Niki is grateful for the cut during her delivery

For drastic actions during childbirth, such as a cut, an injection or an internal examination, a healthcare provider must always ask the pregnant woman’s permission. Research by Marit van der Pijl (Amsterdam UMC), among more than 11,000 women, shows that this often does not happen. More than 40 percent of the women who received a haircut were not asked for permission. Not all women who underwent surgery unintentionally felt that was a bad thing afterwards, but most did. Niki (35), mother of three children, does not understand the negative reactions. “I think it’s special that people are complaining about this. In fact, you consent to such actions when you let someone treat you. I assume that a doctor acts on the basis of your health and that of your child, and that they do not just make a cut.”

Not thinking clearly

When Niki gave birth to her eldest child fourteen years ago, she received a cut (also called an episiotomy) and an injection of oxytocin, which induces labor, during the delivery of her middle child. She didn’t hesitate for a moment whether she wanted to agree to this, although that decision also passed her by a bit. “A delivery goes into such a daze that you no longer know what you are saying and at what time. You cannot think clearly. Doctors may indicate that they are performing an intervention, but you are so dazed that you are not even aware that they are asking a question and that a doctor then just acts.” Because medical consent is often given verbally, it is indeed not always possible to determine whether the patient has heard the question, let alone agreed.

Cut was necessary

A cut makes the vagina larger and should ensure that a baby can be born more easily or that severe tearing is prevented. With Niki’s first birth, a cut was necessary. “My son lay like a Superman with his hand forward, which prevented him from coming out. A cut made it possible, after an hour of pressing contractions, to bring him into the world. I never thought for a moment: I don’t want a cut or I want to find something about this. I just thought, I want this kid out. If the doctors had waited longer to cut my son, my son might have suffocated.” An operation was also necessary for her second delivery. “The delivery went so fast that my contractions stopped immediately after birth. Because the placenta didn’t come out, I got an injection (with oxytocin, ed.) to induce contractions. If I didn’t, I’d bleed to death. Should I then tell a doctor: let me bleed to death? No, I wouldn’t have wanted to have a choice. Why would I want to do that if I’m still puffing? This just had to happen.”

Read also: Getting pregnant with a niche: ‘Seven miscarriages in a year’

Planning a birth is utopia

You cannot plan a birth, no matter how tight your preparation is. “When I gave birth for the first time, I thought I could plan everything in advance, but I soon realized it was a utopia. Planning your birth will only lead to disappointment. Every birth is different, every child is different, every woman is different. It comes as it comes.” She understands that not every woman is eager for a cut. “But complaining because you didn’t give permission for such a minimal intervention, I don’t understand. Again: in my case I had no choice. If you are cut while in hindsight it was not necessary, I understand the frustration.” The fact that women feel they have less control and choice during childbirth could, according to the researcher, lead to a negative childbirth experience.

Time is precious

According to researcher Van der Pijl, some women have less need to give consent than others. “But it is important that a woman knows what happens to her and the baby during childbirth,” she tells NOS. “It helps to discuss what can happen during pregnancy. This makes communication during childbirth a lot easier.” Niki agrees with this, with informed consent, but also says: “The moment that you, as a patient, have everything to say about certain procedures during childbirth, that takes time. And time is very precious, especially at such crucial moments.” She looks back on the interventions during her delivery with a pleasant and grateful feeling. “I am relieved that a clear, sensible person, who has been educated, has taken an oath, and wants the very best for me and my child, saw what was needed at the time.”

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