (mine cost about $800 in Australia) is worth it, especially if you are an anxious person, she will be a support to you and your partner and most importantly your advocate when you are most vulnerable. With a doula your plans won’t fall through, she will make sure that all your wishes are honoured (providing you and your baby aren’t in “real” danger) and that you will have all the information to make informed decisions before your birth day. Good luck 🙂
    Rachel

    Reply

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