In 2022, we saw another increase in intervention and trauma (as shown in the latest Australian Institute of Health and Welfare Mother Baby Report). We saw Obstetric Violence in the headlines, thanks to new evidence published from Western Sydney University. This is a very serious issue.
The state of our maternity system reflects society’s’ attitudes towards women. We have created a hypersexualised1 society that has devalued physiology in favour of convenience technologies. The ‘standard’ perspective is a man’s world2, in the last 100 years we have seen a shift from community based birth into centralised and medicalised birth. This has intensified as technology has replaced physiology.
This hypersexualisation has evolved into a consent-focused society, which crosses over into our medical world. The consent focus is centred on this technological ‘progression’. It creates a context where not consenting (dissent) is placed in the negative. This is strongly discouraged, and in a power imbalance often impossible to respond to in any other way but compliance. There is pressure on midwives to ‘get consent’ and pressure on women to give it. When what is actually required and needed is a DECISION. (why consent when we can decide)
We see ‘birth plan’ templates offered by institutions, providing an illusion of choice. Under the guise of ‘shared decision making’, we are told we are ‘involved’, when this is but a thinly veiled process of coercion.
If we find ‘how to make a birth plan’ online, we will see variations of ‘be polite’ and ‘be sure to say thank you’. This is Negative Politeness. It has nothing to do with manners or respect, and everything to do with power. This is the appeasement we use when we seek to do things ‘off script’.
This means that consent is given in one of four ways (enthusiastic, willing, unwilling, coerced), two of which are not actually consent but the result of NO not being an option. Overlying all of this, is a legal requirement that the consent is Informed. This is often not done (listen to this Midwives Cauldron podcast episode).
If consent is ‘enthusiastic’ this means we welcome the intervention, are glad for it, understand it, and find relief with it.
If consent is ‘willing’, we may recognise a situation where an intervention is warranted and understood.
Then we have ‘unwilling consent’. This comes about when we are worn down, or worried into compliance, or perhaps we feel unsafe. We say yes because we want things to be over, we want someone to go away or we are not feeling heard. This may also be assumed consent, where we may have consented to something previously (like an epidural) without knowing it means we must also have a catheter. This is very common in maternity, as procedures are consented to in isolation, without awareness of how it will impact our options.
Coerced consent occurs when we are bullied or told you can’t do X unless you do Y. For example – you can’t get into the bath unless you permit a cervical exam. Or you Must agree to certain conditions to remain in a public homebirth program or to have a VBAC. This disrespectful behaviour may if you try to assert yourself or decline a ‘standard’ procedure. Instead of respecting your no, you are harassed until you agree. This harassment may involve scare mongering use of statistics or over emphasis of risks if you don’t agree (whilst ignoring or underestimating risks if you do). See Timing of Birth for examples of how language can be (ab)used to encourage a particular decision.
It is for this reason, that consent can not be trusted. We are processed in a system where we are an afterthought, and we are asked for consent in the moment. The system has no allowance for NO, it does not provide care providers with the support needed to facilitate this pathway. Compliance is the oil that keeps the system running.
As Bashi Kumar-Hazard says:
“it comes down to the fact that we are all of us doing our best to navigate a system that was never set up with us in the first place”
Midwives Cauldron Season2 ep13 at 33:49 minutes
references
1 Louise Perry 2022 The Case Against the Sexual Revolution Polity Press
2 Caroline Criado Perez 2019 Invisible Women: Data Bias in a World Designed for Men Vintage Books
Read More (and do not despair!)
From Bolam to Montgomery: a tale of consent
Birth Cartographer Training For Birth Workers who want to know how they can support women within this system
Mapping Your Birth gives you the tools to navigate this system on your terms.