I have been absolutely astounded by the lack of knowledge around this topic from many people who support women through childbirth and beyond in many guises. Understanding this topic is what has driven me to delve deeper into the world of pregnancy and childbirth with the goal of supporting as many women as possible. That is because every single day in Northern Ireland women’s human rights are being violated in childbirth – a sensational statement but stay with me and see what your thoughts are by the end.

At this point I feel like I need to give fair warning. There is discussion of stillbirth and violence against women in this post and it may bring up different thoughts and emotions around your own birth experience as you learn about consent.

Human rights are basic rights that apply to every human being regardless of gender, race, religion or opinion. They set a standard for everyone to be treated with dignity, equality and mutual respect. Basic human rights do not change during pregnancy or childbirth.

The Human Rights Act 1998 protects the human rights of those in countries of the Council of Europe, including the UK. 

Article 3, prohibition of torture, protects your right to humane and dignified treatment. Causing unnecessary suffering or withholding pain relief would contravene your human rights under this Article. Making a woman stay in a position that is clearly uncomfortable for her that has no benefit to her or baby, could be argued as causing unnecessary suffering. Continuing with a painful vaginal examination when asked to stop, continuing to insert a cannula when asked to stop – unnecessary suffering but also against consent law which I discuss further below. Think about that statement you may have heard about “leaving your dignity at the door” when giving birth. Experiences such as being left naked and exposed on the bed during an epidural or in the throes of labour, having strangers enter the room unannounced, allowing students to observe without asking before labour, being told you are being too loud or overhearing hurtful comments about your appearance or actions (all true events). Why should a woman have to feel like that during what should be one of the most empowering experiences of her life? Well she shouldn’t, it’s against her human rights let alone common respect and kindness.

Article 14 sets out the expectation that everyone receives basic human rights without discrimination. This makes it unlawful for caregivers to withhold care or treat any pregnant woman differently based on her race, religion, age, nationality or or other biassed opinion. The latest MBRRACE-UK report (Knight et al., 2020) raises some questions on the basis of race  and, with the background of our wee country, it would be interesting to know if anyone has experience of this in the past. We also have a significant travelling and migrant population, are they treated unfairly? There is some suggestion that they are based on grant aid to provide doula care to minority groups and statistics that show higher mother and baby mortality and morbidity rates in minority groups.

Article 8 (a big rabbit hole coming) specifically protects your right to respect for a private and family life which includes your rights over what happens to your body. You must consent to any treatment, procedure or medical intervention offered to you and can withdraw consent AT ANY TIME, including during the procedure.

During pregnancy and childbirth, caregivers are lawfully bound to receive consent from the woman for any test or procedure that they wish to carry out on her. Therefore, it is important to understand what constitutes consent under the law. In order to give consent it must be informed which, according to international birth rights lawyer Hermine Hayes-Klein, contains 3 parts (Wilmot, 2022):

INFORMATION – what is the clinical situation, what are ALL the options available to you and what are the benefits AND risks of each. Options include interventions that the maternity services can provide and the option of doing nothing at all.

ADVICE – what does the clinician advise and why from a subjective standpoint. This does not mean telling you what option you are allowed or not allowed to choose. And you are “allowed” to choose the nothing at all option.

SUPPORT – whatever the decision, the woman is supported through that option, including one that is against advice. In midwifery practice this is called “Care Outside Guidance”. In this publication for midwives by the Royal College of Midwives, informed decision making, midwives duty of care and human rights are outlined.

Consent must also be given voluntarily and freely to be legally binding i.e. without coercion, persuasion or threat from anyone else. In reality, this means without what many call the “dead baby card”, meaning that a woman is told her baby might die if she does not consent to a particular intervention. Shocking that it happens so often it has been given a name, but true. And while there may be an increased chance of stillbirth in the clinical situation the woman finds herself in, it does not mean that it will actually happen nor does it mean that agreeing to the intervention will guarantee that it definitely will not happen. Other forms of coercion or threat include: 

• Saying they (the consultant or midwife) will get in trouble if they “let you” do something they don’t want you to do.
• Telling you it’s policy so they have to do something (e.g. 4 hourly vaginal examinations might be policy but policy does not trump human rights should you refuse to have them.)
• Saying you are not allowed access to certain services if you don’t consent to something (e.g. you’re not allowed access to the MLU or labour ward without a vaginal examination – this may be policy but, again, policy does not trump human rights.)
• Using hurtful, judgemental or belittling comments such as commenting on BMI, implying you used “doctor Google” to get your information or calling you “emotional”.
• Asking your partner to carry out their wishes in hope you comply.
• Threatening referral to Child Protection Services.

All of the above are real life examples, some taken from a report on coercion that you can find here.

The only times that consent is not required is when a person is unable to give consent which means they are unconscious, or are deemed to not have capacity. Not having capacity means they cannot understand the information given or communicate their preference, but this is very rarely the case and can only be used by appealing to the Court of Protection.

I have outlined what informed consent lawfully is so those of you with experience can decide for yourselves if this is what you gave and hopefully everyone can be more aware of what they need in order to give it in future. However, there is an even uglier side to consent and that is where it is not even attempted. This is fairly self explanatory but it doesn’t change the fact that it happens to many, many women and often without their knowledge. Examples of this are being told “I’m just going to give you a wee cut to help the baby out” (an unconsented episiotomy), “I just gave you a wee sweep while I was there” (and unconsented sweep during a vaginal examination), the breaking of waters while doing a vaginal examination (I was once told a horrifying story of a woman having her waters forcible broken by a senior midwife while screaming for her to stop), and many other (some much more violent) examples.

A fairly new term has been coined to cover what is happening to our human rights in childbirth – Obstetric Violence. Again, shocking that it happens so often it is given a name, but true. 64% of clinical claims against the NHS during 2022/23 were from Obstetrics related due to negligence of many forms and it is clear that not everyone who experiences neglect or mistreatment would feel able to make a claim.

So, if you are still with me, what are your thoughts? From my own experience and from listening to general language used around birth, it seems to me that truly informed consent is rarely given in the case of childbirth. Many people are happy just to do as they are advised, which is of course their right, but they should still be given all the subjective information and advice prior to giving consent. I have personally heard stories from midwives and mothers of what would be legally termed assault and battery on a woman during pregnancy and childbirth. Although this is the case, there seems to be an unwillingness to take such cases against medical staff as well as an unwillingness for the police to pursue them. AIMS is one organisation trying to change this. I hope that by spreading the word and educating women on their rights I am doing something to help mothers and babies begin their journeys more peacefully. Childbirth is a rite of passage (check out Dr Rachel Reed’s book on this subject here) and is meant to prepare us for our journey into motherhood. How women and babies experience this transition is so important and I believe mothers must take responsibility for how this unfolds because no one cares more about her baby than the mother.

If you would like to know how I can help you during pregnancy, labour and postpartum please get in touch (contact details here) or book a free 15 minute discovery call here.

References

Knight, M. et al. (eds) (2023) Saving lives, improving mothers’ care. Available at: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2023/MBRRACE-UK_Maternal_Compiled_Report_2023.pdf (Accessed 7 May 2024)

Wilmot, K. (2022). Hermine Hayes-Klein Human Rights in Childbirth. [podcast] The Virtual Midwife. Available at: https://podcasters.spotify.com/pod/show/virtual-midwife-podcast/episodes/Hermine-Hayes-Klein-Human-Rights-in-Childbirth-e1fmi2t/a-a7ir427 [Accessed 7 May 2024].