Who is really responsible for intervention that happens in our births? Is it us or our health professionals? Or is it both?

In this blog post, I’m referring to situations where unnecessary intervention has taken place. Of course there’s a place for intervention in some labours and this post does not address interventions that are truly necessary. However that’s defined!

Some women argue that birth – and what happens in birth – is their responsibility and they take charge of all decisions and also take responsibility for the outcome of those decisions – good or bad. Women in this category would never dream of blaming their care provider for a bad outcome because the decision was theirs alone and they made a fully informed decision that they were comfortable with. When things go well, they attribute that great outcome to their good preparation and decision making.

Other women will outsource decision making to a health professional such as a midwife or a doctor. “They’re the experts”. In life, we outsource all sorts of decisions, so it’s not surprising that women may choose to do this for pregnancy and birth.

When things go according to plan – a woman has the birth she was hoping for, the baby is healthy, breastfeeding goes really well – there’s no issue at all. When things don’t go as planned, issues of responsibility (and sometimes blame) come up.

Over the years, I’ve sat back and observed women’s reactions when things don’t go well.

I think there are two parts to things not going well. One is the woman’s responsibility for her decisions and the other is the health professional’s conduct.

I’ve observed that when things don’t go to plan, very few women take responsibility for the choices they made that might have led them down a path that they never planned to walk. Eg women who might really want a natural birth who choose a hospital with a very high caesarean, episiotomy, epidural and induction rate. “It won’t happen to me” and then it does.

Some go right back to the same care provider and place of birth – it’s what they know and what they’re comfortable with – even though the outcome is not what they really want. Should they complain about their [caesarean / epidural / induction / forceps / episiotomy] and say they’re not responsible: their care provider is? I think not – choosing the right care provider and place of birth is each woman’s responsibility. If the hospital / health professional has a 50% caesarean rate – yep, that applies to you too.

Some people argue that women can never take full responsibility for their births because the information that’s relevant to them is hidden, disguised, not available until it’s too late and so on. In these cases, some argue that the woman could not have possibly got the information that would have assisted them to make a choice for their birth that is more aligned to what they’re trying to achieve. But if this is the case, how do we account for women who do magically find information, make decisions that are compatible with their needs, and experience the birth they had wanted? What sets these women apart from other women? Determination? A strong sense of self-efficacy? Confidence? Having options?

Information is all around us. We can talk to care providers, hospital midwives, friends / family, google relevant articles and information, talk to private midwives and obstetricians and so on … there’s lots of information out there, even in rural / remote areas, thanks to the WWW. In NSW, hospital statistics are publicly available. Is there any excuse for not knowing your hospital’s caesarean rate if you live in NSW?

When we buy a car, we know we have many choices. Not just the make of the car, also auto / manual, number of doors, convenience features, comfort features, safety features and so on. If we only go to Toyota and buy a car that’s not suited to our needs – and this becomes apparent a couple of weeks later – is this Toyota’s fault? Maybe, but only if Toyota falsely advertised the car’s features. We’re responsible for the choices we make. Likewise, if we choose hospital X without exploring other hospitals, or settle on Dr Y or Midwife Z without interviewing others who might be better suited to our needs – is it the doctor’s / hospital’s / midwife’s fault if the birth has more intervention than the woman had hoped for?

In all industries, it is the responsibility of the consumer to first work out what they want, and next to set about finding a service / product that meets their needs. Is birth any different? It is true that we cannot control birth, but if we want a drug-free birth and we know from the outset that our care provider only attends epiduralised births, is this a compatible choice?

Now, the other side of this whole argument is the issue of conduct. While I firmly believe – and know – that information is out there, freely available, and that women are most definitely responsible for choosing the right care provider and place of birth for their needs, I also appreciate that health professionals are responsible for their conduct.

Negligence says that a health professional owes a duty of care to the patient, the duty of care is breached, the patient suffered harm, and the harm is a reasonably foreseeable consequence of the breach of duty of care.

If this happens, then of course the health professional is to blame and the patient ought to raise this as an issue so that it can be addressed either legally or within the profession. Drug errors, incorrect surgical technique, performing the wrong operation, failing to gain consent, working while under the influence of drugs or alcohol – these are all serious issues that ought to be reported.

So, in summing up, I think that responsibility for birth is a complex issue. While women are most certainly responsible for choosing the right care provider and place of birth (amongst other decisions), health professionals are responsible for how they practice their profession.

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