Monday, February 2, 2015: The Association for Improvements in the Maternity Services Ireland (AIMS Ireland) today released the first wave of statistics from their “What Matters to You?” 2014 (WMTY) survey highlighting statistics for consent in pregnancy, during labour and birth, and following the birth of the baby in the Irish Maternity System.
The findings of nearly 3,000 women, whom had given birth in Ireland in the past 5 years found that while 67% of women agreed that consent had been sought during labour and birth, 52% of those surveyed did not receive information on potential implications to have or not have tests, procedures, treatments to assist with their decisions, and only 50% felt able to make an informed refusal during their labour and baby’s birth.
AIMS Ireland spokesperson, Krysia Lynch, “While the overall rates for consent appear high, the quantitative statistics suggest that informed consent and refusal remain an issue of concern with only 50% of women being provided with the necessary information to assist them in informed decision making. The qualitative data, comments from women, provide us with very worrying information as many women commented that consent was either implied as the procedure was being carried out “we are just going to break your waters now”, or women felt that while they consented, they did not have any choice in doing so.”
The survey also showed that consent and informed consent/refusal were higher for procedures, tests, treatments in pregnancy and following the birth of the baby, than during the labour and birth of the baby, which AIMS Ireland contribute to underlying issues in Ireland’s National Consent Policy.
Krysia Lynch, “The Irish National Consent Policy directly questions a pregnant woman’s right to refuse treatment. This has a serious implication on a woman’s right to make informed decisions outside of clinical recommendation in Ireland. Many of the current routine practices in Irish obstetric led units do not meet evidence based recommendations yet as they are practiced across the board, women who choose to opt out are not supported in many instances. We saw this in the Hamilton v HSE case. The drop in rates of consent and informed consent/refusal during the time of labour and birth suggests that this policy is very much reflected in practice within Irish maternity units.”
Lynch concludes, “AIMS Ireland believe that women should be informed of all the benefits, risks, and potential implications on themselves and their baby for having or not having procedures in order to make the best decision in their circumstances. Women cannot truly give consent unless they understand what it is they are consenting to and are supported in these decisions by health care providers.”
AIMS Ireland will release the over-all consent statistics, as well as the statistics per individual obstetric units and midwife led care options this week.
The WMTY 2014 survey had 101 questions on issues relating to women’s care in pregnancy (ante-natal), care options, consent, labour and birth, and following the birth of their baby. The survey was self-selecting and nearly 3,000 women participated making it the largest survey of this nature to date. AIMS Ireland will be releasing data over the next few months.
AIMS Ireland Media:
Krysia Lynch: 087 – 754 3751
What Matters to YOU? 2014 – Main Findings : Consent, informed consent and informed refusal
Respondents Comments – Qualitative Data WMTY 2014 – Consent:
Many women responded that while consent was sought, they often felt they did not have a choice.
“Consent was sought at all times but I felt pressure that the only option was to agree with what was proposed.”
“Formally yes (consent was obtained), but I wasn’t in favour of being induced, it was never presented as an option but rather as a decision made on my behalf.”
“most things were not presented as a choice. “We have to do such and such” was the usual “choice.”
” I repeatedly impressed my wish not to have oxytocin and this was disregarded and I was treated like I was being silly. I reluctantly agreed but I felt badgered into submission rather than consenting.”
AIMS Ireland also found that many women were cited with ‘hospital policy’ and/or risk to their baby in order to obtain consent.
“Benefits of procedures to hurry Labour up were told, risks of these procedures were not told. Benefits of waiting were never once told.”
” I didn’t want to be induced but in (unit named) the policy was to induce when 10 days over; I didn’t agree with this policy but felt I had no choice but to comply”
” I found the midwives wanted me on my back for birthing as it was easier for them and that even when I requested to kneel as I had no power to push that this was not supported”
“At every intervention I was threatened with catastrophic consequences if I refused such as ‘if you don’t have an episiotomy right now the baby won’t make it’…’if you don’t take antibiotics the baby might have cerebral palsy'”
“I was told by the midwife that I had to have my waters broken in order to get an epidural (I found out afterwards this is actually not hospital policy).”
