#8 Informed Consent in Birth with Danielle Rhodes – The Matrescence Podcast
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Kelly: [00:00:00] The birth of a baby is a defining moment in a woman’s life.
[00:00:14]Bree: [00:00:14] But what about the birth of the mother?
[00:00:16] Kelly: [00:00:16] That’s right. When a baby is born. So two is a mother.
[00:00:20] Bree: [00:00:20] This transition from woman to mother has the name it’s called Matrescence.
[00:00:25] Kelly: [00:00:25] This developmental stage is as powerful and irreversible as adolescents, and yet few women have ever heard of it.
[00:00:32] Bree: [00:00:32] So let’s talk about it.
[00:00:33] Kelly: [00:00:33] Let’s talk about it. Each episode, we will bring you honest and thought provoking conversations, evidence-based research and knowledgeable guests in order to help you emerge and more powerful and aligned version of yourself.
[00:00:46] Bree: [00:00:46] So join us, your hosts, Kelly and Bree. As we attempt to make sense of our Matrescence journey and to help you make sense of yours.
[00:01:02] Danielle. So thank you so much for joining us today. I’m super excited for this conversation and I’ve been looking forward to it. Do you want to start by telling us a little bit about yourself, who you are and what kind of work you’re doing in the birth space at the moment? Yeah, absolutely.
[00:01:17] Danielle: [00:01:17] Thank you for having me.
[00:01:19] Bree: [00:01:19] , so Danielle from sacred space and I am teaching independent birth education across Brisbane. I do do online as well, but predominantly working here in Brisbane and working one-on-one with women or in group settings, teaching hypnobirthing, which is the positive birth program with hypnobirthing Australia.
[00:01:39] Lovely. And so I actually put the question to you when we talked about recording the podcast, what do you want to talk about? What you’re, what are you passionate about? And you actually came back to me and said that informed consent is one of your favorite topics to talk about, and you incorporate that into the positive birth program.
[00:01:57] , but what is it that draws you to this
[00:02:00] Danielle: [00:02:00] topic? It is the most, or I believe one of the most important aspects of having a positive birth. And so if we don’t give informed consent and we don’t feel like we were made part of the decision making, we had ownership over decisions that we. Can feel really disempowered in our birth as opposed to women.
[00:02:23] What I see is that, you know, some women don’t have the birth that they wanted and envisioned when they did the positive birth program, but they know that they navigated the hospital system, made the best decisions that they could talk control when they felt like it was being taken away from them. And that’s the empowerment, pardon itself.
[00:02:42] And so regardless of how they actually give birth, They ended up having a positive experience because they feel so much power in what they did for themselves
[00:02:52] Bree: [00:02:52] and their baby. I love that. And I think there’s such a misconception that birth workers, birth educators are advocating for a certain type of birth, but really what you are advocating for is choice.
[00:03:04] And. Most specifically informed consent. So that leads us perfectly into where I want to start. And that is just getting to the bottom of what is informed consent, because unfortunately I think that a lot of women don’t even understand what it is. So it’s really hard to give something that you don’t understand.
[00:03:20] So can you tell us a little bit about what is informed consent? What is your understanding of what it means?
[00:03:27] Danielle: [00:03:27] Absolutely informed consent. You’ve got to build on it. It’s something that you need to build your skillset in and to even understand what it is. And you need to start with what your rights are as a birthing mother and what your options of care are, what your options through our, anything like inductions is area natural birth, home birth.
[00:03:49] You need to have that knowledge first to then know how to give informed consent. So it’s something you must educate yourself on because. Unfortunately, the hospital system doesn’t always present informed consent. So a hospital system, from my opinion, and what informed consent would look like is a care provider saying, okay, you’re presenting with this medical concern.
[00:04:16] And this is the risk of what you have. , this is what we are suggesting we do. However we could do this. Uh, what would you like to do once they’ve given you all aspects of the risks and the benefits, then handing that decision over to you to make. Mainly from the m’s choice, but also, you know, with collaboration from that care provider.
[00:04:41] So they can absolutely give their suggestions. , but really that choice should be handed back to the mother to make that
[00:04:47] Bree: [00:04:47] decision. I love that. I think you’ve touched on some really important things there, firstly, that it is. The responsibility of both the mother and the care provider, you each have separate and distinct responsibilities in terms of, in terms of informed consent.
[00:05:00] So it’s not just up to the mom to seek it. Care. Providers are actually legally required to provide it. It’s part of their role. , and also that they have a responsibility to present the information in a way that is. Balanced, they’re not advocating for a certain intervention. Like this is the best thing.
[00:05:19] This is what you should do. They actually have a responsibility to present all the information. There are risks. There are benefits. They’re welcome to advise you on what they would choose, but ultimately once they’ve provided you with that information, they then need to support you to make that decision.
[00:05:37] Danielle: [00:05:37] Yes. And to not make judgment, that they’ve made a decision that isn’t necessarily what the care provider or the hospital system is suggesting for
[00:05:45] Bree: [00:05:45] you. Yeah. Now really interesting question here, and one that I’ve recently just started to dive into myself. So if a doctor, for example, an obstetrician makes a recommendation to a mom.
[00:05:58] Does the mother have the right to decline that recommendation and to choose otherwise. And what if that indeed in dangerous her baby?
[00:06:05] Danielle: [00:06:05] Absolutely. So one of the first things, when I talk about informed consent with women is I present all my couples that come through my program with a copy of the AMA guidelines.
[00:06:16] Yes. I remember
[00:06:16] Bree: [00:06:16] getting that from you. Yeah, I love
[00:06:18] Danielle: [00:06:18] that. Yeah. It starts there and letting women know that there’s two in particular that I reference, , that basically indicate that a care provider must give you all of the evidence and the information, however, they don’t have the right to decide for you or to, , push their opinion on you.
[00:06:39] As long as you are fit and competent, then you have the right to make that
[00:06:44] Bree: [00:06:44] decision. Mm, and something that’s really interesting to me is that while we all of course prioritize the health of our baby, our babies, from my understanding as separate individuals, don’t actually have any legal rights. So even if their recommendation goes against what the doctor is suggesting and that the doctor doesn’t believe that it is in the best interest of the child, you as the mother have the right to make that judgment call.
