Hospital Policy – Not The Same As Road Rules

You MUST follow road rules. You are not obligated to do everything you are told to do by a hospital, doctor, midwife, or nurse.

Hospital Policy – Not The Same As Road Rules

Women are not legally obligated to submit to hospital policy when they give birth, or at any time during pregnancy. Although pregnant women are expected – by their families, by medical professionals, and even complete strangers – to follow the instructions of health care providers, to ignore their own wishes, because to have ideas about how we’d like to meet our babies is viewed as unrealistic and secondary to safety.

The law is quite clear though, pregnant women are NOT crazy or irrational, they have complete decisional capacity. Furthermore, they are entitled to make their own choices in pregnancy and labour, and care providers must provide the service that is sought.

When a woman says:

“My doctor / midwife is letting me go until 41w before I have to be induced”

or

“Foetal monitoring is compulsory at my hospital, it’s their policy”

We can instantly establish two things:

  • That the care provider in question has not been upfront about the difference between a legal requirement for pregnant women versus their own personal preference for practice and the policy of the institution at which they practice.
  • That they have not been living up to THEIR legal requirement: that they provide what is known as INFORMED CONSENT (but is perhaps better titled Informed Decision Making).

Using the two scenarios above, what we SHOULD be hearing women say is:

“My doctor / midwife has discussed the choices I will have when I reach 41w. I am currently weighing up the benefits and risks of an induction and waiting for my baby to be born”

and

My hospital offers continuous intermittent monitoring in labour. They have provided some reading material to help me choose”

So just to be very clear about that; When a doctor, nurse, or midwife, tells a woman that their hospital policy is concrete; when they don’t discuss benefits AND RISKS; when they don’t make it clear that a woman is legally entitled to refuse, THEY ARE BREAKING THE LAW, because the law requires informed consent, and supports informed refusal.

When a woman declines anything in pregnancy or labour she is not breaking any laws.

Doctors, midwives, and hospitals do not “let” women do anything because they have no legal power which grants them “letting” rights. The law grants the pregnant woman sole dominion over all the decisions that affect her and her baby. A doctor, midwife, husband, or the family of the woman, can not make decisions on her behalf unless a court awards one of them medical power of attorney.

(Frighteningly enough we’ve seen some doctors seek and receive medical power of attorney over perfectly competent women, but that is a slightly separate topic so we won’t delve into it.  See Here )

Hospital staff regularly leave pregnant and labouring women with the impression that their policies are legally binding, however their policies are designed to make their institution work smoothly. They are not actually created with evidence based practice at the forefront, and this is apparent when different hospitals have different policies and different rates of intervention in labour. Policies serve as a guide for staff, to standardise care, not as a law for labouring women.

Birth care providers should be legally obligated to disclose their motives. Women have a right to know whether their health is under threat or whether they prefer women to have certain procedures to align with hospital policy. Care providers also need to make it very clear that they can only make recommendations, and that the decision rests with the woman.

Sadly it is not unusual for pregnant women to believe they have no say in how they cared for, this is why we see women using the word “let”, and discussing hospital policy as if they are as obliged to submit to it as they are to observe road rules. Although some care providers do explain to women that they can decline recommendations in labour, we frequently see this being recanted on the day. This is sometimes referred to as a Bait and Switch, but it can also be the result of poor communication between hospital departments.

The truth is that women are not only legally viewed as the primary decision makers, but they are extremely competent when they are “given” the freedom to do so. People who believe that women must surrender to the whims of care providers and hospital policy show a clear lack of understanding about the  importance of birth for both women and babies. The only person who can “let” anyone do anything during pregnancy and birth, is the pregnant woman herself, and the only policies that truly matter are hers.

Hospital Policy is not the law - pregnant woman on pier
Hospital Policy – not to be confused with road rules
License: Creative Commons CC0.

FOR FURTHER READING

Is Standardised Maternity Care Really A Good Idea?

Giving Birth Without An Epidural – Nothing Superhuman!

Hormones – The Most Important Factor In Birth

Is Your Doctor The Boss?

Do You Need To Help Bring On Labour?

 

16 Responses to "Hospital Policy – Not The Same As Road Rules"

  1. ASH  10 March, 2016 at 2:58 am

    If you don’t want to listen to a doctor, then go have your baby behind a bush! This article is ridiculous. Wannabe doctors.

    Reply
    •  10 March, 2016 at 4:57 pm

      There’s a few options before the bush I would have thought. Perhaps a new doctor, or a midwife – as most women around the world see. the bush might be my last choice, bushes don’t afford much shelter from the weather, or offer much privacy, and I tend to think that both are important for the safety of women and babies in birth. Wouldn’t you agree?

      Reply
  2. ASH  10 March, 2016 at 3:01 am

    “They are not actually created with evidence based practice at the forefront, and this is apparent when different hospitals have different policies and different rates of intervention in labour. ”

    Practices are evidence based and not all evidence is perfectly equal.

    Different rates of intervention in labour? That’s right… because women are machines and every woman’s body works exactly the same.

