'It felt like a violation of my rights': the issue of consent during childbirth

Amy Dawes and her baby Ellie just after birth.
Amy Dawes and her baby Ellie just after birth. Photo: Supplied

When Amy Dawes left hospital in 2013 after giving birth to her first daughter, Ellie, she brought home more than just a newborn.

Ms Dawes suffered a host of serious injuries from the birth, including a third-degree tear and bilateral avulsion, with her pelvic floor muscle being torn off the bone.

After 21 hours of labour, doctors declared a cesarean or forceps were needed, despite Ms Dawes "begging" for more time to push. Neither she nor the baby were in distress, but forceps ended up being used.

"That's when my world changed," she says. "It felt like a violation of my rights – no one told me what could happen or what the risks were. And that's not OK."

Childbirth is one of life's few big events where unpredictability is almost guaranteed. There is, however, a fine line between necessary medical interventions to ensure the safety of both woman and her baby, and decisions made that violate a woman's rights, and her body.

Lack of adequate consent and understanding about birth-related procedures has led to women being diagnosed with post-traumatic stress disorder, left to care for their newborn while also battling symptoms including difficulty sleeping, an increase in feeling angry and irritated, memory problems or feeling destructive.

Under Australian law, doctors cannot perform a medical procedure without the explicit consent of the patient, unless there is a genuine emergency.

Data on the number of women this affects is not collected. Medical Republic, an online community of doctors and health journalists, has claimed "tens of thousands" of Australian women have been traumatised by their birth experiences.

Janelle McAlpine has been working as a midwife since 2012 and is horrified by some of the births she has witnessed. She recalls a woman in labour being forcibly held down and sedated against her will because she had objected to a doctor's actions.

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"I've witnessed some births that haunt me."

Ms McAlpine says childbirth can be a complex issue, especially when "heightened emotions are involved", adding that there is a big difference between a genuine medical emergency and simply a birth that is deviating from expectations.

"There's various degrees of coercion being performed on women, and an expectation that women will just do as they're told - it's taking advantage of her vulnerability."

She says too few doctors seek consent and instead assume, because a woman is in hospital to give birth, she is okay with anything being done to her body.

"Yes, there are times when a woman or babies life is in danger and it is absolutely essential that a caesarean is performed. But informed consent is done very poorly."

Ms McAlpine says it is essential that expecting mothers are properly informed of their options and right to refuse well before their due date. But in reality, this largely doesn't happen, at a cost to women giving birth.

Professor Peter Dietz, an obstetrician and gynaecologist at the University of Sydney's Nepean Clinical School, believes doctors have an ethical and legal obligation to ensure every pregnant woman is aware of her choices, and the risks involved.

He says a significant reason for this not happening is that the rate of pregnant women receiving a full medical assessment – and a chance to consent or refuse future treatments – has fallen drastically.

At Gold Coast Hospital, for example, the number of women receiving this assessment has fallen from 85 per cent in 2011 to 55 per cent in 2015.

Anecdotally, he says the same fall is occurring in New South Wales.

"Obstetric patients, like any other, are entitled to be told about all material risks. This includes the degree of personal risk in an attempt at natural birth and the overall and relative risks of interventions that might be indicated," he says.

Ms McAlpine claims junior doctors are far more likely to perform caesareans rather than let a birth continue naturally.

"The more senior and the more experienced a doctor is, the less likely they are to perform these things unnecessarily, like a vacuum, and the less damage they do."

A 2014 Queensland study found 35 per cent of women are given an episiotomy without being informed, let alone consenting to it.

Since 2014, women across the world have been sharing their stories online, using the hashtag #BreakTheSilence. Many discuss feeling violated, helpless and later ignored by medical staff. In the overwhelming majority of cases, these women are left without any professional support such as counselling or physical therapy.

Ms Dawes says there is power and healing in sharing experiences and stories, especially for women who felt dismissed or their complaints ignored. She co-founded the Australian Birth Trauma Association to provide support to other women and help educate future expecting mothers about their rights and choices.

She says it took 16 months to realise the extent of her "life altering" injuries, and was devastated by being forced to undergo a forceps delivery.

"Personally, I cried a lot in that early postpartum period and I just thought that things would get better on their own," she says. "But when I found out how serious my injuries were, I went to an extremely dark place."

Ms Dawes was eventually diagnosed with depression and anxiety, and prescribed anti-depressants.

"I didn't understand the full implications; I just assumed that I would get better, not realising how much worse my injuries would get. Luckily, I had a wonderful support network, but it's an ongoing battle."

Professor Dietz says doctors and practitioners need to examine their "motivations" and stop "infantilising" women.

"Instead... give all women a full medical assessment of their risks and their options [and] respect the decisions that they have a right to make for themselves."

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