[00:07:13] , Because you are the you’re the decision maker. You’re the one that gets to decide what is right for her, for your body and your baby.
[00:07:23] Danielle: [00:07:23] Yes. So another one that I like to reference from the Australian medical associations or the AMA guidelines that I was referencing is nber there’s 0.5 in their position statement that indicates that women should be given the benefits, the risks, the alternatives of any kind of medical procedure.
[00:07:44] And then let the women make a decision and they should courage women to have open honest conversations, which means going back and forth with the care provider. And if the care provider says, , this is why I would do this, the m should then, you know, be open to saying, oh, but I’ve heard this. And this makes me feel uncomfortable because, and that open conversation between the mom and the care provider.
[00:08:10] Is really what’s giving her informed consent.
[00:08:13] Bree: [00:08:13] Yes. I love that. Because as you said, it’s a conversation, it’s not a case of the doctor coming in or a midwife and advising the woman. And then the woman just passively accepting the recommendation that does not constitute informed consent. Does it? No, absolutely not.
[00:08:28] And so. We’ve gone through a little bit about what is informed consent, what is not informed consent? What are you, what is some common phrases and statements that you’re hearing thrown about? One comes to mind for me. , but I’m interested to hear what are some things you’re hearing from care providers that do not really.
[00:08:45] Cover that informed consent.
[00:08:47] Danielle: [00:08:47] Yeah, absolutely. I think it’s something that happens far too often in our system. And I can tell straight away when I chat to him on a phone, on the phone before we’ve done any kind of birth education together, I can tell what kind of guidance she’s getting from her care provider in the language that she uses with me.
[00:09:05] So things like saying I’m not allowed to do this. Yeah. Or I will be booked in for an induction at 38 weeks. Yeah. And those kind of. That questions or directive, shall I say? Cause they’re not a question they’re not allowing a woman to make informed decisions. Yeah. Well,
[00:09:26] Bree: [00:09:26] they’re not giving them the information, are they?
[00:09:28] Danielle: [00:09:28] They’re giving them kind of closed statements basically of we, we will
[00:09:32] Bree: [00:09:32] be doing this to you. Yeah. And I think that that feeds into a larger problem we have in terms of maternity care is that we traditionally look as at care providers, as being the experts and women are just. The passive receivers of information and they go along with the recommendations.
[00:09:49] , but that does not constitute informed consent. Uh, so the one that comes to mind for me is after I had my little boy, , I had, uh, a very straightforward vaginal delivery and my midwife said to me, okay, I’m just going to give you a little shot of Cintas and to help that placenta come out. Now I was in Garst in the newborn bubble.
[00:10:10] It was the least of my worries. I had no idea what it did, whether it was good, what the benefits were, what the risks are. But of course in that moment I went, okay, no problem. You know, like, uh, Uh, what else was I meant to do? So I think that this is a common barrier in terms of giving informed consent is that if you don’t know your care provider, if you’re meeting them for the first time on the day, or even if you have really short antenatal appointments, it really limits the ability to build on informed consent.
[00:10:41] Because as you said earlier, these should be ongoing conversations. So do you think that women can give informed consent in the moment? For example, if, , it’s been determined that her labor is going to be classified as failure to progress. And I say that in air quotes and we need an emergency C-section.
[00:10:59] Do you think that there’s time to give informed consent in that situation or that we just need to hand over our decision-making to our care provider?
[00:11:08] Danielle: [00:11:08] Absolutely. In most instances. Yeah. There is a time for informed consent and certain things of just validating a woman, Hannah, how they’re feeling in that moment and matching her with eye contact and explaining what is happening to her and her baby and to the partner in the room as well.
[00:11:27] , and explaining things of what’s happening this majority of the time there is. We make out a lot of the time that it’s this emergency, like I hear women tell me these stories where it was an emergency, but then they waited two hours to go into theater. Yes. And so how would they, do they not have time to give informed
[00:11:47] Bree: [00:11:47] consent for sure.
[00:11:48] And statistically the vast majority of emergency C-sections aren’t for non-emergent reasons. And that doesn’t mean there aren’t exceptions to that rule. Course there are, but as you said, just taking the time to personalize it and make eye contact and speak kindly to the m goes a long way. And we are still hearing these stories, , just from Kelowna, within our family and friends circles of, , they rushed me off to surgery and my husband didn’t know if I was going to die or if you know what was happening, I didn’t know what was happening to my body.
[00:12:20] And when people reflect on that experience, so often it seems as though. It’s not what happened to their body. It wasn’t how they gave birth. It was how they felt about those care provider interactions that they then reflect on as being traatic and scary.
[00:12:36] Danielle: [00:12:36] Yeah, and they become a vessel for that baby, rather than that han person, that she is a han who’s having a baby in the most vulnerable experience of her life.
[00:12:46] And same with her partner that is waiting for news. And so simply articulating to women what’s happening and asking for that informed consent and also using language for women that they actually understand so that they can make an informed
[00:13:04] Bree: [00:13:04] decision. For sure. And I know that you have some interesting statistics on birth traa.
[00:13:08] Can you tell us a little bit about that and how that’s related to informed consent? Yes.
[00:13:13] Danielle: [00:13:13] So one in three women in Australia are experiencing, oh, sorry. A third of women are, however you want to look at. It are experiencing birth traa in Australia, and that’s just far too high. It’s huge. And majority of it stems from.
[00:13:30] The fact that they didn’t feel that they were part of the decision making, how their care providers treat them, what was done to them without their consent tends to be what’s coming up as being the. The most traatic part about the experience, not necessarily how the birth unfolded, but how they would treat it in that situation.
[00:13:52] Bree: [00:13:52] Yeah. And I think that that is so powerful because firstly, it’s quite confronting to hear those statistics that is most, that it’s a lot of women, but also it reminds us that we don’t need to have our birth go in a certain way to feel that it was positive and empowering. That regardless of what twists and turns it takes.
[00:14:10] If we felt that we were consulted and engaged and a part of the process and the decision maker, we can emerge from a birth that was maybe not what we planned and feeling super empowered. , and I think that that is really important to remind people, because as we all know, you can’t plan birth, but you can choose a care provider.
[00:14:30] Who’s going to support you and respect you and seek your informed consent. And that can set you up for those positive feelings.
