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Roanna Rosewood

Informed Consent and Hospital Transfer: A Mother's Perspective

Posted by Midwives Alliance on March 15th, 2014

Roanna Rosewood is an author and was a keynote speaker at MANA 2013 in Portland, OR in October 2013.

Someone else told me about the incident, years after it happened. It was too late to ask questions or involve myself. Too late to find out if I was the reason why my first midwife stopped catching babies, right after my attempted HBAC turned into another cesarean. But I can't help but wonder, if I had been given the opportunity to tell the doctor that staying home for so long was my choice, would it have stopped her from berating my midwife? If I explained that my midwife had recommended transport but I was the decision-maker, would my midwife have been spared the doctor's anger and – I can only speculate – its resulting fear?

I'm not suggesting that my midwife couldn't handle a disagreement. I'm recognizing that the balance of power surrounding birth has become so skewed that belligerent obstetricians are a real threat to midwives. The same outcome that an obstetrician's insurance can write off without question could lead to criminal prosecution and crippling legal fees for a midwife. Does this unjust disturb midwives as much as it does me? Or are you so accustomed to it that you can't tell where fear of persecution ends and your work begins?

I understand that the concept of patient autonomy was so foreign to the doctor that she felt justified in gently soothing me in one room while criticizing my midwife in the other. What I don't accept is that my midwife didn't tell me about it. I hired her to advise and inform me. I trusted her to advise and inform me. That I was out of earshot when doctor let-loose, didn't invalidate her responsibility.

I recognize that my midwife's choice to bear the doctor's wrath alone was a generous and loving act, made to protect the small shreds of sanctity that remained after they tied me down and cut me open. But what she didn't understand, what every midwife who tries to shield her client from our broken maternity care system doesn't understand, is that doing so perpetuates the problem.

Until hospitals are safe and respectful places to transfer to, the attempt to isolate expectant homebirth families in affirmation-filled, "just trust birth" expectation bubbles, isn't only risky for the mothers and babies who might end up needing to transfer to the most dangerous maternity care system in the industrialized world. It is also the abandonment of every midwife who risks her livelihood and freedom to practice without legal protection.

We trust midwives to reveal what we need to know about birth. But this isn't limited to the process of bringing our babies earth-side; we also need to learn that birthing women have not yet established their right to autonomy, informed consent, or to be the decision-makers for their own newborns' care. Homebirth families must be armed with the tools necessary to win the cultural and legal war being waged against physiologic childbirth and stand with the midwives who hold the space for it. At the very least, this includes:

  1. Understanding the manner in which the family, midwife, and records will be received in the case of a hospital transfer.
  2. Awareness of the evidence (or lack of) behind routine hospital interventions and strategies for refusing unwanted ones.
  3. A welcome invitation to join other families around the world who are working to establish human rights in childbirth, by participating in the birth revolution.

Just as mothers must find the courage to face contractions in order to move through them, with midwives on our side, so too will we find the courage to face and heal our maternity care system.

Roanna Rosewood is the bestselling author of Cut, Stapled, & Mended: When One Woman Gave Birth on Her Own Terms After Cesarean, an international birth empowerment speaker, and the managing director of Human Rights in Childbirth.

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