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”
“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”
“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.
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