Is it consent if you don’t really want to, but you say ok anyway. Because it doesn’t seem worth the argument, and you don’t want to piss off the person who’s asking?
If you make a thought out choice to agree to a big thing, can it be assumed you also consent to something lesser as well?
Can you really consent to something if you don’t have all the information about it? Even if everyone else thinks you should?
I’m not talking about sex by the way, though I could be. Anyone watching the news or following social media will be aware of the revelations and debates on the topic. I’m thinking about consent in childbirth.
It’s only recently that I’ve given this much thought in relation to my own experiences. I was aware at the time of the ridiculousness of being asked to consider complex percentages of risks, while half-deranged through exhaustion and pain prior to my emergency c section. I was terrified and angered by the doctor how told me afterwards that I would have to have a VBAC and hugely relieved by the other doctors who said it would be my choice. But looking back now, especially to my first child’s birth, the issue of consent seems a lot more complex than I realised.
We’re just going to do this, ok?
First, there was the crochet hook. The complete stranger with her head between my thighs using a hook to break my waters. The allotted time had passed without the allotted progress. The contractions coming again and again but doing nothing and so: “this is what we do now – ok?”. I agreed, I consented, it just seemed like what I was supposed to do. Besides, I was completely at the mercy of the woman with the hook. I was barely dressed, barely able to move. Every three minutes even the thoughts in my head were dashed out by a contraction, so best just to trust her right? She seemed nice, she seemed like she knew best.
We’re just going to give this a try
A day later there was a form to sign, those risks to weigh up in a brain that knew it wasn’t capable of thinking clearly and just wanted it all to stop, please. I asked my husband if I should sign. Then I did. I didn’t want a C section, it was the only thing I’d been really afraid of going into all this, but there really wasn’t any other choice at this point right? No, the room agreed, this was the only option now.
But then there was another option. In theatre, supine and plumbed into the required equipment ready for surgery, there was something else to try. Perhaps I did agree to this, I have no memory of doing so but there had been more hours of exhaustion, more drugs, more fear and the irrational crush of failure, who knows what I might have said? Not me. Perhaps it was just assumed that, as I had agreed to a caesarean, that looming peak on the list of birth interventions, I’d implicitly consented to everything deemed lesser.
But I didn’t understand why I was being asked to push again. Ventouse apparently. But I’d been told the surgery was inevitable? Then talk of turning, I couldn’t see or feel what was going on, a man I’d barely spoken to was doing something to me, I still don’t know quite what. “Should we try forceps”? Someone asked. They weren’t asking me of course. I was a mere bystander to that conversation, the decision was, thankfully, no.
We’re going to wait
I can look back at this now, in the light of all the recent debates and say, with some clarity that “we’re going to do this, ok?” isn’t ok. It’s gaining consent, not asking for an informed decision. It’s someone in a position of power, telling someone more vulnerable what they should do and getting them to tick a box.
I’m also pretty sure that agreeing to a C section doesn’t mean it’s open season for everything else. Perhaps I did consent, but in such a state where I could barely think and have no memory of it. I don’t think that’s ok either. There was no sudden life or death emergency, I’d waited hours between decision and theatre.
What is even more complicated though is what I didn’t consent to. The thing that there is no tick box or form for: waiting. Doing nothing.
With the benefit of hindsight, a c section was almost inevitable for my first baby. She was in a bad position and she was big. 9lb 10oz big but she also had an enormous, off the chart sized, head.
I knew none of this, but it seems likely that somewhere along the line the midwives caring for me, examining me, must have guessed this wouldn’t be as straightforward as my A4, NCT approved, birth plan confidently assumed.
Those midwives were universally, lovely. They were run off their feet but they got me a birthing pool, they encouraged me to walk around, they helped me from position to position and cheered me on to push, “one more push, come on!” Always one more push, though the baby was still resolutely wedged up against my lungs.
I have absolutely no doubt that they wanted to do the best for me, that they knew birth was unpredictable and that even with the issues of size and position, there was always a chance the baby would turn and come naturally. They wanted to spare me the risks of surgery, they wanted to give me the empowering experience of birthing that baby how I’d planned to and they wanted to spare me the fear and doubt of knowing that that was looking less and less likely. Perhaps they worried I’d just give up straight away if I knew.
So they didn’t tell me. They didn’t have to. At the time there was no requirement for consent to do nothing.
I can’t honestly say how I would have reacted if they had told me. 2018 me would have wanted then me to say fuck this, skip the failed epidurals, the drips, the pushing, the instruments, let’s just do the C section and get it over with. But at the time I was so determined to give birth properly and so scared of surgery, that I may well have carried on, at least for a few more hours.
I don’t know. But I do know that I didn’t make an informed decision to carry on until all chance of a natural birth was as exhausted as I was. You can not make an informed decision if the vital information is deliberately withheld. You can not give consent.
We don’t know
But all those midwives knew of me was written on that A4 sheet. I was a woman who wanted a natural birth, a woman who would rather wait than intervene, a woman determined to remain in the midwife-led unit. How were they to know that I was also pragmatic and prepared to make compromises? That I value honesty and consultation over unremitting positivity and cheerleading?
I had even less useful knowledge. My NCT teacher had told me that midwives were wonderful, interventions were unnecessary and doctors should be avoided as they would force those interventions on me. But what then, when it’s a midwife who wants to intervene? What then when what’s left of your logical brain is pretty damn sure intervention is necessary and every other part of you just desperately wants it all to be over?
I had no framework to make informed decisions about intervention because, to be honest, I’d avoided thinking about them. I was happy to lap up the idea that that wouldn’t happen to me, that I would be strong and brave and these things only really happen if you wimp out.
To give consent when bewildered and scared, to sign a form, to say yes or just ok, is easy. To be the person making an informed decision for herself is far harder. It takes preparation, it means ensuring women have an opportunity to think about the what if’s and alternatives in advance. In a calm and supported way, free from anyone else’s idea of what is best.
We’re going to support you
But I want to end with a positive story. When I was pregnant with my last baby, MissA I was seriously considering attempting a vaginal birth again. The joyful planned C section I’d had with my second baby had been such a positive experience that |I felt strong enough to face the uncertainties of birth again. When I told the obstetrician this her first words were:
“If that’s what you want, we will absolutely support you”.
What she knew, but I didn’t at that point, was that complications with my previous births meant I had an increased risk of a dangerous rupture. She set this out calmly, telling me she couldn’t give me exact figures as it was an unusual circumstance, there was no data to take figures from. She explained what could be done to minimise the risk, that it would, most likely, all be fine and that even if it wasn’t, the full force of emergency medicine was just a button push away.
She didn’t say this is what you should do ok? She didn’t assume I would want a C section just because I’d had one before. She didn’t hide the facts from me for fear I’d be afraid or make what she thought was the wrong decision. She set out the risks and the options for managing them, she admitted to gaps in knowledge and then she made it clear again – “it’s your choice, we’ll support you whatever you decide”.
I didn’t just give consent, I made a choice.