👀 Consent vs Coercion 👀

CONSENT VS COERCION

Sometimes the two are impossible/very tricky to tell apart in a healthcare setting.

Being in a setting where you receive health care unfortunately means that there is a perceived (and rather real, usually) power imbalance.

Most HCPs feel they have an advantage in expertise/deserve trust due to the virtue of them being HCPs/are able to guide you in your choices towards what is best.

Of course, it really is YOU who holds all the power, but this often feels quite uncomfortable to HCPs caring for you.

What if you are making decisions you regret, and end up blaming them (this is a legitimate concern sometimes, but this concern is for HCPs to pick apart not you!)? What if something happens to you? The baby? How will their senior colleagues perceive their client not staying on the normal care pathway?

Many truly feel that their expertise means that they will guide you in exactly the right decision for your circumstances, even if it means being coercive about it.

Not usually out of malice, but out of genuine concerns for your and your baby’s well-being.

However, this can lead to coercive techniques being used that often neither you nor they recognise as such.

And of course often these techniques are used very consciously too. There is even a term that is used…..’nudging’ service users toward the decisions you want them to make.

I personally know that i do NOT like to be nudged. In fact I’m quite likely to make the opposite decision to the one I’m being nudged towards. Even to my detriment

So what sort of things are red flags that might tell you there is coercion happening?

Shroud waving: only presenting you with the worst case scenario, without nuance.

Its best for the baby: recommendations with no regards for your own preference.

Making care conditional: ‘you can have the pain relief but we have to see how open your cervix is first’.

Excessive questioning for your reasoning to decline an intervention: wearing you down, essentially.

Emotive language: making you afraid, without good presentation of the evidence of risk

Bargaining with you: ‘if you come in, we can offer you the wireless monitoring’ (that they full well KNOW often does not work).

Being extra kind: while doing things you specifically didn’t want. Coercing you with kindness.

Getting you into physical positions in which it is difficult to be assertive: on a bed, often immobilised, standing over you.

Gaslighting: ‘noooo, this is not something we can do, I’m not sure where you heard that people have VBACs in the water, or at home. Madness!’

Convincing you of their reasonableness: we just want the best for you.

Making you feel like you are making THEM vulnerable by making your own decisions: ‘I could lose my registration over this!’

Minimising your distress: ‘you are doing so well really! Everything will be fine. Just keep breathing.’ (In the context of you *wanting* help/different things)

Relentless bullying, even after you made your wishes clear: ‘we really just need to talk about the risks again’.

Outright threats: ‘if you do this we will have to notify social services.’

Outright assaults: such as a sweep that has not been consented to, not stopping an examination when requested.

Assuming they know what is best for you: ‘you wouldn’t want to end i up on with a big tear would you?’

Good Cop, Bad Cop Routine: getting another (less nice) midwife to talk to you about the issue you can’t be swayed on.

Lying: ‘you are not allowed to, you can’t, we have to.’

Ooops, that was a lot

Coercive healthcare is not ok, even though it is completely normalised in many ways.

In my experience it’s usually more than possible to sensitively counsel people on clinical scenarios, their options and the risks and benefits on certain procedures, WITHOUT coercing .

Also, as a side note, lack of coercion does NOT mean lack of frankness or honesty. It is very possible to be completely real with someone and NOT make them too scared to practice bodily autonomy or make their own choices .

This is my PSA for today

(Pic of call the midwife person, cos to me, uniforms in themselves are somewhat coercive by implying a power imbalance….)