Rights Violations Quiz Results

Boy_Taking_QuizWow.  It was really fun to read all of your responses to identifying rights violations.  I love what a lot of critical thinkers this community is – but of course you are, that’s why you’re here!

So, here are my follow-up thoughts / answers to the rights’ violations questions:

  1. Vacuum Extraction Scenario –  This one held the most interesting comments for me.  It was funny, because as I was writing it out, I thought, “this one is so obvious, with the doctor offering informed consent and citing a study….”  But not with this crowd.   You all brought up a good number of concerns whereby more information was needed to come to a conclusion.  In this scenario, let’s say that yes, mom was offered position changes but was too tired to try them; and that there was no coercion involved.  My opinion is that this is:

    No, not a violation, but it would certainly depend on the woman’s feelings.

  2. Lip of Cervix Scenario – In this scenario, the woman gave her consent to the procedure, but then rescinded it upon feeling extreme pain.  This is a very clear violation.  A woman has the right to refuse treatment at any point – even change her mind mid-way through a procedure.  A care provider is obligated to respect those choices.  The other factor in this scenario is that there were not other options offered, and not good information given for the woman to make an informed decision.  A cervical lip is very common, normal, and most often is not even noticed, when HCP’s are not doing umpteen vaginal exams.  If you want to read more about it, check out Midwife Thinking for a great summary on the subject.

    Yes, a violation.

  3. Pushing Position Scenario – A woman being forced into a position at any time in her labor that she finds uncomfortable and / or that she resists is also a clear violation.  Care providers should be well versed (and versatile!) in the myriad positions that women find most comfortable and most productive for birthing their babies.  While it certainly is most comfortable and convenient for the care provider for mom to be on her back, it is never a mother’s instinctive position, and is the physiologically the worst position for birthing a baby.

    Yes, a violation.

  4. Episiotomy Scenario – Here, the care provider did not provide informed (OR ANY) consent prior to performing a very invasive procedure.  Regardless of the circumstances, he is obligated to obtain consent, and at a very minimum (i.e. if it were a true emergency) tell a woman what is going on, what he is doing, and why.

    Yes, a violation.

  5. Nurse Takes Baby Scenario – In this scenario, the nurse provided inaccurate breastfeeding information (there is NO REASON to limit feedings at the breast as a general rule), invasively physically disrupted the breastfeeding, and then removed the baby without the mother’s permission.

    Yes, a violation.

  6. Eye Ointment Scenario – Parents have the right to determine which medical intervention and treatment is in the best interest of their child.  To coerce or threaten parents into compliance with medical recommendations, is a clear violation of rights.

    Yes, a violation.

  7. Fetal Monitor Scenario – In this scenario, the woman made her wishes clear upon admittance, and then was bullied into accepting the routine intervention.  The nurse made it impossible or improbable that the woman would refuse by leaving the room and “forgetting” to come back, and later by leaving it in place when the woman was too busy and distracted with laboring to demand that the monitors be removed.

    Yes, a violation.

So, there you have it!  Do you agree with my assessments?  Do you have anything to add? I’d love to hear your feedback.

Comments

  1. says

    What a great service! I agree with your conclusions. Want a bit of cheery news regarding #5? Our local tertiary care hospital has (finally) instituted a one-hour skin-to-skin policy, also acknowledging the baby’s ability to breast-crawl. I just witnessed this: it was the nurse’s first time, and she was as happy as the mama about it! On the one hand, it’s a bit of humane practice that’s been a very long time coming, but on the other hand, it’s an encouraging sign. My daughter (now 31) was born at home, she came up on my chest and stayed there, she peed and pooped on me and I still loved her just as much — it was the pivotal moment of my entire life. Glad more moms and babies will have this gift.

  2. Kate says

    Wouldn’t it be awesome if all primary caregivers had to complete some sort of human rights training and take this quiz?

  3. Rean says

    I completely agree, although in the first scenario I would have liked the risks and benefits to be offered *before* consent was obtained, not after. Once you’ve already agreed to something you’re less likely to rescind that agreement if there’s a risk you’re somewhat uncomfortable with. But I also recognize that that kind of situation comes up so late in the birth process that it is very difficult to have a meaningful informed consent dialogue.

  4. Nurse says

    I work on a busy hospital birthing unit and I can honestly say, I’ve seen all of these scenarios occur. Try as hard as we do encourage women to say no to routine hospital practices, in my experience, most women will agree to what ever the physician declares the mother should do. I’ve seen women scream when a physician will “stretch” the perineum for the baby’s head, yet they continue to do so. I’ve seen a physician threaten to walk out on a mother if she didn’t turn over and birth on her back. (the patient refused, called the physicians bluff and the physician went on to deliver the baby with mom side lying….rare occurrence though). It saddens me to know that women are so intimidated by physicians and many nurses. Shouldn’t evidence based practice be the gold standard? It is hard to empower women during a very vulnerable time in their life. I feel that teaching empowerment during birth should occur during some form of prenatal classes, but, women seem to be attending these less and less. One mother to be said to me, “why spend money on prenatal classes when I can just get an epidural”.

  5. Billee says

    I agree with your assessment & have wintnessed many of these violations. I will share this quiz with all my doula clients & in my childbirth classes.
    Thanks!!

  6. Kelly says

    I agree completely with your assessments. I can see why the vacuum extraction would cause concern but the Dr got consent, clarified risks and benefits and then asked again for permission before starting the procedure. he also stopped once enough had been done for the mother to take over again.

  7. Carol says

    Got them all correct apart from number 1 which needs a bit of discussion. I thought the scenario had one problem that pushed it slightly into the violation range. The Dr could have given all the good information he gave BEFORE he started getting ready and before the woman had consented. All information should be delivered to the woman before she consents. Informed consent … That said I was impressed with the detailed information he gave – citing evidence etc.

  8. Leatisha Pogioli says

    I took my monitors off myself when they got uncomfortable ;) the nurse asked what happened and I told her I was itching. She asked me to put them back on and I said no, I was getting in the shower :P
    they got me with the birthing position and eye ointment though :/
    I have heard of too many cases where CPS (wrongly) takes children for things like that

  9. says

    I am enjoying your articles. I just did the survey on “rights violation” and I would have to point out that in the first question–vacuum extraction, her rights were violated because she was only given one option– the vacuum. Had he gotten her off of her back and attempted other positions, that baby may have come right out. Also, in the discussion he did not outline the very serious complications that may result from vacuum to the baby. One being, brain injury were found in one out of 860 deliveries with vacuum.When it comes to owning our rights in pregnancy and birth we need to start including the effects these procedures have on the baby as well as the mother.

  10. says

    The first one is a bit tricky… Since the care provider didn’t provide the risks and benefits until after the mother consented, even if she was then uncomfortable with it, she would have likely felt pressured to consent again since she already had once and the doctor had already prepared and gotten the equipment ready… Just my two cents.

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