[00:14:37] Danielle: [00:14:37] Absolutely. And I want to also add here that it’s one in 10 of men also experienced birth traa. ,
[00:14:46] Bree: [00:14:46] I love that. That is so important to say, and it’s
[00:14:49] Danielle: [00:14:49] really. Hard to watch someone go through birth, even when it’s a positive experience, you’ve never witnessed birth before.
[00:14:56] It is a very raw, vulnerable experience to watch your partner go through that, even in a really beautiful, positive setting, , is empowering as well for partners. , but it’s also overwhelming. So when we add medical procedures, people rushing into the room. A lot of partners feel like they are pushed out of that space.
[00:15:15] And they are, a lot of our partners are telling me that they just stood back and watch things happen. Didn’t know what to do. And it actually felt like they were in the way. , and so, you know, birth traa in partners as well is something that. It’s
[00:15:30] Bree: [00:15:30] heartbreaking. Yeah, for sure. And I think we are starting to have some really good conversations about birth traa and women, and we need to increase that moment.
[00:15:38] But so often we forget about the dads and I believe that these experiences can be differently, but equally traatic for men as women. And as you said, there is almost always time. To consult the couple and talk to them, , and just show them some respect. Uh, so I think that that is really important to mention.
[00:15:57] Now I wanted to ask you, now you teach this as part of your positive birth program. You do our module on informed consent. Is that right?
[00:16:05] Danielle: [00:16:05] Yes. So session three is my most passionate and we really dive into informed consent. I like to spend a lot of time on it, and it’s my most engaged topic with couples. I find that they’re very quiet in those first two modules.
[00:16:19] And then when we get into informed consent, I see the change in body language, the gist. Amazement that they are allowed to ask questions or to challenge what’s being suggested. And also the first thing that partners say is, well, am I allowed to do that? Absolutely. You have the right. And yes, the m needs to make that final decision.
[00:16:44] However, the birth partner, the doula, the family member. The advocate for that woman in that space, whatever that is, has rights as well to ask questions.
[00:16:56] Bree: [00:16:56] Yes. Yeah. So what are you hearing from women? Are they generally surprised by their rights? And is that the same for first time moms? And second time moms, are you finding that a lot of second time mothers are coming to you and despite having given birth before they still don’t really know their rights in birth?
[00:17:13] Danielle: [00:17:13] Yes. So first-time moms have no idea. A lot of the time that they have rights. And because, you know, I see them at maybe 20 to 30 weeks gestation. And so they’ve already chosen their care provider and they’ve had this language delivered to them throughout the process of we won’t allow and we will, we’ll be doing this.
[00:17:32] And you will book in for this test and you need to do this here. And so when they come and see me, they think, but I haven’t actually been. Asked any questions about, do I want to do that or given an option? So they’re quite mind blown by the fact that they actually have rights. And the next thing that I hear from women is saying, oh, but I don’t want to be difficult.
[00:17:53] And I don’t want to, what if I ask a question and then I rock the
[00:17:57] Bree: [00:17:57] boat? Yeah. That good girl idea that you have to be a good girl and you don’t want to make anyone uncomfortable or inconvenience anyone. I know that was. A huge problem for me. So how do you try to teach women to overcome it? What are you telling them?
[00:18:10] What are the conversations you’re empowering them to have with their care providers?
[00:18:14] Danielle: [00:18:14] I think it starts with language and confidence in self that’s, where we have to start. And that’s a building process. Yeah. Unfortunately in our society, we do look at care providers as a hierarchy, a lot of the time. And so we have to go back to the fact that m knows best.
[00:18:29] And just because something’s being suggested, doesn’t always mean that that’s right for you. And so how do you take ownership of that and redirect some of that Powell and make an informed decision. And so we go through a, , The technique called the brain technique.
[00:18:47] Bree: [00:18:47] Yes. We love that one. Tell us about it.
[00:18:49] Yeah. So,
[00:18:50] Danielle: [00:18:50] , which the hospitals sometimes use as well, but they call it the brand and I’ll explain the difference. We want the eye what’s the, so the benefits. Yeah. What are the benefits of why they’re suggesting something. What are the benefits? If I say no,
[00:19:06] Bree: [00:19:06] that’s an important one too, isn’t it? Yeah. What are the benefits
[00:19:09] Danielle: [00:19:09] of just waiting for a baby to come naturally, as opposed to being a juiced, you know, looking at both avenues.
[00:19:15] Yeah. What are the risks? What are the risks for now care? Providers will usually give you the risk. If you say no to something. And once again, that’s the language and how the question is directed, but what are the risks? If I yet say yes to that? Yeah, just cause I’m mentioning induction here, but, uh, do we talk about the risk of, you know, needing an epidural or a S assisted delivery and so shoulder, shoulder, dystonia, some of these risks that can come with induction.
[00:19:42] Are women really being informed about those risks.
[00:19:44] Bree: [00:19:44] So not only what are the risks of saying no to in for example, induction, but what are the risks? If I say yes,
[00:19:51] Danielle: [00:19:51] yeah, yeah. Doing it both avenues. Cause you can’t make a decision unless you look at both of them.
[00:19:56] Bree: [00:19:56] Right. It doesn’t matter how care providers present that.
[00:19:58] If they say, , you know, the kind of nbers they giving, they’re giving you how they’re presenting those facts. , does it matter? Do they sway you through that? Yes,
[00:20:09] Danielle: [00:20:09] how it’s delivered can have a really big impact. So, yes, and it’s very easy for a care provider to sway that into encourage a specific outcome.
[00:20:22] And this is why once again, that it’s a building process and women need to understand a bit about informed consent and about birth and how the system unfolds. To do that.
[00:20:31] Bree: [00:20:31] And it’s important to note that if they present the risks or benefits in a way that is biased, it actually doesn’t constitute informed consent, but that doesn’t mean that it’s not happening because it certainly is happening and care.
[00:20:43] Providers are hans and they have an idea of what the best choice is. So, but being mindful of that allows you to take some of that power back and ensure you’re calling them and asking them to. Yeah. Present you with all the facts, doesn’t it? Yeah. So we’ve done
[00:20:57] Danielle: [00:20:57] BNR yeah. And then alternatives for a, so what are the alternatives?