    Reply
    •  10 March, 2016 at 4:55 pm

      That’s exactly right! Not all evidence is equal. Women should be able to expect grade A, top level evidence when they hire a provider, and when their care provider isn’t offering that, women have the right to know. They might like to seek a different care provider to see for their pregnancy and birth.

      You’re also right when you say that women aren’t machines, and that is precisely why we’re entitled to the absolute top standard of care, and it should be individually tailored to suit our health as individuals with individual babies, not standardised.

      Thanks for taking the time to comment! These are such important conversations to have.

      Reply
  3. britneycroad  11 March, 2016 at 9:19 am

    The problem is that there is no law against the nurses or doctors reporting you to CPS as a negligent parent of your unborn child when they don’t like you going against policy. You might be found innocent but you’ll still be under investigation and your other kids might be taken away during the investigation. It’s not quite as simple as knowing your rights and standing up for them, unfortunately.

    Reply
    •  11 March, 2016 at 3:48 pm

      There are some good birth trauma support groups on facebook, it’s well worth joining one for some support. I’m sorry no one takes you seriously, please know that you aren’t alone.

      Reply
  4. EricaHaf  12 March, 2016 at 6:54 am

    I had been disrespected by not one, not two, but FOUR (4!!!) OBs when seeking my first VBAC. So for my 2VBAC I sought other care. Was birthing behind a bush an idea in the back of my head? Not exactly. One thing I knew for sure was that I’d had enough with being disrespected while following the rules set before me. I ended up with PTSD, PPD, and anxiety from my first two births because I didn’t feel I could exercise my rights to informed consent/refusal, and they would have been for simple things like holding off or limiting cervical checks. So when birth #3 (2VBAC) came looming, I DID exercise my right to refuse and consent to the things I found were important and necessary in the success of my respectful, deserved, 100% med-free and intervention free 2VBAC while still being in a hospital. I sought hospital-midwifery care (after being denied homebirth midwifery) across state lines, and although I still ended up with an on-call OB for the birth, I went into it feeling alot more respected, informed, and more ready than I had with my first two. And it worked to my advantage as I still had to fight for my right to refuse cervical checks with the OB.

    Despite the fighting, we are all here, healthy as can be and living life to the fullest without having more depression and anxiety looming over me from a potential third traumatic birth that was already there from the first two. I am so glad I informed myself of my rights and I was able to exercise them.

    Reply
    •  12 March, 2016 at 10:41 am

      Hi Erica! Nice to see you in this neck of the woods, thanks for sharing your story xxx

      Reply
  5. Christine Brook  22 April, 2016 at 11:32 am

    As a midwife, I love this piece, the message is well argued.

    Sadly, I have seen the ‘Bait & switch’ used against women. One woman who had been subjected to this told me that, if her husband had not been with her, and had not stood up for her rights, she would have just accepted what the midwife wanted to do, on orders from the obstetrician (orders given by phone, while he was home in bed in the middle of the night); orders that contravened what she had negotiated during pregnancy! Because, as she said “I felt so vulnerable in labour”.

    Women ARE vulnerable during labour. That’s why it’s so important for women to be able to consider, during pregnancy, options that might come up during labour, so she and her partner can consider, taking time to think about risks and benefits, how they might like to respond – forewarned IS forearmed – and for partners, midwives, obstetricians etc, to respect those choices during labour.

    Reply
    •  22 April, 2016 at 12:54 pm

      Thanks for commenting, it’s so important for women to hear from professionals within the field.

      Reply
  6. SaaZ  11 May, 2016 at 11:18 pm

    When I was being induced with my second child I got a bit fed up of decisions being made for me, and being told one thing to get me to comply then the opposite being insisted. I told the midwife to remove the pessary because I was going home. She said she wouldn’t, so I said I was going to the toilet to remove it myself. (Had already dislodged it about 3 times by accident anyway!) she said that she wouldn’t recommend that and I said that that was fine, but I didnt regard her recommendation as very important as she wasn’t a very good midwife.
    She told my husband he needed to control me because I was ignoring her requests. My husband said “I do not “control” my wife, she’s an adult human being, she controls herself. She’s just as entitled to ignore your requests as you are to ignore hers.”

    Then all of my “outrageous” requests like being in water and having an undisturbed nap with my husband, and delaying an internal exam until I felt it was nessecary, became suddenly very doable.

    But she really was a terrible midwife. She said I wasn’t in labour when I was 8cm and that I wasn’t ready to push when the baby was crowning. She nearly wet herself when I ripped the cannula out of my arm, squatted on the bed, and delivered my beautiful boy myself while my husband chuckled beside me.

