By Kaitlin Reilly, YAHOO LIFE
Consent in the medical field is vital to ensuring a patient’s comfort and safety. Some people, however, are sounding the alarm about what they believe to be a major blind spot: the lack of informed consent during the birthing process.
In the medical field, informed consent means that a patient must have sufficient information in order to make a decision about their care. Consent issues during the birth process can vary greatly, but the women who experience them often describe feeling powerless and betrayed by the medical system.
What does violating consent during birth look like?
Violating consent, according to birth rights advocate and educator Cristen Pascucci, founder of Birth Monopoly, is an example of “obstetric violence.” It means “dehumanizing” pregnant individuals by “taking over their bodies and decisions, in large and small ways,” she tells Yahoo Life.
“It can include force, but most of the time it’s much more subtle — it usually shows up as what we call ‘coercion,’ pressure to get you to do or not do something,” Pascucci explains. “Some really common examples of obstetric violence are when a provider or hospital dictates how or when you give birth, things like ‘not allowing’ you to eat or get out of bed during labor or requiring you to push your baby out in a certain position or on a certain timeline. This kind of treatment is not only inherently less safe — these are all examples of non-evidence-based care — but it can be traumatizing as well.”
Pascucci adds: “As it is, a third of births in the U.S. are considered traumatic, and a big chunk of that is due to psychological injury to the mother. Mistreatment in birth tends to be especially traumatizing to women who have previously experienced sexual abuse.”
“Please don’t cut me”
Lori B., of North Carolina, tells Yahoo Life that she was subjected to unwanted internal exams by her labor nurse, despite repeatedly protesting. She says the experience led to broken trust in the medical system and that the “betrayal was a huge reason I chose a home birth for my next birth.”
Ohio resident KD, who wishes to remain anonymous, says that her doctor began a vacuum extraction of her baby without informing her beforehand — even though there was no emergency reason for doing so, and she had been pushing for only 30 minutes. It left her with a third-degree tear in her perineum, which caused “unbearable” pain even after repair.
“The more I learned after his birth, the more I realized that none of that likely would have happened had I been given time to push as long as my body needed,” she tells Yahoo Life, adding it was “all because the doctor wanted to go home.”
Then there is Kimberly Turbin, of California, who became the face of the informed birth consent movement after her 2013 birth, during which her obstetrician, Alex Abbassi, cut into her perineum 12 times, despite her vocal protests. The ordeal was captured on video, which Turbin uploaded to YouTube.
She says her doctor’s reasoning for the forced episiotomy was that her birth was not progressing “fast enough.” Since 2006, routine use of episiotomies is no longer recommended by the American College of Obstetricians and Gynecologists.
“My PTSD had set in, and I was like, ‘Please don’t cut me,’” Turbin, who now volunteers her time with Consumer Watchdog and helps those who have been harmed by medical negligence, tells Yahoo Life. Abbassi “was arguing with me, saying things like, ‘I need to cut you — if you don’t want to have the baby here, go have it on the floor or go have it in Kentucky.’”
Turbin worked with national birth-advocacy organization Improving Birth and civil rights attorney Mark Merin to sue Abbassi, who ultimately surrendered his licensedue to “age-related cognitive defects.” In 2017, her case was settled for an undisclosed amount.
Why do informed consent violations happen?
Maternal health advocate Dawn Thompson, who is the president of Improving Birthand the chief executive officer of Birthify, a virtual support service for pregnant people, says that the “doctor knows best” mentality that exists within maternal care often means pregnant people are left out of crucial decisions — frequently with doctors not even realizing what they’re doing is wrong.
As a former doula, Thompson saw people suffer following these consent violations, while doctors often wouldn’t see their patients following birth for six to eight weeks. Many times, Thompson says, they didn’t know their patients were experiencing any postbirth hardship.
“These providers do not necessarily know what informed consent looks like because they’re not seeing it in their training, and they’re not seeing it from their superiors, who are sometimes in their 60s and 70s,” Thompson tells Yahoo Life. “They came into this field where people just do what their doctor tells them to do, and they don’t ask questions.”
During her time as a doula, Thompson would make sure to inform patients on current research. In one case, she worked with a doctor who would induce patients at 36 weeks, no matter what — even though the current research didn’t support that. Though she would inform her patients of their options, she says that the “problem” was that “we’re up against what evidence says versus what’s good business.”
