Informed choice is the big catchphrase in the birth world. All birth workers claim to uphold informed choice and decision making. How lovely that people are finally giving the agency back to women, right?
It would be nice to think that we do have choice, but as it stands we don't. How many of our choices are taken from us before we have even begun? When you attend your antenatal appointments and are designated midwife-led or consultant-led, more often than not that dictates your place of birth. How many second time mums know that statistically the evidence says if they want to avoid intervention they should birth at home and far away from an obstetrical unit?
Even worse if you go overdue, have a prior caesarean section, carry multiples, have premature rupture of membranes, are older, or with a raised BMI. You can expect to have your choices whittled away into something considered acceptable by somebody else. To be told that you HAVE to do things a certain way. Bullying phone calls and letters through the door demanding you relinquish your right to choose.
Then maybe you arrive at the hospital in labour and have your choices completely disregarded. Perhaps you get sidelined into something you didn't want by emotive language, emotional blackmail, even tricks. Consent not clearly obtained to do procedures on you, the need for a solid yes or no hidden by ramblings about obscure risks and guidelines. How many women have been assaulted by a medical professional, be it via a vaginal examination, monitoring device or drug administration as true consent was never properly obtained?
Let me be clear on what consent is.
Consent is not... I'm just going to do this now.
Consent is not... You need to listen to ME now as the medical professional.
Consent is not... You can't do this without this pain relief.
Consent is not... You are at risk and your baby WILL die.
All of these things have either been said in my presence or witnessed by colleagues.
Consent is... Do I have your permission to do this?
Consent is... You have options. These are the percentage risk factors involved. What would YOU like to do?
Consent is... I am suggesting we do this. These are the benefits and the risks. These are the alternatives. Yes or no? What would YOU like to do?
I would really like to know... what is so threatening about a woman exercising her right to choose? Is it so inconceivable that she is capable of making her own decisions? Why do you think just because she is not doing what YOU want then she clearly must be under the influence of somebody else? Yes, record that she is declining whatever if it makes you feel better and protects you professionally, but don't force her to say it to you ten times before you'll actually stop harassing and scaring her.
Until women are seen as people and not just a set of risk factors we will not see any change. I am exhausted by this whole thing. Every day women are bullied, coerced and demeaned into things they do not want by those who claim to be protecting them and their baby. Let us be completely clear - nobody in that birth room cares more about that baby than the mother. She is the one who will live with her birth experience for the rest of her life. So many women telling their stories are angry, and rightly so. They felt that their rights were taken away and they were coerced in their most vulnerable moments.
Informed choice, informed consent, they're great phrases to bandy around but I'm beginning to believe they are worthless.