Uninformed non-consent

There seems to be a popular myth that a doctor cannot do, or never does, anything to a pregnant woman's body that she hasn't consented to first. Yes, in an ideal world, but this is the furthest thing from the truth. But in some cases, it seems that 'informed consent' is a relative term.

A baby is born via c-section in Brazil, where surgical birth rates are among the highest worldwide. 

While hopefully not the norm, this kind of stuff does happen. Even here, in the United States of America, the most wealthy country with all this knowledge, medicine and technology at our fingertips.

The other day on Yahoo! Answers I read a question about a woman who had received a tubal ligation without her consent. Her now ex-husband had ordered it after the birth of her third child, in the event that if they ever divorced she wouldn't be able to have children with another man, from what it sounds like. The doctor agreed, and thus the tubal was done.

It's important to note that this woman was posting from India, where reproductive rights are not what they are in Western countries. So I have no doubt that this woman was telling the truth when she presented her plight.

Women left and right answered her with a barrage of stupid, insensitive answers, some calling her a "troll," others assuming that there is no way a doctor could do that to her without her consent and suggesting she seek legal action. Yeah, sure, in a perfect world she could do that. But it is plainly obvious that women the world over, even in this country, are treated like nothing more than vessels to hold the baby, like they have no feelings whatsoever and are hormonal time bombs waiting to explode.

When I responded, I took notice of how the reproductive rights of women in her homeland were probably very different than in the US. I also noted, however, that women even in this country suspect they've been the victim of tubal ligation (and other procedures) without their consent. One particular website, that of a tubal ligation reversal clinic, features a forum in which several women have written in complaining that they inexplicably can't get pregnant after three children, and suspect that their doctors did a tubal without their consent. On another forum, thankfully one physician saw it for what it was: a felony and assault, if proven that the procedure was done without the patient knowing. But what are you going to do about it? (Read on to see that the woman in question reports that other patients in the practice suspect they had the same thing done, yet were totally okay with it.)

And even if the practice is consensual, many times the OB will ask a woman in labor if she wants a tubal while he's 'at it.' Surely you can discuss this beforehand or at the six week check up, when hormones aren't raging and the body's response to a painful birth isn't doing all the talking. Lots of women give in to a tubal at this point, and later come to regret it.

Another procedure often done for no reason and without consent is the episiotomy. The option is to tear or be cut, and conventional wisdom assumes that it's better to be cut in a 'controlled' manner than to tear. Thankfully my midwife asked me what I wanted to do, and I consented to be cut because I wanted the baby out. (I know... duh!)

People are horrified at the terrible acts of genital mutilation often practiced on women in African countries, yet a similar practice goes on in the obstetrical wards of hospitals every day in the US (and in other industrialized nations). One criteria for true female genitalia mutilation is 'non-therapeutic reasons,' and given that it's estimated that nearly 99 percent of all episiotomies are totally unnecessary, I'd say this definitely qualifies. And while Wikipedia, of all places, has an in-depth article on FGM as used in African cultures (including types that don't involve tissue removal, which I'd guess is most similar to a typical  'western' episiotomy), they don't mention anything about this phenomenon in American obstetrics.

Studies have shown it's actually easier to heal from a tear than from a cut. Some OB practices do them on every woman, whether they really need one or not. And sometimes it's done before the woman can even say anything, or even though she's already refused and has continued to do so immediately before the procedure takes place. I've read countless stories - including my own, I believe - where the mother has requested no pain relief during labor, which somehow cruelly translates to the OB, "Don't give me pain relief for an episiotomy."

And sadly, one of the most common obstetrical surgeries is often done without "consent" - a c-section. In this situation, I think it's important to define 'consent.' Consent under duress seems much more fitting - (Read it and weep. Literally.)

No one is arguing that sometimes a section is necessary, or that sometimes there is just no time to dilly dally and debate it. But in the case of a woman who is actively, successfully laboring on her own, can this interruption of normal labor be considered true consent?

In the case of Florida homebirthing mom Laura Pemberton , who was arrested during active labor and taken to the hospital in shackles for a court-ordered c-section, do you really think she had a choice? Was her consent given? Or this woman, who was in the process of a successful VBAC, nearly ready to birth her baby when the attending physician interrupted and insisted on a c-section ? She granted consent only after extensive harassment, which included the threat of not helping her deliver her child and discharging her from the hospital, even though she was moments away from giving birth.

It's sad and terrifying to think that women have to take such protective measures with their own health. And that the more educated about their bodies that they are, the more threatening their situation can become. The words "First, do no harm" have long flown out the window and been replaced with shades of grey.

For more reading on this subject, click here .