When is consent not consent?
Well, there are several possible answers to this, and all are worthy of debate, but this blog post focuses on just one.
The kind of so-called consent that is sought when someone is halfway through performing a vaginal examination which a woman has consented to and, out of the blue and before removing their fingers, asks the woman if she would like to have another procedure performed at the same time.
This post is excerpted from my book, “What’s Right For Me? Making decisions in pregnancy and childbirth.”
I’m sharing it here as well because I think it’s something that everybody needs to be aware of.
Non consensual intervention
This procedure is usually the breaking of her waters or (in countries where intervention in pregnancy is even greater than average and vaginal examination is carried out during pregnancy) a stretch and sweep.
I was horrified to receive several emails about this after I published the first edition of What’s Right For Me?
Because it is not justifiable and it flies in the face of the notion of informed decision-making.
Why is this inappropriate?
First, both of the procedures given as examples above (ARM and stretch and sweep) might sound innocuous, but they are means of attempting to induce (bring on) and/or augment (speed up) labour.
Some women might well decide they want to have them, after they have had a chance to weigh up the risks and benefits, but they are interventions which can affect the outcome.
Women deserve to have time to think about them, seek more information, consider their options and discuss them with loved ones.
None of which is possible or practical while one is being examined in that way.
Most of which might not even be possible or practical for some women while they are in the company of a waiting professional. But I acknowledge that this depends a lot on the relationship between the woman and her attendants and that there are occasionally times when this might be unavoidable.
Those are very rare though. (But before anyone asks, one example is a situation where a midwife or doctor finds a loop of cord and is concerned about the baby’s wellbeing.)
These are not emergencies!
Neither membrane sweeping nor membrane rupture is an emergency procedure, though.
Nor are they offered in situations in which speedy decision-making is necessitated.
Many – perhaps most – women find vaginal examinations uncomfortable, embarrassing and/or painful.
For some women, vaginal examination is physically and/or psychologically excruciating.
Women will not always tell their attendants if that is the case, though. In some cases because they do not know the attendant well enough to trust them, or because the only possible response for them is dissociation. Either way, they want each one to be over as soon as possible. In some cases, a woman might agree to anything in order to get the examination to stop.
That is not informed decision making.
We need clinicians to think
I don’t think that every practitioner who does this is necessarily setting out to coerce or harm. I can see how, from a technocratic perspective, they might genuinely think that it’s kinder to save women from having an additional examination. Or they might not have thought about the ramifications of this.
But it’s not okay, on any level.
Please, if you attend births and have ever done this, think about what it does to the women you care for. And never do it again.
What should you do if this happens to you?
If this happens to you while you are receiving any kind of health care, you are completely within your rights to tell the attendant to finish examining you before discussing any further decisions. Or to tell them to stop immediately.
You can say ‘no’ or ‘stop’ at any time.
If someone continues to touch you after you say ‘no’ or ‘stop,’ this is an assault, and you should report it.
Being clear about consent
Some people suggest to women that they are very clear with the attendant before they consent to a vaginal examination that they are not consenting to any related intervention and that they do not want to discuss further interventions during the examination.
That isn’t a bad idea at all. But women should not have to be proactive in this way. Given the enormity of the interventions and the invasive nature of some of the examinations carried out in maternity care, the emphasis should be on attendants to initiate such discussions only at appropriate times.
But it is the reality that modern maternity care is fragmented, standardised, and often impersonal, which is why it’s a really good idea to get informed ahead of time and to take responsibility for the decisions you make.
If you’d like more information on to support you in making the decisions that are right for you during pregnancy and childbirth, grab a copy of What’s Right For Me: making decisions in pregnancy and childbirth.
You may also find a couple of my other blog posts useful, as they cover related topics:
About the Author: Dr Sara Wickham is an author, speaker, and researcher specialising in pregnancy, birth and maternity care. Her work focuses on evidence-based, woman-centred information and informed decision-making, drawing on more than 30 years of midwifery knowledge and experience.
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