Thousands of women are having intrusive procedures performed on them during childbirth without their consent amid a continuing scandal in NHS maternity care.
A survey by the Birth Trauma Association has found that two in five women are subjected to interventions such as surgical incisions without being told or asked for permission, which is required by law.
Meanwhile, half of women who underwent surgical procedures such as emergency caesareans said they did not have the capacity to provide consent because doctors and midwives left it too late to inform them of the risks.
A lack of basic respect is leaving new mothers feeling “dehumanised”, the association said. One woman described how she was “drifting in and out of consciousness” and “covered in blood” when she was asked to provide written consent for an emergency caesarean.
Donna Ockenden, the midwife who has led inquiries into NHS maternity scandals at Shrewsbury and Nottingham, said that the failure to inform women about procedures was “unacceptable and must change”.
Advertisement
She said: “Women must be informed about the care they are receiving, every step of the way. Without open communication, women cannot make the right decisions for them, nor have full autonomy over their bodies.
“Women and their families should be at the heart of everything we do, and should not end their maternity journey feeling vulnerable, traumatised or distressed.”
By law, patients must be asked for their consent before any examination or treatment. The new survey, involving 1,584 women, found that 42 per cent had a procedure performed on them without them agreeing to it.
The most common was an episiotomy — an incision made during childbirth — which 16 per cent of women said they were subjected to without being told. Meanwhile 12 per cent had a cervical sweep — a procedure to induce labour — without giving consent. One woman said this left her in agony with “blood pouring down my legs”.
Some 70 per cent of respondents had procedures such as a caesarean section in an operating theatre, which requires a signature on a written consent form. However, more than half said they did not feel fully competent when they were asked to sign because they were too sick or exhausted.
Advertisement
One woman who was taken to theatre after being left in labour for four hours with no pain relief said: “I was then asked to sign consent forms when my mind and body were completely exhausted. I was delirious with pain and fatigue.”
Another wrote: “I didn’t feel like I had the option to say no but also was barely conscious. I was naked, covered in sick and blood and had no idea what was happening, what my options were or what I needed. I had a piece of paper waved in my face and ‘We need your consent, please sign here’ as I was already on the move to theatre.”
Other women described a basic lack of dignity. One said that ten staff members casually “wandered” into the room where she was giving birth, with none of them even saying hello, which was “extremely dehumanising”.
Campaigners and MPs have called for maternity care to be overhauled, and for the NHS to provide better education to pregnant women on birth choices, including of the risks and benefits of different medical interventions, to ensure that they can provide informed consent during labour.
Kim Thomas, CEO of the Birth Trauma Association, said: “By law, health professionals are required to obtain informed consent before they carry out a procedure, and our survey shows that in many cases this simply isn’t happening.
Advertisement
“It also shows that when written consent is needed for emergency procedures such as forceps or caesarean section, more than half of women do not feel in a fit state to give consent, demonstrating the need for conversations about the risks and benefits of instrumental birth or caesarean section to start in the antenatal period.
• Alice Thomson: NHS must end medieval maternity practices
“We need a culture change in maternity so that it is never considered acceptable to perform procedures without a woman’s consent.”
Earlier this year a landmark parliamentary inquiry into birth trauma concluded that women are “neglected, ignored or belittled while at their most vulnerable”. MPs highlighted how there was “a clear problem with consent when interventions such as forceps or caesarean sections were being carried out”.
Numerous women told the inquiry they had procedures such as vaginal examinations performed without consent during labour. It added: “A number of women also reported having their request for caesarean section denied, either before labour or during labour.”
Advertisement
The inquiry was launched by the Conservative MP Theo Clarke, who thought she was going to die when giving birth to her daughter, Arabella, in 2022.
‘I felt pressured into it. No one listened or cared’
Amber Barnes felt “pressured into something I didn’t want to do” when doctors repeatedly ignored her pleas to have a caesarean section. She said it seemed like “no one listened or cared” during the birth of her second daughter, Imelda, in December 2020.
Barnes, 36, had decided during her pregnancy that she wanted to have an elective caesarean, following a difficult first birth seven years earlier. But when she went into labour, two days before the scheduled operation, staff at her local NHS hospital in Hull insisted that she give birth naturally
“There was no medical reason why they couldn’t have done a caesarean. I got pressured straight away into having a natural birth. They said everything will be quicker and easier,” she said.
Barnes, a train conductor, was given an epidural but after several hours in labour it was clear that her baby “wasn’t going anywhere”. She was then wheeled into an operating theatre and doctors told her they would attempt a forceps delivery.
Advertisement
“Even though I signed the consent form it’s not what I wanted. I felt under so much pressure. I was in so much pain. I didn’t feel listened to. My mum had died three months earlier and I remember crying saying I just want my mum,” she said.
Her husband, Ollie, had initially not been allowed to join her in the hospital because it was during a Covid lockdown, meaning that at one stage she was left “on her own and screaming”.
Her daughter Imelda was eventually delivered healthy, but Barnes lost a lot of blood and believes that the process would have been much less traumatic had doctors respected her choice and performed a caesarean section.
