Week 17: Is the patients’ bill of rights possible to implement in maternity care?

How do hospitals protect patients’ rights? It must be tricky for providers to work for a place that has a written bill of rights on the one hand, in many cases with those rights mandated by law, and on the other hand be faced with real life situations in which those rights may be violated due to routine, urgency, or hospital policy.

Both of my backup hospitals have a bill of rights on their websites. They are identical and cite state law as their origin. Patients supposedly have the right to:

Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.

How can one demand considerate and respectful care while in labor? Who gets to define whether it is respectful or not, and could you get into an argument over that? What if it’s the attending, or the person in charge, who isn’t being considerate or respectful? What if it’s hospital policy that disrespects a person, for example, by not allowing them to eat and drink in labor?

How can restraints be eliminated? Who decides whether certain restraints are or aren’t necessary? If they are necessary, is it medical necessity, hospital policy necessity, caregiver comfort necessity, cultural necessity, that determines if and when they are needed? Routine maternity care involves many restraints, including time limits for labor, prohibitions on eating, fetal monitors, blood pressure cuffs, IVs, epidurals, beds and stirrups. In order to claim one’s patient rights, would you have to walk into the hospital in labor and begin a debate over whether any of these are necessary, and demand the environment be free of the unnecessary ones?

Keep in mind that I am not talking about a situation where someone has had time to find a caregiver who is interested in supporting their birth preferences. Because I am planning a home birth, I am talking about a transfer situation, for myself. I’m also talking about those who can’t afford to hire out of pocket a small practice and are likely going to be with an in-network practice of at least 10 doctors, have had 15 minutes for each prenatal visit, and don’t have the privilege to have been able to discuss all this beforehand. Why should these rights apply any less to those people, or to someone without any health coverage or prenatal care, who walks into the hospital when they are in labor?

Know the names, positions, and functions of any hospital staff involved in your care and refuse their treatment, examination, or observation.

If a patient refuses treatment from a particular staff member, what if the hospital is busy and no one else is available? If you draw a nightmare nurse, and none other is available to switch places with her, how does the hospital deal with this, protocol-wise? Do they send in a social worker? Or does the attending coerce/talk to you? On paper, would they be required to bring in a new nurse? What if the reason you have refused treatment from this particular person is because they have violated your patient rights, or threatened to do so? What if the birth is imminent?

Also, when does one get the chance to accept or refuse treatment, examination or observation? If the question is asked during a contraction, and the person can’t speak, does this count as acceptance? If the question isn’t asked, and a phalanx of interns, residents, nurses and students walks in the room as a baby is crowning, does this count as acceptance?

Refuse treatment and be told what effect this may have on your health.

I think in my case this is the most interesting one. What if I don’t want anyone manhandling my lady parts during labor or while I give birth? The way hospitals do it, this probably constitutes “refusing treatment.” So does that mean they kick me out because I’m rejecting what they have to offer? Could you imagine a doctor standing back, and allowing a woman to birth her baby in the position she prefers, catching her own baby, without touching her or the baby as it comes out? Just because of a clause in the bill of rights? Does the doctor putting his hand in the patient’s vagina constitute treatment? How does one realistically invoke these rights in such a way that they won’t just be ignored?

Also. What happens if these rights are violated? Who decides a violation has actually happened? What are the avenues for redress?

If you have read my birth story, you know why I am asking all these rhetorical questions. Birthing women have rights, legal and otherwise, on paper. But in practice, hospitals are set up to routinely violate those rights, and don’t have safeguards in place to protect people who speak up, whether before or after the violation. Likewise bodily autonomy is a legal right on paper, but the system in practice does not have ways for those rights to be legally protected or for violators to be prosecuted.

I wonder if ancient rules on divorce and other women’s rights were this way. Divorce hasn’t always been available to women and was supposedly a great innovation when some cultures added divorce rights for women to their books. The same goes for property rights. Did women have avenues through which to exercise those rights or did they find that the society was set up to practically block them from exercising the rights that were theirs on paper, and from finding redress when they were unable to exercise them in real life?


About investigatingbirth

My investigations of birth began in 2009 when I was trained as a doula. I helped women consider the evidence on common interventions, and helped them prepare for the physical and emotional challenge of giving birth. After some time it became clear to me that there was another type of challenge that I was unable to adequately prepare them for, the challenge of the maternity system. But it was only after my own traumatic birth in 2013 that I realized how little I had understood. I began to ask questions that few around me - doulas, nurses, midwives, doctors - were comfortable hearing. Questions like: Under what circumstances, and for what reasons, do doctors not practice informed consent? How do hospitals deal with other patient populations vulnerable to abuse? How does loss of professional autonomy, for obstetricians, and professional authority, for midwives, impact the quality of care they are capable of providing - regardless of their training? This blog will collect noteworthy information that attempts to answer these and other questions. Most of what you see here will be aggregated from other sources and analyzed. You will also see original interviews, and the occasional opinion piece or personal story, as I try to piece together a clear picture of the system in which American women give birth.
This entry was posted in Uncategorized. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s