By Samantha Thurlby-Brooks
First Published on www.birthworks.org
Each week in my pregnancy and postnatal massage practice I find out from my clients that they’re being told they have to have an induction for various reasons that they don’t fully understand. Most are really unhappy and don’t want the procedure, but many are told they will be risking their baby if they don’t. My heart sinks every time I hear this as these women are strong and intelligent, yet their voices are muted and not heard. Why is it that so many unnecessary interventions are done without true informed consent or the space to refuse in this day in age? Especially when there are laws protecting patient choices?
The answer, I have been discovering, is three-fold; Doctors and midwives actually don’t know what the law is; very few childbirth educators are teaching rights as legal rights; and society is instilling the notion that inductions and caesareans are ok and birth is dangerous.
Health professionals often don’t realise they are breaking the law when they say “we won’t let you…”
My partner has been a nurse in the NHS here in the UK for the past 12 years. When I asked him if he knew what the NHS constitution is he had never heard of it. I started asking clients who were doctors and nurses and they had never heard of this legal document protecting patient rights either.
Given how high the intervention rates are in the USA I am assuming the doctors and nurses over the water haven’t been taught the USA Health Care Law and Patient Bill of Rights either… or maybe it’s that people are not talking about these legal rights enough to know when they’re being violated?
From what I understand here in the UK, health professionals are given short training on the rights and ethical behaviour towards patients. This makes it sound like a ‘nice thing’ to do for patients but not necessarily essential. It’s a completely different thing to teach legal rights. The psychology is very different.
With my BirthWorks students and my massage clients, I teach about the legal rights they have in the healthcare being offered. When I use the term Legal rights, it’s received very differently than when I say you have the right to certain care. The general childbirth classes here in the UK touch on rights in birth but it doesn’t sink in for expectant parents. Why? I believe there’s no emotional learning.
It’s very empowering for expectant parents to know they have a legal right to accept or refuse any care offered. They also have a legal right to be respected with their choice. Being fully informed to make a decision is also a legal right.
If a doctor or midwife doesn’t give them a choice, doesn’t respect their wishes or doesn’t give them of all the benefits and risks to make an informed choice, then that doctor or midwife is breaking the law. I’ve found using this terminology and repeating it throughout the classes, really helps couples understand they have a voice, they have rights, and the doctor or midwife is not the one who makes the decisions.
So what happens when they are given the ‘dead baby’ card? I frequently hear of doctors and midwives saying if they don’t do an induction at however many weeks, there is a higher chance of baby being stillborn. The shock of this will mute any loving parent and create a compliant patient. It’s the ultimate tool for getting patients to do what you want them to do. Instead of giving realistic statistics about the risks they leave the parents feeling scared and confused. Saying you’ve doubled your chances creates a totally different picture than saying you you’ve gone from a 0.01% chance to a 0.02% chance. So much of the medical profession is about consent as seen by the way they present information. I warn some parents who might be at risk of the doctor or midwife saying this to them, to help take away the shock if it happens, so they have a voice and can ask for more accurate information.
I’ve been doing some research about the USA Health Care Law and Patient Bill of Rights. The Health Care Law is Federal Legislation and then each state will have their own Patient Bill of Rights. Under the Health Care Law, each patient has the right to informed consent. As BirthWorks facilitators we all cringe at this notion… informing a patient so they will consent. However, reading more, it should more accurately say Informed Decision. USA Health Law says patients can accept or refuse care and must be fully informed by their healthcare provider of the benefits and risks of each option and alternatives.
I lived in New Zealand for nearly eight years. The NZ Health Consumer Act is printed on posters and hung in every health professional’s office. Most expectant couples are given a leaflet by their midwives stating their legal rights. However, the same thing is happening there as it is in USA and UK; a doctor or midwife saying “we won’t let you…” and the parents following their instructions against their own gut instincts, feelings and knowledge.
This is one of the many reasons why I love teaching BirthWorks so much. We teach about Human Values. We give the power back to the woman in making her own right choices. When you couple this with teaching legal rights you have an incredibly powerful system for great births, strong women and changing the way health providers work.
While in New Zealand I taught a couple expecting their third baby who had previously had two very traumatic births. With this pregnancy, baby was persistently breech, despite attempted ECV and trying every trick in the book. At the last minute her first midwife had dropped her as a client for a homebirth and refused to be with her for a vaginal hospital birth because of baby’s position. Her local hospital told her she would have to have another caesarean (this would be her second). Fortunately, she knew me(!) and I had just found out about a wonderful, strong and experienced midwife who agreed to support her with a breech VBAC in a hospital further away. It was because of this midwife and the birth plan I helped the mother write that resulted in an empowering, successful, natural birth. (I have had permission to publish this birth plan on my website so others can use it).
The first clause of the birth plan stated “I am a strong and intelligent woman who has done in depth research about VBAC and breech birth and understand the risks and benefits. Please treat me with the respect and intelligence I deserve, something that I didn’t get during my first birth. I trust my body and I trust the hospital to keep me safe.”
The second clause of the birth plan was “I know my rights under the Health Consumer Act 1996”.
These two statements are what caused the obstetrician to wait outside the room until the last two contractions and for the hospital to honour the mother’s wishes for a natural, drug free and mobile birth (we found out later that the midwife had endured a lot of pressure from the department to go straight to caesarean).
The mother knew her legal rights and followed the Human Values. She calmly stated what she wanted, interviewed the right people, prepared really well and stuck by her decision. It was the talk of the hospital for months and had a profound impact on all involved.
I believe teaching expectant parents about their legal rights is one of the best ways to challenge and change the system to make childbirth a safer, more respectful and empowering experience.