Thompson notes that some informed consent violations are a symptom of issues within the medical system as a whole. Even the most well-meaning doctors have only so much time in their week — which, in some cases, can lead to them encouraging planned C-sections and inductions.
“There are ‘bad apples’ — there’s no question about that,” Thompson says. “But I don’t think the majority of doctors walk in and think, ‘Who can I traumatize today?’ They just think what they’re doing is fine. Sometimes it’s that they don’t think their patient is educated enough.”
Dr. Emiliano Chavira, a maternal fetal medicine specialist, tells Yahoo Life that “it’s not informed consent if you’re not properly informed. If you’re giving misinformation or disinformation, or if there is information that’s kept from you — then it’s not informed consent. I think that’s really rampant in obstetric care.”
He adds: “It’s not fair to expect patients to become professionals and be able to proceed when the physician is not giving them the best advice.”
Chavira says it isn’t “reasonable to assume that all patients can educate themselves sufficiently to defend themselves in this kind of scenario. There is an extreme imbalance in the knowledge and information that the two parties have.”
Amber Price, a registered nurse and the president of the Sentara Williamsburg Regional Medical Center, tells Yahoo Life that “hospitals have an obligation to obtain consent prior to any procedure.” Yet how this consent looks may vary depending on the provider.
“When you walk into any hospital in the United States, you will see by the front entrance the Patient Bill of Rights,” Price says. “It’s a give and take — there are things that we ask of our patients, like being forthright about their medical conditions so we can treat them optimally, but it also entitles the patient to courtesy and respect and an informed consent. But the way hospitals usually do that is by having the patient sign a consent for treatment, which is very broad. Those contents often only state that you consent for somebody to care for you.”
She adds that because childbirth can be an “unpredictable process,” consent forms are usually quite broad and cover things such as surgical intervention when necessary. However, things like episiotomies are not typically spelled out separately in a form.
“We see a range of how people ask for consent,” she says. “Sometimes it’s something as blanket as, ‘Hey, I have your best interest at heart, I think we have a trusting relationship, this allows me to care for you.’ Some people sit a patient down and have them consent for everything, including before they touch somebody. People who advocate for women tend to err on that side of the spectrum, because you’re really spending time with people and understanding that everything you do has consequences, and [they] take the time to include the patient in their care. That’s ‘shared decision making,’ which is our goal.”
How can women protect themselves during the birthing process?
Chavira says the first thing people can do to protect themselves during pregnancy and delivery is to research your provider and make sure they are the right fit for you. He also suggests having an advocate during pregnancy, such as a doula, who can act as a professional birth assistant and tend to the patient’s physical as well as emotional needs. If you’re a low-risk patient, he says midwifery care is a potential alternative to a traditional ob-gyn.
Thompson says that having a birth plan in advance — in which you explicitly share your wishes during labor and after childbirth with your health care team — is “so important,” adding: “It empowers pregnant families to get informed about their options and determine individual needs and preferences.”
For those who are struggling following their consent being violated in birth, licensed therapist Krysta Dancy, founder of Dancy Perinatal and the Birth and Trauma Support Center, says it’s important to seek out support.
“As a mental health professional, I am a deep believer in first getting support,” she tells Yahoo Life. “There are online groups. There are specialty therapists and social media posters who are taking on this issue and offer many free resources. Get support first and foremost because — especially as a new parent — you need to be in a stable place emotionally and mentally as soon as possible.”
Dancy also points out that it’s important to work on your own mental health prior to taking any possible legal action following a consent violation, should you wish to pursue that avenue.
“After you’ve got the tools and resources you need in order to be well, then you can consider using resources like Birth Monopoly or Improving Birth — which walk you through the process of making official complaints,” Dancy says.
She says that “one important reason I don’t suggest this as a first step is that many have found it is incredibly frustrating and dehumanizing to seek justice on this issue. The system is designed to protect liability and to discourage any legal action. It does this through making patients feel unheard, frustrated, confused, gaslighted and, frankly, doubting themselves. So for a newly traumatized person to seek justice before healing … it can actually be another layer of trauma. Only seek activism when the time is right.”