taracnm

Logically, there is a distinction, but to the woman who feels violated, I believe the perception of harm is the same. In some respects, I believe that the woman feels that the offense is that much greater because she feels she SHOULD be able to trust and feel safe, but then experiences a betrayal of that trust. Trust is such a huge part of this, and part of the process of informed consent is to ensure that a woman does not feel she is being made to make a decision and give consent under duress. This starts with building a relationship with the woman before the potential emergency. Injury to baby is, unfortunately, one potential outcome, as a woman has the right to decline intervention. We cannot abuse a woman in the name of saving her baby. However, I believe all women really are trying to do what they believe is in the best interest of both themselves and their baby. This, again, is why trust is so important. A woman is more likely to sue a provider they don't trust, or who they feel violated them. If a patient refuses an intervention, it is up to the healthcare team to document the refusal, steps taken to gain consent, etc. to protect themselves from litigation. Although there is a blanket consent signed on admission, it does not explicitly cover all procedures, it is more of a consent to provide care, unless stated otherwise. A patient can revoke consent and decline care at any time. It does not give us license to do whatever we want. If individual procedures are covered in this consent, then it needs to be covered, in full, between the patient and provider. There is, of course, an ethical obligation to the baby, but not a legal one, as most states do not recognize the unborn as people, and the mother is the legal decision maker for the baby unless this is revoked by court order. Again, having the mother's trust allows her to make appropriate decisions based on informed guidance. When a provider betrays this trust, then poor decisions and poor outcomes are even more likely, in my opinion.

I was going to say exactly this.

Irrational is not the same as unable to give consent. I don't care if you think it is the best thing for her, or if you think she will be "thankful", it is her right to decline. I don't know of a single person who has EVER thanked someone for a forced episiotomy. Even if there is a medical emergency, there is time for consent.

It is not about the outcome, but the lack of consent

I'm sorry this was your experience. It should NEVER happen, and we cannot solve a problem we don't identify. Thank you for sharing.

It's not about the outcome, but about the lack of consent.

Yes, this is a real thing. As a CNM and former labor nurse, I can tell you that it goes beyond just "informing" a birthing woman what is going on. You must get informed consent. Think of that in the context of a "traditional" tape scenario...would being "informed" by the rapist make penetration okay? Of course not. The woman must be asked permission and have control over her own body. No one should touch a birthing woman without asking her permission, informing her on the perceived need for the touch or intervention, and the possible risks and benefits. THIS is informed consent, and does not change, simply because a baby is involved.