Consent from the Mother’s Side
Not too long ago, a prominent Canadian media icon, Jian Ghomeshi was charged with sexual harassment and assault. At the time, a conversation began that talked about what consent looked like when two adults were engaging in sexual conduct. The individual under investigation said that all acts of sexual violence were consensual, however several women came forward to tell their experiences and allege that no consent was given.
It could be that the idea of “consent” was not mutually agreed upon. In one situation, the alleged victim/survivor claimed that Ghomeshi, who was subsequently acquitted, assumed consent was given because the complainant was drinking, was alone in his apartment, and had engaged in kissing. The woman claims that she received unexpected blows about her head, was pushed against a wall, was choked and more. It seems that we are often at odds at what constitutes “consent”.
Mothers who join birth trauma support groups are very clear about what traumatised them. With few exceptions, it includes a violation of her consent. Does showing up at a labour and delivery ward pregnant and signing the general “consent” form actually amount to consent to treat without discussion?
Not according to the law. According to the Health Care Consent Act:
- The consent must relate to the treatment.
- The consent must be informed.
- The consent must be given voluntarily.
- The consent must not be obtained through misrepresentation or fraud.
- A consent that has been given by or on behalf of the person for whom the treatment was proposed may be withdrawn at any time.
Consider these first-hand accounts:
- A mother arrived at the hospital shortly after her water broke but wasn’t having contractions. The on-call doctor suggested they begin an induction immediately. The mother asked if they could wait to see if labour could begin on its own and the doctor replied, “Sure, if you want a dead baby.” The mother went ahead with the induction. Did she consent? Was the medical prognostication of a dead baby true?
- A mother discovered later whilst reviewing her chart that IV Pitocin was administered when she was 8cm. When questioning her care provider at a follow-up appointment she is told, “It’s hospital policy. It helps the placenta come faster and stops bleeding.” Did she consent? Was this medically true?
- The birth plan clearly stated that the mother would prefer to tear rather than have an episiotomy. As the baby’s head is crowning, the doctor cut an episiotomy. Was this consent? Or was this a crime?
- A mother had been pushing upright and the baby’s head was close to crowning. The nurse called in the birth team and 2 nurses repositioned the mother on the bed, on her back and lifted her feet into stirrups. Did she consent? Was this an agreed-upon position for the birth of her baby?
- The baby was born and the doctor pulled on the placenta to expedite its delivery. The doctor inserted her hand into the mother’s uterus to manually retrieve the placenta whilst the mother screamed, thrashed, and yelled at her to stop and a nurse was called to hold her down. A haemmorhage ensued and required further treatment. Did she consent? Was there an emergency or was she being raped?
There is any number of reasons a doctor might have suggested the baby in scenario #1 might die, including confirmed chorioamnionitis, however, it might have been just plain laziness, as investing in an informed conversation takes time. Yet in the absence of information about the condition of the mother and baby, confessions of hospital routines, and a risk/benefit discussion – there was no consent. And bypassing consent is against the law.
Routines that seem like a good idea at the time, such as prophylactic IV synthetic oxytocin during labour to prevent a postpartum haemorrhage are often proven incorrect very quickly. Sometimes it takes a a few generations to end bad habits that begin early in one’s career. We only need to look at the ongoing prevalence of routine immediate cord clamping, routine episiotomy, or routine continuous electronic fetal monitoring.
Many birthing parents have come to realise that entering a hospital for their birth means giving up their decision-making autonomy and her legal right to participate in her care as routines, rituals, habits, superstitions, and the on-going remnants of paternalistic misogyny continue to dictate bad behaviour. An institution runs on order, hierarchy, established routines and everyone knowing their place.
How do we begin to address the non-consensual violations surrounding birth? It’s time for a new conversation. Birth plans and advocates haven’t made much of a dent in habits that continue to hurt mothers. We need to address the culture of maternity services and insist they learn what consent means to the mother.
And just as the victims/survivors of sexual violence are telling their experiences of what a lack of consent really looks like, perhaps mothers could begin explaining what they expect when they require their providers to gain their consent.
We’ll get there. After all, it’s the law.
Much love to you all,
Health Care Consent Act of Ontario