[00:21:01] And just because there hasn’t been an alternative presented to doesn’t mean there isn’t one, a lot of the time, if you ask for an alternative and say, look, I’m open to this. However, I want to try something else first. So what else can we do? And a lot of the time, or if you’ve got an idea that you’ve heard of, maybe you’ve listened to something and you’ve got an alternative suggesting that yourself as a mom, and then they might say, all right, that’s not hospital policy.
[00:21:26] That’s okay. , we can still try it.
[00:21:29] Bree: [00:21:29] Yep. Hospital policy is not lower. It’s
[00:21:32] Danielle: [00:21:32] not. So just because something’s not within that policy, doesn’t mean it’s not going to work for you.
[00:21:37] Bree: [00:21:37] And I’m going to ask you for some tips later. , but I did want to mention that something I came across in my research for this topic is the idea of, , asking the care provider to leave the room.
[00:21:46] So if you are in labor and you’re trying to employ this acronym, it’s really hard to do when you have the pressure of having the care provider in the room. So you are. Well within your rights to say, can I have some time with my husband or my support person to think through our options? And you’re allowed to ask for that time to process, you do not need to give an immediate decision you, unless it’s of course an emergency.
[00:22:08] Danielle: [00:22:08] absolutely. I’m so glad you said that because that’s the, one of the. First things I say, when we’re talking about this brain technique and how to give informed consent, the first thing I say is when someone comes into a room, making a suggestion that, you know, is there an indicator that something’s happening immediately to my baby?
[00:22:23] And if it’s a matter of all, we’ve got a little bit of time or, you know, you know, that, is it really an emergency? , and then saying, look, can we have. However long you can have, depending on the situation, whether it be five minutes, whether it be 20 minutes to make a decision, can you come back in that time?
[00:22:42] Yeah, because I think what happens when someone walks into a room and says, why worried about your baby, our stress hormones, flood our body. And then care providers stand there and wait for your answer. And so we tend to make fear based decisions rather than those educated decisions that we’re sort of talking
[00:23:03] Bree: [00:23:03] about here.
[00:23:04] Yeah, for sure. And it’s really, it’s a big barrier to giving informed consent is when information is presented to you in a way that seems as though it’s an emergency when it’s actually a non-emergent situation. So I think that if you ask your care provider, Hey, do we have time to talk about this? If you don’t, they’ll tell, you know, they’ll say we actually don’t, we need to do this right now.
[00:23:25] And sometimes that happens and we need to lean into that. But most of the times we are able to take that time. So that leads us into, I tell us about I am I on I?
[00:23:38] Danielle: [00:23:38] Yes. Yes, you are. Uh, intuition, intuition. What is your intuition telling you as a mother? We have relied on that intuition for the last. 38 40, 42 weeks, whatever it be.
[00:23:50] , you know, when you present at the hospital was anything wrong. Are you concerned about anything? How’s your pregnancy going? Especially at the moment with COVID a lot of normal kicks, a lot of time we’re having tele health calls. So we’re not even physically going in. We are being guided by women’s intuition.
[00:24:07] Yes. However, we come into a best week. Oh, we don’t, you know, absolutely think about intuition. That’s not part of the
[00:24:15] Bree: [00:24:15] textbooks. So a reminder that you are the mother and you know, what’s best and you can consider those risks and benefits, but then tune into what feels right to you. What’s your body telling you, what’s your baby telling you?
[00:24:27] Yeah, lovely and N
[00:24:29] Danielle: [00:24:29] nothing. What if we do nothing at all? What if we wait a little bit longer? I love that. Time is really irrelevant, depending on the setting. Sometimes time is irrelevant and even a lot does, as we’ve sort of said that often things don’t happen whoa, quickly in the hospital. Yes. And so if you can simply delay something by an hour, really maybe looks more like two hours by this time they can’t provide, it comes back.
[00:24:54] You could have had a baby by then,
[00:24:55] Bree: [00:24:55] for sure. And again, when we go back to the C-section statistics, an overwhelming amount of our C-sections emergency C-sections are for failure to progress, which is a whole topic in itself. , but generally that’s one of those fantastic situations where we have the opportunity to say, well, what if we do nothing?
[00:25:14] What if we leave it a little bit longer? Because your baby and yourself generally are not in immediate distress there’s time. , And I’ve had many stories of women who are being told, they need us an emergency sec C-section and then they being bped and it’s 40 minutes. It’s two hours. It’s. So generally we do have that time to ask about doing nothing don’t we absolutely,
[00:25:36] Danielle: [00:25:36] uh, things like someone coming in and saying, look, it’s been four hours since we did a vaginal exam.
[00:25:42] Uh, and we take m out of. The shower that she’s in and she’s in a good flow, but we feel like, oh, we, you know, we have to comply with what the care provider is saying. So we get out of the shower and we hop on the bed and we slow labor down. What if we just say, Hmm, can you come? What if we just say, can we come back in, you know, an hour?
[00:25:59] Or what if we just say, no, we don’t need a vaginal exam at all, then. Yes.
[00:26:04] Bree: [00:26:04] So, what are you, what are you encouraging women to say to their care providers? For example, if they want to decline an intervention, do they need to tell their care provider why they don’t want it and justify it?
[00:26:17] Danielle: [00:26:17] No, they don’t actually have to justify their answer.
[00:26:21] , I think going through the brain technique does help a care provider as well. Also feel confident that that woman is making an educated decision. And I guess there is some fear from a care providers perspective that, you know, if women make decisions that may be doing then go well then is there risk and litigation to the care provider?
[00:26:45] Bree: [00:26:45] Yes, and we’re operating in a litigious environment, but it is really important to note that if the care provider has fulfilled their professional requirements of giving informed consent, they can not be held legally responsible for the choice of the woman. But I do really love what you’re saying in terms of.
[00:27:01] Ultimately, we want this to be a respectful relationship between mother and care provider. So while it is not necessary, it can be quite helpful to explain your rationale and your thinking, , if you’re in a state to do so, for example, transition is not the ideal time to be negotiating this. , and in those situations, yeah.
