Before any sort of surgery, patients will review and sign consent documents. Consent forms generally allow for doctors to perform emergency treatments, but patients are allowed to consent or refuse to any proposed procedure at any time before it happens. Doctors must inform their patients about what they’re doing, and that includes any sort of procedure while a woman is in labor or giving birth.
So, what is consent during labor? What happens if a doctor doesn’t listen to his patient and continues on with a procedure without consent?
Childbirth and Informed Consent
When we create a birth plan, we know that not everything may go to actual plan on the big day. Thinking about alternatives ahead of time and letting our support system know, including our medical team, is important.
Women who give birth in hospitals are asked to give written informed consent ahead of childbirth. The pre-admission forms generally authorize vaginal or cesarean delivery, needed treatment for your newborn baby, and medical treatment or diagnostic procedures by your doctor and his assistants or designees.
The idea of consent prior to labor can imply that women are not capable of giving consent during labor, which may lead to some murky legal issues.
Legal Claims of Ignored Consent During Labor
Take for instance one woman living near Los Angeles who had been a two-time rape survivor and was about to give birth. She requested that medical staff get her permission before touching her and to keep her informed of everything they were doing during labor. Her OB/GYN told her after her epidural that he would be performing an episiotomy, and she said “no.” Despite her multiple refusals, he cut her perineum 12 times.
Because she had an epidural, she didn’t know her doctor went ahead and gave her an episiotomy without her consent. The woman’s mother had videotaped the birth, however.
“I didn’t know he did that until I saw my video. Nobody could tell me why and that’s what bothered me. I was so mad he forced me to do something I didn’t want to do.”
While many women, particularly those who are experiencing their first child being born, receive an episiotomy, they are generally only used to prevent perineal tears. The logic is that a surgical incision will heal more quickly than a natural tear; however, episiotomies carry their own risks and usually aren’t recommended unless they are medically necessary. Pain and tearing can actually worsen with episiotomies.
The American Congress of Obstetricians and Gynecologists began recommending against routine episiotomy in 2006, but some hospitals still perform a higher rate of episiotomies than others — similar to how C-section rates can vary among medical facilities. The average frequency of episiotomies in vaginal births in 2004 was 25%, but in the 10% of U.S. hospitals where episiotomies were used more frequently, the mean adjusted rate of episiotomies was over 34%. White women and women with commercial insurance over Medicaid coverage were more likely to receive an episiotomy, while women in rural areas or at teaching hospitals received fewer episiotomies.
In the case of the woman who lived just outside Los Angeles, her doctor allegedly told her after she refused an episiotomy to “go to Kentucky,” as he was “the expert here.”
Women’s Rights During Childbirth
So, what are women to do if this happens to them? Do they have any rights during childbirth if they’ve already signed consent forms before being admitted to the hospital?
Although there may have been a legitimate reason for the woman who received an unwanted episiotomy to have that procedure done, women can still speak up during birth to refuse a proposed operation or procedure. In this example, the woman posted her birth video to YouTube and watched the comments roll in from doulas, nurses, and others. She then began to look into obstetric violence and traumatic births, and advocacy groups that could help.
That woman found out she was not alone.
Women’s Childbirth Experiences Survey
In a 2013 survey on women’s childbirth experiences titled Listening to Mothers III, 2,400 women ages 18 to 45 from diverse backgrounds who had given birth at a U.S. hospital to a single baby who was still living were asked dozens of questions to help give them a voice on the process.
Nearly 9 out of 10 women chose their prenatal care provider and hospital because they were a good match for their values, yet many women held back on asking their providers questions because they either thought the provider seemed rushed (30%), their maternity care desires differed from their provider’s (22%) or they were afraid they’d appear to be acting difficult to their provider (23%). Ten percent of women felt they were treated poorly in the hospital because of their race, insurance issues, or disagreeing with the prenatal care provider.
As for interventions during birth, 41% of women who had vaginal deliveries experienced perineum pain, largely related to episiotomies, with 11% citing it as a major problem. Women also felt pressured to receive an epidural, a C-section or accept labor induction (13%-15%), with three times as many women who actually received those interventions saying they were pressured to.
One woman commented:
“I refused a c-section… because I knew it was not necessary. The doctor on call was not happy about it! I felt relieved when he finally said it was my ultimate decision, but nervous because I felt he used scare tactics.”
A Birth Injury Lawyer May Be Able to Help
If you have been injured during childbirth, you have legal rights. Many people think when they hear the term “birth injury,” it only has to do with the child. But childbirth involves both mother and baby, and women’s injuries during childbirth are more common than you may think.
To speak with a qualified birth injury attorney who can review your case, contact the Safe Birth Project today.
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