“I’m just going to pop a little clip on baby’s head” “Um, OK” you reply
“I’m just going to give you that injection now” “Um, OK” you reply
I’m just going to leave my fingers in a little longer through this contraction is that OK…. “Um OK you reply”…
As doulas we witness Maternal Health Providers (MHP) using this language all too often at births. It’s not OK!
This is not an example of you making an informed decision, nor does it demonstrate you providing consent for a procedure, assessment or intervention. #ENOUGH
Imagine yourself in labour, you’re in the peak of your effort, you’re being challenged by your contractions, you’re doing everything you can to focus. Your Maternal Health Provider (MHP) needs to have a conversation with you. Most often they will wait until the intensity of your contraction has reduced and begin talking to you during the rest and recovery space. This interruption has implications too, as this is the time that you will need to free your body of tension, let your body go soft and floppy, zone out, close your eyes and regroup ready for the next wave of activity and effort. If you are distracted during the rest and recover stage you have a high probability of building tension and taking this you into the next contraction making that contraction more difficult to manage. So, it really is difficult for MHP’s to have conversations with you during labour, however, they often need to and often do - so prepare yourself for frequent disruptions whilst in labour at hospital
So here you are a conversation needs to be had, there’s a short window in which to have this conversation so your MHP cuts some corners to quickly relay a message for a procedure they they deem necessary, or they routinely do, or they assume you’ll consent to anyway, so they scurry through the process of gaining your consent. It’s a scenario we see, and we hear all too often.
So how can you protect yourself from having things done to you while you are in labour that you would not typically consent to? How can you protect yourself from receiving interventions that lead to the cascade of interventions? How can you advocate for yourself while in a position of vulnerability? How can you say no to things when you are in a blissed out Oxycontin high where it is know that women are more compliant? How can your partner or Birth support team advocate for you during labour, without causing conflict, tension and further disruption?
Our top 4 tips to avoid saying yes to a procedure without adequate prior information.
1) Choose a continuity of care model within your chosen hospital.
2) If a continuity of care model is not available hire a Doula or an Independent Midwife
3) Invest the time into creating a Solid Birth Plan. A Birth Plan that you fully understand, that you deeply connect with. A Birth Plan that is thorough, one that includes your Birth Vision and plenty of space for your pre planned thoughts surrounding interventions, birth challenges and contingency plans. Your Birth Plan needs to be a collaboration with your Maternal Health Provider (MHP). You must feel respected and heard when discussing your birth plan with your MHP. Ask yourself how do you feel when discussing your birth plan with your MHP? If you feel intimidated, silly, unimportant or rushed during an antenatal appointment this is a red flag. We’d recommend either a change care providers, the confidence to speak up and communicate how you are feeling with your MHP or bringing in additional external support for each antenatal visit and building a well prepared birth team to support you through your labour and birth.
4) Use the BRAINS acronym to support your ability to ask good questions
The BRAINS acronym stands for.: BENEFITS, RISKS, ALTERNATIVES, INTUITION, NO/NOT YET, and SPACE
Here’s how it works : You’d ask: What are the BENEFITS of this intervention, assessment or procedure. Then you’d ask What are the BENEFITS of NOT having that intervention, assessment or procedure?
What are the The RISKS of having this intervention, assessment or procedure? What are the RISKS of not having this intervention assessment or procedure?
What are the ALTERNATIVES to this intervention, assessment or procedure?
The you ask yourself what is Your INTUITION telling you?
At any point you can say NO thank you or NOT NOW/ NOT YET
At anytime you can ask for SPACE, space, time and privacy away from your MHP ( you can ask them to leave the room for a moment or two to make your decision, to discuss things in private with your partner and support team and to ask more questions when you are ready.
It’s really tricky to do all of this in labour under pressure or during times of stress. It’s almost impossible to learn about the intricacies of interventions in labour. The opportunity to learn is now. As early on in your pregnancy as you possibly can.
So what does asking for your consent look like and more importantly how does this FEEL for you when you do not know your Maternal Health Provider?
You should feel that any decision is yours to make, that you felt respected, validated and have had time to ask good questions should you want to. You should feel that the decision you make are in your best interest and the best interest of your baby.
The information should be communicated without coercion, bias and without judgement. You should not feel that you need to people please, that you can’t say no or feel any pressure to consent or be a ‘good girl’. You can decline any procedure at anytime regardless of the outcome. You can also request procedures, assessments and interventions.
Your MHP should explain a procedure in detail especially if it is invasive, or has any known side effects, risks or likelihood of causing a cascade of intervention.
One example of a cascade of medical interventions, whereby a decision can step you towards other more complicated interventions
For example: An internal Vaginal Examination: Ideally your MHP is in a position of equal eye height if possible to ensure that they are not physically creating a feeling power over you, they should speak clearly and slowly, pausing if your contraction begins to build.
“I’d like to perform an internal examination of your cervix because X….
This procedure will involve X…. (require me to touch your vulva and enter your vagina with ,my fingers to feel your cervix)
This procedure will take X amount of time
If at any point you wish me to stop I will remove my hands immediately.
This is a once off procedure.
The risks of me doing this procedure are X
The risks of me NOT doing this procedure are X
The benefits to you and your baby in having this procedure are X
The benefits to you and your baby in declining this procedure are X
If I feel a second internal assessment is required I will fully explain the procedure again, why it may be necessary to repeat and ensure that you feel that you can offer your consent or refusal.
Do you have any immediate questions?
If you choose to go ahead with this procedure, I will have some information about your cervix, and possibly about your baby’s position in that moment. Would you like to receive any information after the assessment about what I feel or notice, Would you prefer that I discuss these findings with your partner or would you prefer that I note my findings without further interruption?
Your MHP should then offer you the following: SPACE “I can just pop out of the room for a moment so you and your partner can have a discussion about what you would like to do from here. Feel free to have your partner pop their head out of the room to call me back in when you are ready”.
Please let me know if you would like to proceed or decline this procedure,.