[00:27:23] Uh, it’s sufficient to say no, absolutely it is. Or more powerfully. Maybe I don’t consent. Yeah, I
[00:27:29] Danielle: [00:27:29] kind of, yes. Is there something medically wrong with my baby or with me? Well, a lot of the time as a mom, you know, if there’s something medically wrong with you, but is there something that’s happened to my baby now?
[00:27:40] No. , then I don’t consent to what you’re suggesting
[00:27:43] Bree: [00:27:43] for sure. And from the conversations you’re having with ms, how are you finding that these. That this is being received by care providers, both in anti-natal appointments when moms are seeking informed consent and declining routine testing, for example, and in birth, do you feel that generally care providers are quite receptive to ms, , exercising this, right?
[00:28:08] Danielle: [00:28:08] Not as much as I. Well, not as much as they should be because it’s, it’s their right. Uh, but a lot of the time, I think women can be pressured where they should simply be able to say no, And they are entitled to that, but sometimes they get pushed back from care providers, , especially private care providers.
[00:28:28] And so, so
[00:28:30] Bree: [00:28:30] obstetricians. Yes.
[00:28:32] Danielle: [00:28:32] Yes. A lot of the time don’t get me wrong. There is, uh, some obstetricians that advocate for this. I talk about this all the time on my end. Instagram. And there’s a particular care provider that high-fives, every time I have this conversation and when my clients go to her at, she loves these conversations because she understands that this is what is important and positive birth.
[00:28:54] And if her women can’t come and have educated conversations with her, Then they’re not going to potentially have a positive, empowering experience that they’re
[00:29:02] Bree: [00:29:02] looking for. Yeah. I think that there is definitely a difference between the education and the practice of midwives and obstetricians, but there are absolutely always going to be exceptions to that rule.
[00:29:13] So what would you encourage a woman to do? For example, if she’s gone back to her care provider and said, , I’ve considered your recommendation for induction. I’ve read about it. I’ve made a decision that I do not want to proceed with it. And they receive a response that is quite, , on supportive. Uh, I’ve often heard of care providers pulling out the dead baby card, , in that situation.
[00:29:37] So for a lot of women, this will be quite late into their pregnancy. What options do they have then
[00:29:43] Danielle: [00:29:43] to terminate care? , and this is where I wish I worked more with women in the early stages and starting to see what we call red flags for this kind of behavior. , because. Yeah, it is a building block.
[00:29:56] And if you can get comfortable with what informs consent, ease early on and start using the correct language and taking ownership of those decisions and showing your care providers that you aren’t just going to follow standard procedure, and that you’re going to make decisions that feel right for you.
[00:30:14] Then I usually find that the it’s a different course for women that go in educated and articulate themselves. Well, yeah. They get a different response from their care providers or they see the flags early and they terminate care and they look for a care provider that’s going to welcome and encourage these kinds of conversations.
[00:30:34] Bree: [00:30:34] Yeah. And you absolutely have the right to fire your care provider right up until you’re pushing that baby out. So if you are finding that you’re being cared by, for example, a hospital midwife who is not. Supporting you during labor and not listening to you and gaining your informed consent, you can ask for another midwife.
[00:30:51] And I don’t think many people know that and it is uncomfortable and no one wants to do it. But if it means that you’re going to get the care that you need and you deserve, then you should absolutely do that. , but what you said is really important because it’s, it’s very similar to my own experience and conversations I’ve been having with other moms through social media.
[00:31:10] , for example, who are going through the MGP program, So they didn’t meet their midwife up until I think it’s about 23, 24 weeks. And then it’s only monthly. So by kind of that third trimester, they’ve only met this person a couple of times, they’re quite short appointments and there may be finding that they’re not getting the necessary time and information they need out of those appointments.
[00:31:36] And then people are quite late into their pregnancy and it feels really hard to change care providers. But I believe in. I’m interested to know if you agree that generally, if your care provider is not seeking your informed consent for things like routine antenatal testing, that’s not going to change or improve in birth it’s as the set of red flags.
[00:31:56] Danielle: [00:31:56] Absolutely. And I see the light bulbs in women when they’re doing positive birth program and they start to realize that they. Uh, being told what they will and will not be able to do. And so I see them, I can see it ticking over in their brain and then they come and maybe speak to me privately and say, look, I feel like I have very much been caught up in the system and this is what’s happening to me.
[00:32:21] And I will always encourage them to start building and taking ownership of, , This conversation with their care providers. So starting small writing, some questions that they have from the positive birth program and just some things that are important to them, and then trying that brain technique and to do the informed consent conversations with their care provider and see how it goes.
[00:32:44] And if, once again, they get that red flag, I think then they’ve built that confidence a little bit more of that. I need to either. I need to make a decision here, because if that person’s not meeting me in the way that I need them to in pregnancy, the chances of them being able to step up and meet me in the way and to support me and facilitate the birth that I’m wanting in birth, it’s probably not going to happen
[00:33:07] Bree: [00:33:07] for sure.
[00:33:07] And you can achieve the kind of birth you want to achieve regardless of who your care provider is. Right. But with certain care providers who are not listening to and respecting you, you’re going to have to work a lot harder and fight for yourself. And what we know about the hormones of labor is that you do not want to be, oh, you didn’t tell me which part of the brain is it?
[00:33:28] Danielle: [00:33:28] What’s the thought in your neocortex cortex advocating for yourself in there? Then that’s going to disrupt our homeowner flow, probably going to get a bit of stress of hormones there, which is another, which is going to reduce our oxytocin. We’ve engaged the Neo cortex. We start overthinking things in birth, and this is a really slippery slope to our labor starting to subside because it no longer feels.
[00:33:52] Safe and the environment that we’re in. And so I do work with partners as well and encouraging them, them to do some of this advocacy for women. It’s important that women have these conversations with themselves and be confident and to trust in their body and their decisions. But also partners have such a say.
[00:34:11] And I love seeing the moment where partners, you realize just how important they are in the birth space, because they can navigate some of these things in the hospital system. Yeah. They can go and ask for another midwife. If the mother feels that this person’s not right. And so yes, as you said before, you can do this and yes, it feels uncomfortable, but you’re potentially having that person in your birth space, eight, 12 hours, whatever it be, hopefully it’s quicker than that.
