Most people have heard of consent but what does it really mean? When it comes to pregnancy and birth do you know your rights? I hear the phrase “ I wasn’t allowed” or “ I wanted to give birth here but was told I had to have XYZ so I had to be in hospital” a lot, women being told what they can or cannot do and often feeling like things are done to them and they have to passively accept “what is best for them and their baby”.
So this blog is going to look at consent in more detail. What is true Informed consent? What are your rights as a birthing person in the UK? How can you be an active part of the decision making process during your pregnancy?
Firstly, what is valid consent? According to the NHS website to be valid Consent has to fulfil 3 prerequisites. It must be voluntary, it must be informed and the person giving consent must have capacity.
Let’s break that down-
Voluntary- This means there can be no coercion, influence or force from anyone including family members and healthcare professionals. Coercion can be done using fear i.e “ Why do you want your baby to die?” or withholding another part of the care “ We cannot let you have gas and air unless you have a vaginal examination” Being forced into giving consent because you are scared or because you want access to something is not ok. You need to be consenting to intervention because you feel it is the right decision for your situation.
Informed- This means you need to have access to all the information, what the intervention is, why it is recommended, what it involves, what the risks of consenting are, what the risks of not consenting are, are there any alternatives. Information needs to be fairly presented, accurate and as unbiased as possible. Do not be afraid to ask questions. Ask for what evidence backs up a recommendation. Ask about risks of the intervention offered. Read the NICE guidelines for yourself, ask about your local hospitals policy and whether it follows NICE guidelines or not. If not, why not?
Capacity- The person must be able to understand the information given to them and be able to make a decision. All adults are assumed to have capacity unless there is significant evidence to show they do not.
So some other things to remember, consent can be given and then withdrawn at any point, you are entitled to ask for another opinion, you are entitled to ask for your care to be transferred to someone who will respect your autonomy and if you make an informed decision it must be respected even if it goes against the HCP recommendations. The NHS website says “If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.
This is still the case even if refusing treatment would result in their death, or the death of their unborn child.”
The best way to ensure every birthing person gives informed consent for all their treatment and care is to ensure that they are at the centre of all decisions relating to their care. We must accept that the woman is the primary decision maker in pregnancy and birth. Healthcare professionals can give information, recommendations and even advice but they cannot and should not make a decision for the woman or birthing person.
So what sort of things can this informed consent apply to? Well pretty much everything! Let list some examples;
Weighing during pregnancy
Screening such as GTT
Place of birth including those with more complex pregnancies
Monitoring during labour
For the record- Consenting to a vaginal examination for any reason is not the same as consenting to a sweep. " I did a quick sweep while I was in there" is not acceptable and is performing a medical intervention without consent. A sweep is a separate medical procedure that needs discussion around the benefits and risks before a person can consent, this should not be happening while you have someones fingers inside your vagina!
Did you feel like you understood your choices and gave voluntary, informed consent for the above things during your pregnancy and birth? How did your care provider ensure you felt at the centre of the decision making process?
How do you make a decision? Use your BRAIN!
Below are some links where you can find out more about consent and guidelines during pregnancy and birth.