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Friday, February 5, 2010

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 .


Knitted in the Womb said...

I'd like to respond to the idea of non-consented sterilization...

In 1991 my older sister was diagnosed with Hodgkin's Disease. At the time she was 18, just a month or so shy of her 19th birthday--but being 18, she was legally responsible for her own medical decision making.

But she is mildly developmentally disabled, so in reality, our grandparents were making many decisions for her--though there was no legal paperwork that granted them this authority after she reached the age of 18.

My grandmother told me in about 2002 that when my sister was getting radiation--in her NECK--to treat her Hodgkins, the Dr had asked my grandmother if she wanted to the Dr. to also radiate her ovaries to make her infertile, and my grandmother agreed to this plan. My grandmother told me this because she knew that eventually my sister would become my responsibility, and she wanted me to know that I "didn't need to worry about THAT."

I know my grandmother. She was NOT confused about what was suggested. Whether the Dr. actually did radiate my sister into infertility, I do not know.

I do know other people with similar mental abilities as my sister who have chosen to become parents, and are good parents. I know that because of my sister's emotional issues, the thought of her becoming pregnant frightens me.

But it does make me angry that this was done to her without her consent or knowledge--and how many other women have been similarly handled by this Dr? At this point...with my sister not being in a relationship (she's dated in the past, but its been at least 5 years) would not make sense for me to tell her about this. So nothing will be done.

Convulsiveliar said...

This post and the posted articles make me very nervous. I suppose they shouldn't, given the fact that my approaching c-section is fully understood and approved by me (I'm having identical twins, and baby A is breech) and I really do believe it would be safer to have a c-section based off of the research that I have done not just my doctor's word.

The simple fact that the opportunity for so many mistakes and abuse exists makes me near-terrified. I've never really been worried about the aspect of having my children delivered via c-section and where I do trust my doctor, it scares me that had I not decided to do my own research and figure out if delivering surgically was something that I really wanted and was comfortable with, that I could have, perhaps, been forced against my will.

I have stated before (even in my own blog, I believe) that I would prefer being knocked out via general anesthetic rather than have to endure a needle (as I am completely needle-phobic) and be awake during a major surgery. This post and these articles definitely make staying awake during the surgical process a lot easier to handle, simply because I'll be aware of what's going on, and not have to worry if something is misplaced inside of me, or if someone really screws up.

Oi. Just the thought of it gives me the shivers, though. :(

shelbel said...

I am shaking with anger over the Laura Pemberton story. I had not heard that before, and I am horrified that she was treated like this.

Does no one realize that tying her legs together and denying the baby to be born naturally is MORE dangerous than the VBAC she wanted? Have none of these mental giants ever heard of a little thing called "Cerebral Palsy" that happens when the baby's brain is denied oxygen? Getting stuck, or in this case being forcibly trapped, in the birth canal could have caused catastrophic damage??

Shame on them, this was tantamount to assault, perhaps even kidnapping and unlawful imprisonment. I can only hope that Laura sought some kind of legal recourse for these crimes against her and her baby.

Just sick...

The Deranged Housewife said...

Thanks for your comments, everyone.

In the case of Laura Pemberton, she did try to sue her state for a violation of her rights. It was determined that her baby's rights were more important, basically, and she lost her case. She did go on to have several VBACs, though.

Jen - I am glad that remaining awake for the surgery is something you are considering. It is surreal - especially if it's your first - because it almost seems like an out-of-body experience. But this still is the birth of your children. Your girls sound healthy and that there's no Twin to Twin transfusion syndrome, which is common in identical twins. Perhaps the baby will turn, you never know - and it can happen in labor, too. But I understand your wanting not to take that risk, especially if you have two babies to think about. They can deliver one vaginally and one by c/s, but that is a lot for the baby to handle and I don't know if doctors will even entertain the notion anymore. Just know that once you have a csection, it changes the way you give birth in the future - whether you have more sections, or have to literally fight tooth and nail for a VBAC.

(I think I should have emailed you instead - sorry ...)

KITW - your story made me think you said 1931, not 1991 ... to think that these things were, and probably still are, happening in the late 20th century ... I'm so sorry for your sister.

The Deranged Housewife said...

I almost forgot about this story - this is just recently, too.

To some people, this might be a gray area. A mother of 9, who is in a stable relationship and receives public assistance - after a planned c/s she was involuntarily sterilized by the doctor. No consent was given and no form could be found. WTH?

It doesn't matter if she's poor or not - it's still her body and her choice.

Convulsiveliar said...

I don't mind comment-chatting. I suppose it comes with the territory when you have a public blog, you know?

I'm really not worried at the idea of having the surgery and I'm not being forced into it by any means. And the idea that it can alter future births--should I choose to have anymore children--really doesn't bother me, either. I just didn't know that this was something that some women could be so adamantly against, and that their wishes can just be tossed out the window like that. Maybe I've been really naive, but I didn't realize that these kinds of things could actually happen.