[00:34:39] But if not, do you really want that person in your space? That’s not helping you and not articulating things to you in the way that you need them
[00:34:47] Bree: [00:34:47] to, especially. Yeah. And as he said, The goal of labor and what we need for labor to progress effectively is safety. And if your care provider is making you feel unsafe, and unfortunately this is happening far too common, then it’s going to inhibit your labor.
[00:35:02] And you may end up with interventions that you did not want to have. So, as you said, when you weigh up the, the discomfort of asking for new care provider versus putting yourself through potential birth traa, , You know, it makes sense.
[00:35:17] Danielle: [00:35:17] It’s a five minute conversation, a difficult five minutes of vulnerability and having a difficult conversation.
[00:35:24] , the verse potentially, you know, birth traa and carrying that home. And you know, when you say goodbye to that care provider or that midwife, whoever it be, they’re not going home with a new baby and adjusting to milk production and being a mom and being a partner and navigating that. That’s the end for them.
[00:35:43] And it’s not, it’s just the beginning for you as to how you then go on and
[00:35:46] Bree: [00:35:46] parent. And I think Mo we hope that most birth workers are passionate about it, but this is about birth, but this is your special day, not their, this is their job and that’s, it’s different. And I love the idea of delegating that job to the husband.
[00:36:00] Cause I would absolutely do that and send him out there to have the hard conversation. , but as you said, ideally, we are. Intercepting this process prior to birth, we’re not waiting to have this conversation in birth. And it’s interesting because it reminds me of the differences between my first birth and my second birth.
[00:36:19] And this is something that the three of us killed Danielle and I are really passionate about is. Not having to suffer through a traatic first birth to then have a more empowered second birth. And it’s trying to remind women that if they are getting these red flags in their pregnancy, as a first time, mom, you don’t want to wait to go through a negative experience and experience birth traa to then come back and have a redemptive.
[00:36:43] One of course, if you’ve had a. And a negative experience. The first time we want you to have that redemptive birth, but can we intercept that and avoid putting yourself through that traa in the first place? And unfortunately, I didn’t have a traatic first birth, but it certainly wasn’t empowering and informed consent was not a big part of it.
[00:37:03] And that is why I have made different choices this time, including seeking you out to teach me the hypnobirthing course. And it’s something that’s been really lovely is. Getting to really see in real time what informed consent looks like. So for example, for me, I’ve been having the conversation recently with my private midwife about, , vaginal examinations.
[00:37:28] So I started from a position of, no, I don’t want any, because I had an incredibly traatic one in my first birth. And she was like, okay, I’ll support you if you want. To do that, but let me tell you a little bit about them. Here are the risks. Here are the benefits. And so then I sat with those and came back to her and said, okay.
[00:37:44] So what are you thinking about the general examinations? When do you usually do them? When do you think they’re important? What information can they give us? And she answered those questions for me. And then I sat with that again, and this is happening over weeks and months and we have two hour long appointments.
[00:38:02] So we are really diving into this and I’m getting a sense of how she feels about it. And she’s getting a sense of how I feel about it. So we’ve come to a position where I’ve. Written in my birth plan, minimal vaginal examinations, which is no surprise to her that is very consistent with how she practices anyway, but then specified for example, that, , if I’ve been pushing for multiple hours, I’m open to the suggestion.
[00:38:28] Or if it’s looking like we will be transferring to hospital, I’m open to it. If it’s going to give us more information that we can’t seek. In another way, then they’re the situations that I would consent to a vaginal examination. So as you said, I’m nearly nine months pregnant and this has been built over months and months of conversations so that when I go into my birth and I’m trying to surrender to that process, I can really trust that she knows.
[00:38:56] How I feel about this and that she’s going to be respectful of that. And therefore she is telling me that we need one I’m knowing that it’s not just because it’s routine or protocol it’s because she really deems it to be necessary. And then I can make that decision.
[00:39:11] Danielle: [00:39:11] And this is the benefit of continuity of care.
[00:39:15] Exactly. As you describe it there, because we need to build that relationship as pregnant moms. Especially first time we don’t know this stuff. And sir, how do we give informed consent? We, we need to be having conversations back and forth over a period of time and building our skill set and building our confidence in themselves.
[00:39:36] And a lot of that does come from, you know, the information that we’re then given from our caregiver and how it’s received, and then this, , really open relationships. So that what, and what I say is so important for women and especially for my clients, is that you want to go into birth. Knowing that that care provider supports your requests and will do absolutely everything they can to facilitate those requests.
[00:40:02] However, if they meet you in that moment and say, we need to deviate from this plan, this is why. This is why we’re suggesting this. I know it’s outside of what you wanted. , are you okay with this then? That’s the empowerment bit when they give that back to you and you can say, yeah, I wholeheartedly, they know that that suggestion was so warranted.
[00:40:27] And I already, I knew because of the relationship that we’d built. That they were only offering it because it was really important and was what we needed to do next to have a positive and safe experience.
[00:40:39] Bree: [00:40:39] Absolutely. And I think that we, , very strong advocates for specifically midwifery led continuity of care, but we know that such a small amount of our population has access to that kind of care at the moment.
[00:40:52] And there are some real barriers to giving informed consent if you are in a different model of care, especially time. But I think that it’s really important to remind people that information sharing is part of their job. You are not being inconvenient or annoying, or high-maintenance by asking for this information.
[00:41:11] It is your right, and it is their responsibility to provide you with this information. And. On the topic of vaginal examination. So there’s one more thing that I wanted to share because I’ve come across it on social media, in terms of, , giving informed consent for vaginal examinations. Because as I said, I had a really negative experience in my first birth and wanted to figure out how, if I needed a vaginal examination, I could make myself feel safe and I can not remember where I came across the idea, but if I remember we’ll put it in the episode notes and.
[00:41:45] What this midwife is saying is that when you’re giving, having a vaginal examination, you have the right to be in control and withdraw consent. And that is something that was ignored in my first birth in that I was screaming. No, and I remember the sound of my scream and it must’ve been so traatic for my husband.
[00:42:05] I remember thinking, oh my God, I’ve never heard myself make that sound ever before, but it was. By far, the most painful part of my whole labor. And so I was telling this midwife to stop and I was saying no, and she was like, it’s fine. We’re almost done. Like just a little bit longer. If I stopped now, we’re not going to get the information and we’ll have to do it again.
