MOTHER KNOWS BEST : A failure to warn is an infringement on women’s bodily autonomy.
Written By Muskan Khadka
Women are constantly infantilised when it comes to their bodily autonomy and the road to motherhood is no exception. In the area of obstetrics, there is a frightening history of a failure to warn women of material risks around key pregnancy procedures, mostly regarding delivery, and too many times has the lack of choice left women worse off. Patient’s bodily autonomy is protected in the form of informed consent, more so, in the 90s the Court held that Australian doctors must disclose material risks of proposed treatments. Despite this, there is a growing concern that obstetricians are not upholding their duty to warn and obtain informed consent - effectively taking away women’s bodily autonomy.
Take for example, the case of Nadine Montgomery, a woman who managed her own diabetes, held a degree in molecular biology and worked as a hospital specialist for a pharmaceutical company, and was still deemed incapable of making her own decisions by her obstetrician. Information about a 9-10% risk of shoulder dystocia was deliberately withheld from her because the obstetrician believed Nadine would make a choice outside of her best interest. These risks, despite being low, materialized as Nadine’s son suffered significant injury causing brain damage and cerebral palsy. In 2015, the Court found that the obstetricians actions were unlawful as Nadine’s sons injuries were a direct result of the obstetricians failure to warn and it was highlighted that important health information should never be withheld from competent adults. This is not an isolated incident, in 2018 a 38 year old overdue in-vitro fertilisation patient with a medical background was not made aware of the associated risks resulting in stillbirth, due to their obstetrician failing to uphold their duty to inform. Despite the terrible outcomes of when an obstetrician gets it wrong, the likelihood of women receiving full medical assessments in the first place and subsequently having a chance to consent to treatment is on the decline.
According to the Australian College of Midwives referral guidelines, an increasing number of antenatal patients are not being seen by a doctor at all, i.e. the professionals qualified to provide informed consent. This also means women with high risk pregnancies that require specialist attention may never see a doctor because according to the referral guidelines, consultation with an obstetrician is optional. Further, a major Australian hospital implemented a policy in 2010 requiring trainees to become proficient in forceps before being allowed to use vacuums during deliveries, despite the known risks of maternal trauma associated with forceps. This meant forceps were increasingly used as the first response to an obstructed labour and patients were not informed of the risk of forceps or possible alternatives and therefore not provided with the ability to properly consent.
Women should be given the chance to make choices about their own bodies and should be recognised as capable of doing so. Accordingly, obstetricians should take into account the importance of the preservation of bodily autonomy when providing essential care and respect the decision making power women are entitled to about their own bodies.