The Rights of the Childbearing Woman anywhere in the world must be taken seriously, but for the purpose of my local community I have put together some really important resources so that women have an easy reference point to go to and know that they do have rights, they can refuse treatment without recourse or shame and healthcare providers need to support women more and treat them with respect, as a person and with dignity.
The way a woman is treated during childbirth can and does have a life-lasting effect on her future.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) are the body responsible for training and examining obstetricians and gynaecologists in Australia and New Zealand, but they are also aligned with RCOG.
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As I was reading through these guidelines, I came across the section titled “Duty to inform of risks” (page 4 paragraph 2), which I found really interesting because I have never come across a woman who has said her Obstetrician explained “the alternatives to the treatment”……wouldn’t that change so many birth outcomes today!
You bet it would.
Here is an extract from that document:
“While the doctor is not required to burden a patient with unwanted information, the doctor is still obligated to explain the procedure to the patient (at least in broad terms), the alternatives to the treatment, the likelihood of a satisfactory outcome, and the more serious and common possible side effects or complications. Information should not be withheld from a patient unless the doctor believes that the patient’s physical or mental health could be seriously harmed by provision of the information.”
So in other words your Obstetrician should provide you with adequate methods of alternatives to treatment and also give you the opportunity to make an informed choice of what you want to do, not what they want to do.
Here are their guidelines on consent titled “Consent and Provision of Information to Patients in Australia Regarding Proposed Treatment – July 2016”
I have also included the National Guidance on Collaborative Maternity Care 2010.
This guideline has been released by:
The Australian Government
National Health & Medical Research Council
Department of Health & Aging
In this document it clearly states:
A woman decides who she involves in this decision-making process, be it a health professional, partner, doula, her extended family, friends or community (see Box 2.2), and should be free to consider their advice without being pressured, coerced, induced or forced into care that is not what she desires (McLean and Petersen 1996).
Women have the right to decline care or advice if they choose, or to withdraw consent at any time. Therefore, if a woman declines care or advice based on the information provided, her choice must be respected (UNESCO 2005). Importantly, women should not be abandoned because of their choice (FPA Health and Read 2006, Faunce 2008; NHMRC consultations 2009).
Even the Australian Medical Association (AMA) has it’s own Position Statement and Ethical Guidelines surrounding maternal decision making and one of those guidelines is: “A pregnant woman’s capacity to make an informed decision should not be confused with whether or not the doctor (medical practitioner) considers her decision to be reasonable, sensible or advisable. A doctor may not treat a competent pregnant woman who has refused consent to treatment. Recourse to the law to impose medical advice or treatment on a competent pregnant woman is inappropriate.”
The Australian Law Reform Commission (ALRC) is a federal agency that reviews Australia’s laws to ensure they provide improved access to justice for all Australians by making laws and related processes more equitable, modern, fair and efficient. The ALRC also provides a comprehensive resource about “informed consent to medical treatment” for all states and territories in Australia.
The Australian Charter of Healthcare Rights was developed by the Commission in 2007 and 2008. The charter was developed with extensive and widespread consultation and specifies the key rights of patients and consumers when seeking or receiving healthcare services. In July 2008, Australian Health Ministers endorsed the charter as the Australian Charter of Healthcare Rights for use across the country.
The charter applies to all health settings anywhere in Australia, including public hospitals, private hospitals, general practice and other community environments. It allows patients, consumers, families, carers and service providers to have a common understanding of the rights of people receiving health care.
“This article looks at human rights in the area of maternity care, following a recent UK legal case. In the past it used to be that a doctor tells the patient what to do and the patient had no choice but to follow. Now, it is not enough for doctors, midwifes, nurses and others to recommend treatment, even though they may look at the scientific evidence when advising medical care. They must also listen to the women/patients, and hear what they want and don’t want. Treatment that is both compassionate and based on medical evidence is connected to human rights in general, and should be taken in to account when decisions are being made about care.”
The Royal College of Obstetricians and Gynaecologists (RCOG) is a professional association based in the UK.
Its members work in the field of obstetrics and gynaecology, that is, pregnancy, childbirth, and female sexual and reproductive health.
RCOG set the standards for the clinical practice of obstetrics and gynaecology in the UK and across the world, including Australia.
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There is a lot being shared regularly in social media and many of the pregnancy and birth groups about the Rights of the Childbearing Woman and more particularly the right to consent or not to consent to medical and obstetric procedures.
I have included a link to the handbook “Obtaining Valid Consent “ Clinical Governance Advice No. 6” released in January 2015 by RCOG.
I believe this will be a very good reference for women to read and quote from if they feel they are being bullied, coerced and pressured into something they do not wish to do.
One section says:
“When consent has to be obtained from a woman during painful labour, such as to perform a vaginal examination, episiotomy, operative delivery or to site an epidural, information should be given between contractions. If appropriate, upon admission in labour or for induction of labour, consideration should be given to the provision of summarised information concerning possible procedures and interventions.Women should be encouraged to express their views on such procedures so that their carers are aware of the choices made by the women and act accordingly.”
There is also a very good article written by the Ethics Committee at the American College of Obstetricians & Gynaecologists, which states:
“The use of coercion is not only ethically impermissible but also medically inadvisable because of the realities of prognostic uncertainty and the limitations of medical knowledge. As such, it is never acceptable for obstetrician–gynecologists to attempt to influence patients toward a clinical decision using coercion. Obstetrician–gynecologists are discouraged in the strongest possible terms from the use of duress, manipulation, coercion, physical force, or threats, including threats to involve the courts or child protective services, to motivate women toward a specific clinical decision.”
Make sure you and your birth team are all on the same page.
If they are not, then you need to make a choice to stay and have your birth choices stolen from you, or seek out alternative care.
Your first priority is to focus on your wants and needs.
I believe all women should have a copy of these very important documents when they are discussing their birth preferences, consent and withdrawal of consent with their healthcare providers and support people.
My name is Vicki Hobbs and I am a Certified Childbirth Educator, Hypnobirthing Australia Practitioner, Remedial Massage Therapist specialising in Pregnancy Massage, Spinning Babies Practitioner, Birth & Postpartum Doula, Certified Placenta Encapsulator, Hypnotherapist, Aromatherapist, Reiki Practitioner and Life Coach. I am based in the northern suburbs of Perth and can be contacted by email by [email protected] or phone (08) 9303 9111.