“I was told I had no choice when it came to my treatment, everything was ‘hospital policy'”
“My consent was sought but I was very much led to believe it would be negligent not to consent”
“nothing was done without my ‘consent’, but is it consent when you are bullied into it… as how do you get round the ‘put the baby at risk’ card even if you know that what you are asking is in line with best practice…?”
Other women described how procedures were performed without consent with many women citing breaking of waters, episiotomy, membrane sweeps, and CTG as issues:
“Did not know my waters were going to be broke at examination the doc just did it thought she was just checking how the gel was working.”
“They broke my waters without consent. I was told by the consultant that she did not need my permission to break my waters.”
“The following procedures were performed on me without explanation or my consent being sought: – ARM – Pushing back a cervical lip A CTG machine was applied to me and when I asked for it to be removed this was refused. My attempts to remove it myself were prevented. I was also physically restrained in a position I was not comfortable in (flat on my back) and verbally abused when I did not want to engage in purple pushing.”
“My consent was only sought for internal exams. I was given an episiotomy without being asked. I wasnt even informed that the consultant was going to do one it was just done. I was given drug to deliver placenta without my consent or knowledge even though I had on my birth plan that I did not want either an episiotomy or injection for placenta delivery”
“Monitor placed on baby’s head without telling me what they were doing”
Many women described their experience very emotively
“It was awful, felt like medical rape.”
“I found it very traumatising and felt that no one listened”
“No permission sought for anything. Intervention for no reason. Treated like a lump of meat.”
“Never setting foot in (hospital named) again”
Others described very supportive care where care providers went out of their way to ensure that women were informed and decisions were supported.
“very thorough info given before c section and it was repeated on several occasions”
“The midwife assigned to me was very very empowering as she saw my hopes for a natural birth disappear… she made me feel that I was in control throughout the labour and was very conscious of my need to be guided rather than forced into anything. At times the supervising nurse was suggesting moving things along and my midwife was very firm in her support for me, my partner and our rights. This means that despite a somewhat traumatic birth experience I didn’t feel ‘voiceless’.”
“Even though I was induced, had waters broken, put on a drip (all due to previous stillbirth) I made all of those decisions, decided when they would do things, how they did them. They listened carefully to me, and I was in total control of my birth”
“Consent was verbally sought for most tests and procedures”
Other women felt that consent was not applicable to them, did not arise, or that they trusted health care providers in their recommendations.
“8cm when arrived in hospital”
“My birth was very fast so there wasn’t time for tests, etc. Midwife did explain everything she did though”
“At one stage I was barely conscious so consent was obtained from my husband”
“I had an unassisted birth”
” I was absolutely out of my mind on pain relief and I can’t even remembering them asking”
” Crash section, no time”
“Not enough time, had to trust my midwife completely”
” Homebirth with a SECM”
Others were able to make an informed decision but described this as being difficult ‘a fight’
“I had to fight hard, and I still didn’t get the birth I wanted. I got the birth I wanted in the sense that my baby and I are well and I didn’t have interventions, but it wasn’t pleasant in the hospital.”
” I felt I had to be very vocal/pushy to have my concerns listened to”
” I was listened to because it was my second baby and I forced people to listen to me – you learn from the 1st experience”
AIMS Ireland WMTY 2014 Consent Results:
In pregnancy, was consent fully sought for all tests, procedures, treatments?
In Pregnancy, were you fully informed of benefits, risks, and potential outcomes to have/not have tests, procedures, and treatments?
In pregnancy, were you given the opportunity to make an informed refusal of a test, procedure, treatment?
Labour and Baby’s Birth
In labour and during your baby’s birth, was consent fully sought for all tests, procedures, treatments?
In labour and during your baby’s birth, were you fully informed of benefits, risks, and potential outcomes to have/not have tests, procedures, and treatments?
In labour and during your baby’s birth were you given the opportunity to make an informed refusal of a test, procedure, treatment?
Following the birth of your baby was consent fully sought for all tests, procedures, treatments?
Following the birth of your baby, were you fully informed of benefits, risks, and potential outcomes to have/not have tests, procedures, treatments?
Following the birth of your baby, were you given the opportunity to make an informed refusal of a test, procedure, treatment?