    Reply
    • silver fox  22 May, 2016 at 2:22 am

      You my dear are a bad ass and I admire you

      Reply
  7. Lenna Mac  13 May, 2016 at 3:09 am

    “when they don’t discuss benefits AND RISKS;”

    Whilst I agree with pretty much everything else, this bit isn’t strictly true. There are nuances to how much health care professionals are required to tell someone about the risks of any given intervention. This is evidenced here: http://www.mentalcapacitylawandpolicy.org.uk/informed-consent-the-supreme-court-and-the-patient-as-agent/

    Reply
  8. Devon  13 May, 2016 at 7:02 am

    OB providers are sued more than most other doctors which is probably why they are so protective of their policies, because moms want to blame absolutely anyone else when something goes wrong with their babies and the last thing they may consider is that their “choices” about their pregnancy, labor and birth may have played into whatever went wrong. This is why obstetric care must be a partnership, providers must listen to their patients and involve them in making the plan of care but expectant moms need to LISTEN to their providers. OBs, midwives and nurses have spent years studying pregnancy, labor and birth and not everything they say is meant as harmful or disrespectful to the mother. It’s time articles like these shift from telling expectant mothers to be inflexible and that they know more than medical professionals and start telling them to find providers who they can trust and work in partnership with to bring healthy babies into the world.

    Reply
  9. Pingback: Wednesday Wrap Up May 18 | Andrea Lythgoe Doula Salt Lake City Utah

  10. AnonMom  31 May, 2016 at 1:33 pm

    I had to comment on this because I experienced so much of this with the birth of my son – basically being treated like I had no rights in the hospital at all.

    My doctor was aware that I wanted to have a natural birth, it was a huge part of my birth plan.

    I wasn’t “allowed” to take off the fetal monitor from my stomach so I could move around while in labor, and my doctor wouldn’t let me just have the port on my arm (I had to have the IV connected to me at all times). Eventually I took off the stomach monitor, and they wanted to do an internal monitor stating no matter what the baby’s heart rate had to be monitored at all times.

    Not one time, NOT ONCE, did they explain what that meant – the internal monitor – that something would be stuck in my son’s head to monitor is heart rate while still inside of me. We didn’t know that is what happened until after he was born, there was a pretty big red mark on his head from where the monitor was shoved into his scalp.

    Additionally, RIGHT as I entered the hospital my OB called and requested I be started on Pitocin, even though I was progressing just fine, was at 4cm, rocking and rolling. I had only just started to feel like I was in labor, while I was at work an hour before. After realizing I may be in labor while I work, I wanted to go home and labor (which was my plan), but my coworkers refused to let me drive (it became a big show in my office, “she’s in labor!! wahoo!!”). They got wrapped up in the whole “Let’s take her straight to the hospital!!” story, so my boss just wouldn’t let me go home. Imagine how awkward that was, it’s like I had no control over anything from the start. I didn’t have a bag packed, I didn’t have my family with me, so I was basically rushed to my boss’s car with some other coworkers who wanted to ride along (thinking it was so fun!). Right when I arrived they started the Pitocin.

    My husband tried to stand up for me when he got there, and told the nurse no, and they said yes – the doctor said it was going to happen – and the whole confrontation got so uncomfortable I just told him to stop & that I would do the Pitocin. I had this horrible fear we would get in trouble or something, even though deep down I didn’t want it and knew I didn’t need it. I had no idea how that would effect contractions being a first time Mom, BIGGEST regret of my delivery was taking the Pitocin.

    When my OB finally came in to deliver me, she said her main concern was a quick delivery because the next day she had to be in the office and didnt want to have to miss work. She told my husband (because he was pissed about the Pit) that she put me on Pitocin to just make my labor faster so she could deliver me before nighttime. So basically, she didn’t want her schedule to be messed up, so she just sped up my labor. I finally reached 7cm but the contractions were so horrible (I was at the max Pitocin dose one could receive at that point), that I caved for the epidural. I passed out twice at that point, so I didn’t really have a choice.

    Immediately after birth, the nurses only let me hold my son for 5 minutes they took him to the nursery for about 2 hours. Again, no reason. None. I didn’t realize I had the right to actually have him with me after birth. So I literally sat alone in my delivery room (my whole family was upstairs checking out my beautiful crying son) waiting by myself with no one in there right after I gave birth. I actually felt awful, I saw my son for such a brief moment that I didn’t even really see him. I gave birth at 9:30pm and didn’t see him again until 1am in the morning. Then the night shift nurses continually pressured me to put him in the nursery but all I could do was hold him, I was paranoid of him being taken from me!!

    I felt, throughout my entire delivery, that I had absolutely no control over my experience, my body, my baby, nothing. It was extremely traumatic, even though I had a healthy son. I suffered pretty terrible PPD from it. No one has any clue what it’s like unless you’ve been through it – it’s like your not even a person at some points, just a procedure.

    My son is now 5 years old, and I just started going to therapy to talk about the lingering anxiety. From his birth onward, I never felt I was adequate to be a mother, and my therapist (who used to be a doula & midwife assistant) finally said to me “you have birth trauma!” it was a huge wake up for me & I’ve started to process it in therapy.

    I just found out I’m pregnant with baby #2 (8 weeks along), and you better believe this mama is going all natural and may do a home birth if we can afford it. Knowing what I know now, I wont be worried to stir the pot of be a bitch. This delivery will be so different!

    To the person who said the comment about birthing behind a bush, um I would take that over my birth experience I had ANYDAY. Give me a bush. Please.

    Great article!

    Reply

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