[00:42:24] So, and again, that was the traatic part of it was feeling like I had no ability to withdraw my consent and, you know, be in control of my body. So what this post was saying was that she suggested using two words during vaginal examinations and having this conversation with your care provider, where you will say, , stop, if you don’t want you to care provider to progress any further, that means don’t move, don’t move your fingers.
[00:42:50] Just PR phrase and let me adjust or out. And if you say out, they need to take their hands out their fingers out immediately. No questions asked. And this is something that I then talked about with my midwife and said, Hey, this is what I need to feel safe. If we do need a vaginal examination, I need you to know that these are the two words I’m going to use, and I need to trust that you’ll listen to them.
[00:43:14] And I think that is so powerful because reminding women that you can withdraw your consent, even in the middle of a procedure is so important.
[00:43:25] Danielle: [00:43:25] Yeah, that’s really powerful. I haven’t actually heard that before. I love it.
[00:43:29] Bree: [00:43:29] Me too. It’s good. Isn’t it. So good. So I’ll try to find where I got that from, because I absolutely can’t take credit.
[00:43:34] , but so often we come across all this great content on social media and, , I’ll pop it in the episode notes if I remember that, but that’s just to say that, you know, you, you get to be in control and having these conversations is so important. And
[00:43:49] Danielle: [00:43:49] every time someone wants to do a vaginal exam, You that questions should be asked again and it should be, are you okay if I do this, not hop up on the bed, it’s time for your vaginal exam.
[00:44:03] Bree: [00:44:03] Yes. And I think that this is again another whole episode, and I’m sure we’ll get you back on to talk about something different, but that is where doulas complain incredibly vital role in your birth. And I know it’s a bit of a touchy subject about weather. , doulas can actually advocate for you or not, but having someone who understands the birth process and the policies and can just inform you of, Hey, you’re being offered this because it’s routine because it’s procedure, , you might want to explore that further can be so powerful because while dads can be incredible support people often, unless they’ve taken your course, they don’t know these things.
[00:44:42] They don’t know what they don’t know. So it’s really hard for them to advocate for you in the way that you
[00:44:45] Danielle: [00:44:45] need. Yeah, absolutely. Doulas are an amazing, , second support. The one thing I always say about doulas is that once again, the empowerment comes from you and they can absolutely support you. I don’t believe that they.
[00:45:02] Usually will that advocate for you as in make a decision for you? You know, women say, oh, if I had a doula, they advocate for me. And I think the empowerment thing comes from you and you advocating for yourself. I think that they remind you of what it is you want. And sometimes as you said that, yes, this is more of a policy and a procedural thing than actually our requirement at this situation.
[00:45:24] What do you want? And still encouraging women to use that voice. And I think that a lot of doulas would. Would absolutely agree with me here because giving that power back to the mommies with the doulas are all about, and that’s what they’re there to do. So they will encourage you back to your own voice with just a little bit of
[00:45:39] Bree: [00:45:39] guidance.
[00:45:40] And we don’t want to just replace one care provider, making decisions for you with another care provider, making decisions for you. What we’re advocating for is that you are then making decisions for yourself. So, yeah. I wanted to wrap up. I think that we can finish this conversation by talking about some tips for women.
[00:45:55] What other things that you discuss in your course, , and just your personal opinion that women can do to make sure that they’re giving informed consent, that they’re getting the information they need. Uh, does it start with care provider choice, , certain phrases? What does that look like?
[00:46:13] Danielle: [00:46:13] It’s a hard one as in where it starts, because it starts so early.
[00:46:16] We choose our care provider so early. So the knowledge really needs to happen really early, uh, so that you can start now choose your care provider. First, that’s going to align with you making informed decisions and you know, that education is a building process. Even when I say to my clients, when you do the positive birth program with me, it’s two days, you can’t leave it there.
[00:46:38] You have to do the work. You have to keep evolving as your birth. Uh, evolves and things change for you in your pregnancy. , so it starts with the knowledge and that really comes from independent birth education and, , The little bit of difference. I won’t go into it completely, but the difference between independent birth education and hospital-based birth education is that independent encourages all of the things that we’ve talked about today of looking at all avenues and then making a decision that feels right for you.
[00:47:06] There’s no bias behind it. There’s no policy in place then there’s
[00:47:10] Bree: [00:47:10] no agenda because you’re not pushing for a specific choice that. Aligns with the hospital philosophy or will make their operations run smoother or covers them in terms of litigation. So it’s really it’s non-biased
[00:47:23] Danielle: [00:47:23] yeah. I encourage women to contact me as early as they can.
[00:47:26] I love it. When I get a woman in her first trimester, often they, in my case,
[00:47:30] Bree: [00:47:30] Like five weeks
[00:47:32] Danielle: [00:47:32] often, if I can’t, I like often it’s like, oh, I think I’m calling you too early. Cause what EDF? And I’m like, Nope, stop there. Yeah. This is going to be a positive experience. You taking ownership from the start. It’s amazing.
[00:47:43] And here are some things to think about. And I, when I get women in that space, I had a woman that I got at eight weeks and we had a chat on the phone and she went from choosing one completely different form of care to a completely different avenue, just on me giving her some knowledge. And then she went in.
[00:47:59] Uh, interviewed the care options that she was looking at and completely changed directions simply from a 20 minute conversation, she hasn’t even done the positive birth program yet. She’s she’s coming soon.
[00:48:11] Bree: [00:48:11] Yes. Using a care provider. Is it sets you up for so many other decisions. So you want to get that ride don’t you?
[00:48:17] Danielle: [00:48:17] Yeah. So yeah. Choosing to do independent birth education early and contacting that person. Yeah. Whoever it be, I’d love it to be me, but you know, if it’s someone locally to you then absolutely diving early because there’s always. Instagram things that you can watch, especially from people that do independent birth education.
[00:48:34] We’re constantly trying to share drips and drabs of, you know, what to look for and what to start doing early and podcasts like yours, so that you can sort of really start to immerse yourself in positive bath. Before you even come and do the positive birth program, and you’re already making educated decisions and building your, what I like to call trust muscle in yourself, or you’re constantly building your own self-worth and your positive mindset and your confidence in your body is a building process.
