Medical consent

[emma_in_dream]

I want to write about the birth (and the issue of medical consent) before I forget it.

Going through labour made me realise how meaningless the issue of medical consent is. When I had the epidural the doctor explained the possible side effects, but it was merely an exercise he had to go through for legal reasons.

I could only hear intermittently. When I was in the midst of a contraction, I could neither hear or see. I could only feel pain.* It was as though he was speaking in another room, sometimes inaudibly.

I could certainly not speak in response. Or understand what I could occasionally hear.

And, frankly, even if I had been able to understand him, I would have taken it even if he was saying there was a ten per cent chance of a crocodile eating my head.

Now it didn’t matter because I had done lots of reading beforehand. I could occasionally hear him and recognised some of the risks he mentioned. And I had written down that I wanted an epidural in my plan, as well as signing a heap of papers beforehand which I think included permission for an epidural.

On the other hand, it made me think about how meaningless it must be for doctors to ask for patients to make decisions in circumstances where they are unexpectedly in pain and have to make major life decisions.

The law considers us to be rational beings at all times - it’s a legal concept called the reasonable man (ie. what would a reasonable man do) - but there are obviously circumstances when we are incapable of researching, measuring options and making the best decision.

I was particularly wondering about the experiences of my friends who have had serious illnesses. I was wondering if you wanted to talk about it.



* Lots of pain. I had always heard that morphine was a strong drug. They gave me some and all it did was alter the pain from so unendurable I was barely conscious to unendurable.

Comments

[lauredhel]

Having been on both sides of the medical consent equation... for one thing, while you're explaining or asking anything in labour (short of a get-this-baby-out-within-two-minutes emergency, which happens vanishingly rarely), you stop during contractions. So, well, yes. If you assume the "reasonable man" approach applies to both sides, continuing the consent speech during a contraction was not a reasonable thing to do.

We had some pretty major issues around consent when the Lad was in his first 24 hours or so, and I was extremely unhappy with the paediatrician's approach and decisions. He was rude and dismissive, and his decisions were wrong.

When I was sick in hospital (the worst time), I was pretty happy with the approach to consent. I had my people in the room who could understand and help during the biggest discussion, the options were explained pretty carefully, and the prep (having a central line, etc) was managed well. The only part of the team I had a problem with was radiology and their completely non-existent privacy and safety arrangements.

[emma_in_dream]

Re the epidural guy talking while I was in contractions - he was obviously in a hurry, was over three hours late to see me, and had people literally shouting at him through the doorway about his next job. Just the right circumstances for an accident.

[lauredhel]

Ugh, that sounds like a really horrible situation to have someone sticking needles in your spine :/ I'm sorry.

[fred_mouse]

I have quite atypical birth experiences, but the thing that comes to mind was having my choices disregarded by the midwife with eldest. Partly this has to do with the fact that she had seriously miscalculated how long the delivery would take, given that it was my first baby, and that I had called her the minute my waters broke. Which meant when she got to examining me, she was completely unwilling to provide any pain killing options before an internal exam, and I was pretty much already in (or through?) transition by that stage, and cranky as all get out.

I do remember absolutely flatout refusing to do something that she wanted me to do. Having said that, I would be interested in talking with my three attendants to see whether they remember the same things.

On the other side of the coin, while my health issues haven't ended up with me in hospital, I do find it very exhausting dealing with doctors, because I spend a lot of time feeling like I'm being fobbed off. The most recent one is good - telling her I'm a medical researcher means that she shows me the test results, and trusts me to understand what they mean.

[emma_in_dream]

Yes, the nurse kept telling me they weren't contractions but just the baby settling. I was offered a hot water bottle and a panadol. When she finally examined me I was fully effaced and 6cm dilated.