Doctor acting without mom's consent

MamAmor · 01-08-2010, 12:52 PM

Hi again,

I had a birth last week where a doctor did an episiotomy without the mom's consent, just said "I'll give you a little freezing here" but nothing else. Inmediately after, she just did the cut and didn't said anything to mom until after the baby was born, she said "we had to cut a bit there..." The sewing was done by a resident doctor, with the supervision of the doctor. Mom was very tired and after she had her baby she said she didn't mind the cut.

Dr. also put an internal monitor on baby's head by saying "We will put a little monitor on the baby's head" but didn't ask the question or explained why, just described what she was doing. Parents were focusing on breathing and it seemed to me that didn't care about it at the moment. Nurses monitored the baby externaly several times during labour and baby's heart was great, they even said "baby's heart is great" several times.

I know that this could be just "my issue", not the parents's issue, but I see that all this might have been part of "the plan" between doctor and the resident doctor, where the resident got to practice sewing for example. Since mom was also asked to be on her back ("Drs. here don't attend births on your fours" a nurse said), it seems to me that all this was for the convenience of Dr. and resident, not to mention the violation to the rights of women to be informed of whatever procedure is done on them.

My questions:

Are doctores allowed to act without the consent of parents in a non- emergency situation? Would this depend on each hospital's and/or doctor's practices or it goes beyond that?

Where you ever in a situation like this? What did you do?

What is our role as Doulas in a situation like this?

What can we do at the moment? How to debref this with parents on the postpartum visit?

Any feedback from more experienced doulas?

Thanks ladies!

DoulaWendy · 01-08-2010, 01:33 PM

When you sign the admission forms upon arrival or at the pre-registration at the hospital you are basically giving the doctors consent to do anything and everything to you unless you state otherwise (verbal refusals of consent are legally binding). I have been telling my clients that when signing that form to feel free to cross out anything or write in anything you do not want. Read everything you sign.

As doulas all we can do is try to catch a doc in the act and turn to the mom or dad and say "The doctor looks like he/she wants to perform a ________________, do you have any questions for him/her before it's done?"

Other than that just inform your clients ahead of time of their rights and let them know they need to speak up and you will do your best to give them cues (like the questions posed above) for them to know that something may be happening that is not within their wishes.

I'm sorry that happened. The only thing I can say is that I would let them process their own birth and not bring any frustrations into their experience that they may not have. If they do bring it up, they are welcome to write a patient lisason to explain their displeasure with the way they were treated. If they expressly said to the doc "no episiotomy" and the doctor did one anyways the doctor is now performing a procedure against their desires and can be sued.

I hope that helps. I have been giving The Rights of Childbearing Women to all of my clients and it helps them know what rights they do and don't have in a hospital setting:

http://www.childbirthconnection.org/...Link=0&area=27

1stimestar · 01-08-2010, 02:20 PM

This is where your experience comes in handy. Cover these things in prenatal meetings. To some clients, an episiotomy is not really on their priority list of things to avoid but you should cover them anyways. If you have a client that REALLY wants to avoid one, or internal monitoring, then she needs to express that to him beforehand in THEIR prenatal appointments and she needs to write it in her birth plan and remind her dr. when they come in for pushing. If you have one of these clients and see the dr. reaching for internal monitor or the scissors, then as Wendy said, tell the client that it looks like dr. is about to perform an episiotomy and ask if she has any questions. I really go over this with dads before hand because I tell him his wife is busy having a baby and may not be able to comprehend what I am implying but he, as the protector of his family should start asking questions if I say something like that. On the other hand, be aware that if you ask that and she says "no, it's fine" then you will feel a bit foolish and the dr. might take it badly.

MamAmor · 01-08-2010, 04:10 PM

Thank you ladies, this is very reasuring!

The couple did have a birth plan, but episiotomy was never mentioned, this was a surprise for both, the couple and myself.
Yes, surely that experience plays a great role here, I will make sure I put a lot of emphasis on this with my next hospital client!

Comfy · 01-08-2010, 10:22 PM

I see doctors taking it upon themselves to do things without explaining or telling a client what they are about to do. Especially rupturing membranes. They examine, and then just slip the hook out and sometimes say "I am going to break your water"....... not ask...... just tell, and sometimes they don't even do that. I think that it is very important to discuss in prenatals, and I feel it is one of the roles I play as a doula . I am there to tell my client what is going on. In a diplomatic way of course.

DoulaCBE · 01-08-2010, 10:32 PM

Also be aware that the specific consent for vaginal birth almost universally includes a "with possible episiotomy and repair" clause in it. I haven't seen one that doesn't.

So if clients don't want to be cut, read the consent for vaginal birth carefully and cross out consent for episiotomy and write "I do not consent" beside it and sign their name under the hand written note.

sunshine · 01-09-2010, 12:22 AM

i think it's particularly disturbing that perhaps this doctor did the epis. just so that the resident could practice sewing. that's just appalling. another reason to talk about residents and students w/ clients and let them know they have the right to refuse them.

TO Doula · 01-09-2010, 01:40 AM

It wasn't that long ago that this sort of thing was standard procedure. I rarely see it nowadays, though.

The last time it happened I apologized to the client for not speaking up quickly enough before it was done, and she said she was *glad* the doctor didn't tell her ahead of time so she didn't get scared or tense up. <shrug>

Episiotomy is uncommon here, but women worry about it and ask me about it all the time, so we discuss the possibility of surprises.

I've also seen women given scalp monitors without consent, and seen them actively lied to about rupture of membranes. It makes it hard to relax and trust the care providers.

MamAmor · 01-10-2010, 12:08 AM

Thanks again ladies, I feel much better about this whole thing now, especially after debreefing the birth with the couple today.

Since my client had mentioned in her Birth Plan that she didn't want an episiotomy done, in reality, she could sue the doctor for not even reading the BP, or for not respecting her wishes. However, she decided to talk with her own doctor about this, to make him and the rest of the team aware of what had happened, mainly to prevent future situations like this.

As far as myself speaking out, I didn't even have time to breath!, it was all sooo fast that there was not time for intervening. As well, I also think that speaking out at that particular time it could have made things worse for mom, she was already in pain, exhausted and who know how much more stress would knowing something like that would have brought. Without excusing the Dr. acts, I think that not saying anything to the mom might have been her strategy to keep thing the way there were, who knows...It is still very sad that situations like this still happen, and more often than what we think, unfortunately.