[00:49:05] And we just keep adding to it as the months go on. So that by the time you get to birth, you own it, you are empowered, you are making informed decisions and it comes in naturally to you. Because you’ve spent nine months building that
[00:49:18] Bree: [00:49:18] for sure. Also, as we touched on, , recognizing the red flags and acting on them, if you need to knowing that you can change care providers, , using those statements, no, that’s all you need to say.
[00:49:32] No, or I D I do not consent. , Also potentially, if you have a care provider who you feel is unsupportive, but you are not able to make change. And that’s a reality for many people. For example, if you’re going through the public system, you are limited in your options. , You still have options, but you are limited.
[00:49:51] So you might want to choose a doula, which is potentially a cost effective option to give you that support and advocacy as we touched on. , and also just as you said, knowing your rights, whether you learn that through an independent childbirth education or through your own research, , knowing that you have rights and what they are.
[00:50:12] And what your care providers, rights and obligations are, can give you that confidence to ensure that you’re giving informed consent.
[00:50:19] Danielle: [00:50:19] Yeah. And making sure that your partner is on board with this and understands all of the importance of all of these things as well, because a lot of boom and go, oh, I’m not going to do that because my.
[00:50:29] Partner doesn’t want to. And they just simply, it’s not really that they don’t and they just don’t understand. So they need to come along and immerse themselves with you so that you guys start that process together, confident, knowledgeable, and you can both, , advocate and, you know, have a positive journey for
[00:50:46] Bree: [00:50:46] both of you.
[00:50:47] For sure. Now. I can personally attest to how great your program is. I’ve taken it. I loved it. I’m practicing all the skills to prepare me for birth. So if people want to find you and connect with you, where can they find you? Yes. So
[00:51:01] Danielle: [00:51:01] please come on over to your dot, sacred.space at Instagram. I’m probably most online on Instagram trying to share as much as I can, as regularly as I can.
[00:51:11] Just giving you little bits of information. I run group classes in Birkdale in Brisbane. Yeah. But I also do zoom so I can support you wherever, wherever you are across Australia. , we can absolutely deep dive on zoom and you get the full program. , it’s just done in the comfort of your lounge room and your pajamas, or we can work together privately like you and I did.
[00:51:34] , and it’s. You know, when we do it privately, we can tailor it to your needs. Exactly. Like we did with you. , I’m very much about the first conversation I have with a woman is what are you looking for? What’s a positive birth for you. That’s how I start the conversation. And because the positive birth program is going to be different for each person.
[00:51:50] Each person’s going to have different needs and desires. So I like to move and adapt and tailor my program to each individual.
[00:51:59] Bree: [00:51:59] Beautiful. And then my last question is if people want to know more about the topic of informed consent, are there specific, , blogs and books and resources that you’d recommend outside of you?
[00:52:10] Of course. I know a favorite. One of Aussies, anything by Dr. Rachel raid. Yeah. We talk about her constantly and I know she has a good one on, , I believe it’s induction. And what informed consent in induction looks like?
[00:52:25] Danielle: [00:52:25] Why induction matters is my absolute go-to. It’s pretty much my golden book actually.
[00:52:30] Can’t believe I haven’t referenced her today.
[00:52:32] Bree: [00:52:32] I never done well, actually I do have a quote from her that we’ll finish with, but go on.
[00:52:37] Danielle: [00:52:37] I love that book. It is. That’s actually what I would really recommend you starting with, if you’re just thinking about getting pregnant, it’s such a little book, but it’s packed with information purely factual.
[00:52:48] , but interesting to read. Yeah. And it talks about the brain technique. It talks about lots of different things that happen potentially throughout pregnancies and how to make informed decisions and stats as well. For
[00:53:00] Bree: [00:53:00] sure. And not everyone’s going to have an induction, but I think our rates at the moment are about 40%.
[00:53:04] So the first
[00:53:05] Danielle: [00:53:05] six alarm, 40%.
[00:53:06] Bree: [00:53:06] Yeah. I’d also add anything by Ray Dempsey. I love
[00:53:11] Danielle: [00:53:11] that thing without confidence is my favorite of her. Oh my gosh, Beth, with confidence,
[00:53:18] Bree: [00:53:18] we definitely want with confidence. Yes, that’s a fantastic one. And, uh, the last thing I was going to say was the, was it the Australian medical association guidelines that you referenced?
[00:53:28] Danielle: [00:53:28] I encourage all women to go and read that. And if anyone ever starts saying to me or my care provider, even once I’ve done the program, I still sometimes see that language coming back. I w I want you to go and read your AMA guidelines and the childbirth, , rights on Chubb. I’ll put the link in of the childbirth rights for women.
[00:53:46] It’s a government website that we referenced in the hypnobirthing Australia program. , I’ll, I’ll give them to you because we have rights and then the care providers actually need to facilitate the rights to the sexual. Amazing that. They combined they’re very similar in, , their content. Yeah,
[00:54:02] Bree: [00:54:02] we will absolutely include that.
[00:54:03] So I am going to finish with a Dr. Rachel Reed quote because of our sheer love for her. So it says women need to be given adequate information in order to make birth choices and practitioners need to give adequate information in order to meet legal requirements. So I think that’s a really important reminder and.
[00:54:19] I just want to say thank you so much. This has been an incredible conversation, and I know that women are going to get so much from listening to it.
[00:54:27] Danielle: [00:54:27] Thank you. It’s been amazing. And I cannot wait to hear about your birth.
[00:54:32] Kelly: [00:54:32] Let’s just push back to you for a
[00:54:34] Danielle: [00:54:34] virus. I’m so excited
[00:54:36] Bree: [00:54:36] very soon, sooner, rather than
[00:54:39] Danielle: [00:54:39] later.
[00:54:40] Beautiful. Thanks Danielle. Bye for now.
[00:54:45] Kelly: [00:54:45] Thanks for joining us for today’s conversation. If you want to hear more like this. Don’t forget to hit subscribe. So you don’t miss an episode. If you’d like to know more about anything we’ve talked about or you’ve heard on the podcast today, check out our website, http://www.birthofamother.com.edu. You can find us on Instagram at Matrescence dot podcast, or send us an email to firstname.lastname@example.org
[00:55:08] Bree: [00:55:08] that I use.
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Kelly and Bree